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The Journal
OF THE
Medical Associa tion of Georgia
Owned and Controlled by the Medical Association of Georgia
PUBLISHED MONTHLY under direction of the Council
Copyright 1950 by the Medical Association of Georgia
Number 1
Volume XXXIX
Atlanta, Georgia, January, 1950
Single Copy, $1.00
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CONTENTS
Congenital Intrinsic Duodenal Obstruction.
Lon Grove, M.D., and Earl Rasmussen, M.D., Atlanta. 1
Burns.
J. D. Martin, Jr., M.D., Richard Caudle, M.D., and J. M. B. Bloodworth, Jr., M.D.,
Atlanta . 10
Goiter: Hashimoto Type.
T. C. Davison, M.D., and A. H. Letton, M.D., Atlanta 19
Acute Pancreatitis.
William G. Whitaker, Jr., M.D., Atlanta 26
Right Thoracic Approach in Combination with Laparotomy for Resection of Cancer of the
Esophagus at the Level of the Arch of the Aorta.
Richard King, M.D., Atlanta . 30
Public Relations: Good and Bad.
Enoch Calaway, M.D., LaGrange 33
(Continued on Page VI)
Entered as second class mail at the Post Office at Atlanta, Ga., under the Act of March 3, 1879.
Accepted for mailing at the general rate of postage provided for in Section 1103, Act. of Oct. 6, 1917, authorized Nov. 14, 1928.
The Journal of the Medical Association of Georgia
V
WHY MANY LEADING
NOSE AND THROAT
SPECIALISTS SUGGEST
to PHIUF *ORR'S
"cha°9e
Where smoking is a factor in a throat condition,
the physician may advise "Don't Smoke/'
But where the patient persists, many eminent
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the one cigarette proved definitely less irritating.**
Perhaps you too will find it advantageous
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" Change to Philip Morris." For your
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PHILIP MORRIS
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•Completely documented evidence on file.
**Reprints on Request:
Laryngoscope, Feb. 1935, Vol. XLV , No. 2, 149-154;
Laryngoscope, Jan. 1937, Vol. XLV II, No. 1, 58-60;
Froc. Soc. Exp. Biol, and Med., 1934, 32,241 ; N. Y.
State Journ. Med., Vol. 35, 6-1-25, No. 11, 590-592.
Please mention this Journal when writing advertisers.
VI
The Journal of the Medical Association of Georcia
EDITORIALS
Medical Dues, 1950
A. M. A. Membership Not Compulsory for Enrollment in Local Groups
Whooping Cough Yields to Antibiotic Drug
' I ired Feeling- is Major American Disease __
Attribute Relief from Shaking Palsy to Psychotherapy.
Worry
Name of Hygeia, Health Magazine, to be Changed to Today’s Health
Are We Neglecting Skin Tumors?..
Portrait of Dr. Fischer Unveiled at the Crawford Long Hospital
GEORGIA DEPARTMENT OF PUBLIC HEALTH
The Prevention of Congenital Syphilis.
Rudolph W. Jones, Jr„ M.D., Atlanta
34
34
34
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MISCELLANEOUS
Healthgram.
A.M.A. Offers Health Education Service to Schools.
New York Ranks First in Hospital Facilities for Polio.
News Items.
Communications.
Obituary.
Find Streptomycin Effective Against Bacillary Dysentery.
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and Cure.
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Department for Men Department for Women
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THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia, January. 1950 No. 1
CONGENITAL INTRINSIC DUODENAL
OBSTRUCTION
Report of 9 Cases
Lon Grove, M.D.
Earl Rasmussen, M.D.
Atlanta
Congenital duodenal obstruction is a rela-
tively rare anomaly; however, during recent
years more and more cases have appeared
in the literature, and the number of success-
fully treated cases is likewise increasing.
There have been several single-case reports,
but in only a few instances has there been
anything approaching a series. Calder, in
1733, first described congenital obstruction
in the upper gastro- intestinal tract of the
newborn, and Ernst1 of Copenhagen in 1916
first reported the successful treatment of a
case of duodenal obstruction which was
congenital in origin. In 1945, Ladd and
Swenson' reported 21 cases of intrinsic duo-
denal obstruction with 13 recoveries after
operation. Stetten has reported the young-
est infant treated successfully by operation,
a 3 day-old, one month premature hoy.
It has been estimated that this anomaly
occurs about once in 20,000 infants, and in
15 per cent the obstruction in the duodenum
is associated with complete or incomplete
obstruction elsewhere in the gastrointes-
tinal tract. Apparently there is no predi-
lection for race or sex, and a familial inci-
dence has not been striking; however, in
1940 Brodsky4 reported two cases of atresia
of the duodenum in consecutive female
Read before the Medical Association of Georgia in annual
session, Savannah, May 12, 1949.
members of the same family.
Embryology: Prior to the second month
of fetal life, there is a definitely established
lumen in the gastro-intestinal tract. Due to
epithelial concrescences from a rapid epi-
thelial proliferation, the lumen of the
gastro-intestinal tract, from the esophagus
to the ileocecal valve, becomes obliterated
and is converted to an almost solid organ.
After the eighth week numerous vacuoles
appear, coalesce, and a larger lumen is
established. Persistence or exaggeration of
the normally constricted condition of the
embryonic lumen produces congenital atre-
sia0.
Pathology: Three distinct pathologic con-
ditions resulting in intrinsic duodenal ob-
struction in the infant have been reported.
These include: (1) a diaphragm-like septum
with or without a small opening or perfora-
tion, (2) a cord-like structure of small to no
caliber connecting two partially blind ends
of the duodenum, and (3) a complete di-
vision of the duodenum into two blind ends.
By far, the majority of these anomalies have
occurred distal to the papilla of Vater, in
the second and third portions of the duo-
denum. The extrinsic factors resulting in
congenital duodenal obstruction may be
peritoneal hands and adhesions, torsion,
volvulus, anomalous blood vessels, tumors,
cysts, and persistence of the hepatoduode-
nocolic ligament after rotation of the stom-
ach and duodenum1'. Donovan3 has stated
that both types of lesion are often asso-
ciated with some error of rotation of the
embryonic midgut loop.
Clinical findings: The clinical findings
and symptoms vary with the degree of ob-
2
The Journal of the Medical Association of Georgia
struction. If the obstruction is complete,
vomiting occurs within the first 24 hours
and, as the atresia is generally below the
papilla, the vomitus usually contains bile.
It is not uncommon to find old and some-
times fresh blood in the vomitus as we have
observed this on several occasions. The
vomiting may occur any time from immedi-
ately to 2 or 3 hours after feedings and
usually becomes progressively more intense
and frequent. Other signs and symptoms of
a high obstruction become evident. Dehy-
dration may be marked if the lost fluids are
not replaced. Distention and peristaltic
waves may or may not be present depend-
ing on the length of time the infant has gone
untreated. The stools are smaller in amount
and at times are nothing more than a small
diaper stain which may be observed on only
one or two occasions. They are usually dry,
grayish in appearance and may contain a
small amount of mucus. With lesser degrees
of obstruction, vomiting may be periodic
and delayed for several days or weeks.
We have utilized a thin mixture of barium
for x-ray study in almost all instances.
There have been no complications due to
this procedure. Immediately following
x-ray study all barium proximal to the ob-
struction is removed by lavage. In one in-
stance air study was used for diagnosis.
Mullins and Milman' in 1946 described the
method of roentgen diagnosis of congenital
duodenal obstruction by the insufflation of
air. Gastric contents are aspirated follow-
ing a plain x-ray of the abdomen. Air is
introduced under fluoroscopic observation
and spot and serial x-rays at hour intervals
are taken to differentiate complete from in-
complete obstruction. If the obstruction is
complete, there is a complete absence of
gas beyond the duodenum. There may be a
small gas pattern if the obstruction is incom-
plete. Kantz, Lisa and Kraft'' have pointed
out that peristalsis in the stomach and duo-
denum is usually poor and, if the stomach
and duodenum are greatly distended, there
may be an hour-glass appearance.
Preoperative treatment : Infants with com-
plete duodenal obstruction obviously cannot
survive unless some type of corrective sur-
gery is instituted. As soon as the diagnosis
is suspected, a small catheter is placed into
the stomach for constant decompression.
Fluids, blood, proteins and vitamins are re-
placed as soon as possible. In our experi-
ence, the ultimate outcome has depended to
a very great extent on the early recognition
and treatment of this condition together with
the absence of other congenital anomalies
or complications such as pneumonia.
Discussion of cases: Since 1938 there
have been 9 cases of congenital duodenal
obstruction admitted to the Henrietta Egle-
ston Memorial Hospital. Surgery was per-
formed in 6 instances and all 6 infants sur-
vived and were discharged from the hospital
in satisfactory condition. The remaining 3
infants died before surgery could be under-
taken. One baby died at 6 days of age from
pneumonia and atresia of second portion of
duodenum, and the second case died at the
age of 14 days, was a Mongolian idiot and
an atresia was present in the first portion of
the duodenum. The third case died at 7
days of age and autopsy revealed congenital
cardiac anomalies and an almost complete
stenosis of the second portion of the duo-
denum.
Of the 6 infants undergoing surgery, 4
were females and 2 were males. There were
3 atresias and 3 incomplete duodenal ob-
structions or stenoses in this group. The 3
cases of stenoses underwent surgery on the
17th, 8th and 10th day of life respectively.
All 3 cases of atresia had surgery on the
7th day of life. The duodenal obstruction
in five instances was located in the second
or third portion of the duodenum. In the
sixth case there was a stenosis in the first
January, 1950
3
Fig:. 1. Case 1 — Atresia of second portion of duodenum.
part of the duodenum.
Drop ether was the anesthesia used in all
cases. Retrocolic duodenojejunostomy was
performed on three occasions, antecolic gas-
trojejunostomy was performed twice and an
antecolic duodenojejunostomy performed
once. Blood is always given these infants
during the operative procedure.
Postoperative treatment : Constant gastric
decompression is maintained for the first 24
to 48 hours following surgery, during which
time nutrition is maintained by parenteral
feedings. A formula is started on the second
or third day and gradually increased. Ladd
and Gross' recommend the frequent use of
saline enemas for dilatation of the colon.
Constant care and diligent nursing is an ab-
solute necessity in the postoperative care of
these babies. It may become necessary at
any time to reinstitute gastric decompres-
sion if vomiting persists.
The proper management of these cases
requires the constant cooperation of the
surgeon, pediatrician, roentgenologist and
house staff.
REPORT OF CASES
Case 1. S. A. N., a fairly well developed, 3-day-old
infant girl was admitted to the hospital July 2, 1945
with a diagnosis of intestinal obstruction. The baby
was delivered at term by forceps after a difficult labor
and appeared normal at birth but began to vomit bile-
stained fluid after 12 hours. The baby failed to nurse
at breast and was started on subcutaneous fluids and
supplementary feedings but continued to vomit after
each feeding. On admission to the hospital, the child
was vomiting a moderate amount of old blood; tem-
perature rose steadily and respiration became labored
and rapid.
Physical examination: The general appearance was
that of a markedly dehydrated, acutely ill 3-day-old
infant girl. The skin and mucous membranes were dry.
No petechiae were present. The heart was normal.
There were numerous moist rales in both lungs. The
remainder of the physical examination was deferred.
Laboratory : RBC 4.500.000, Hb. 63 per cent, 11.5
Gm„ WBC 7,200, 52 pmn’s, 48 lymphocytes, 7 nucleated
RBC’s. Vomitus was positive for occult blood.
On the day after admission there was almost a con-
tinuous flow of greenish-black vomitus, the infant was
verv weak and there were areas of Dallor alternating
with do'] red blotches in the skin. The fontanels did
not bulge but felt a little firm. When the baby was
disturbed, there seemed to be athetoid movements of
the arms and some spasticitv of the lower extremities.
There was no nystagmus nor twitchings. There were
fine, mo'st and crepitant rales scattered over both
lungs. There was no enlargement of the spleen, liver
or glands.
X-rays revealed bilateral pneumonia and no gas
pattern below the stomach. A thin barium meal re-
vealed duodenal obstruction in the second portion,
prcbablv distal to the ampulla.
The baby received Vitamin K. oxygen, subcutaneous
4
Tiik Journal of the Medical Association of Georgia
Fig. 3. Case 3 — Atresia of first portion of duodenum.
fluids and one transfusion of 40 cc. whole blood. The
baby died on the third hospital day without surgery.
There was no autopsy.
Case 2. R. V. R., a 48-hour-old infant boy was ad-
mitted to the hospital April 9, 1943 with the complaint
of vomiting and periods of apnea.
Family history: Father’s age 24 years, alive and
well. Mother’s age 20 years. One pregnancy, no history
January, 1950
5
Fig. 4. Case 5 — Stenosis of second portion of duodenum.
Fig. 5. Case 6 — Atresia of third portion of duodenum.
of tuberculosis or syphilis. Paternal grandfather had
asthma.
Past history: Birth April 7, 1943. Had hard labor
about 3 hours, hydramnios, breech. Weight about 7
lbs. Length of pregnancy 9 months. Condition of child
following birth was poor and he failed to nurse. No
specific infections, no immunizations, sleeps fairly well.
Bowels moved during delivery but did not move after
6
The Journal of the Medical Association of Georcia
Fig. fi. Case 7 — Atresia of second portion of duodenum.
Fig. 7. Case 8 — Atresia of second portion of duodenum.
that time.
Present illness: Baby born 2 days prior to admission
to hospital. Delivery was breech and the head was
delivered easily by manual extraction. Mother had
hydramnios and the baby was full of amniotic fluid,
was not breathing and the heart heat was not discern-
ible. After about 10 to 15 minutes an occasional gasp
was obtained. The baby vomited everything taken by
mouth. When the infant slept there were intermitent
periods of apnea.
Physical examination: General appearance was that
of a well-developed and well-nourished 2-day-old baby.
Skin and mucous membranes were moderately dry and
there was mild cyanosis. No glands were palpable.
The head appeared larger than normal and measured
14 inches in circumference. The sutures were slightly
overriding and seemed to be ossified. Pupils were equal
in size and reacted equally well to light. Ears, nose,
throat, mouth and neck were negative. The lungs were
clear and no cardiac abnormalities could he detected.
The abdomen, extremities and genitalia were negative.
Laboratory: Urine: acid, 2 plus albumin, sugar neg.,
6-8 WBC, occ. RBC, 3-6 coarse granular casts, 1-2 pus
cell casts. Blood: 5,370,000 RBC, 18.5 Gm. Hb., 11,400
WBC. 47 segs., 11 bands, 6 juveniles, 31 lymphocytes,
5 eosinophils, 56 nucleated RBC. Insufficient quantity
for blood Kahn. Tuberculin test negative.
X-ray: Skull: Skull large as compared to the face.
Parietal bones are fully calcified and overlap slightly
at the fontanels. Chest: Both lungs show fetal atelec-
tasis and are poorly expanded.
The child was given barium which passed into the
stomach readily. At 24 hours the stomach retained all
of the barium and was dilated to at least twice the
normal size. The pylorus appeared open and the first
portion of the duodenum was dilated. No gas was
seen in the small or large bowel.
The baby received subcutaneous fluids and nasal
0- but became progressively more cyanotic and died
on the 5th hospital day.
Autopsy: Heart and cardiovascular system: patent
ductus, right atrium distended with blood. Thin flap
of membrane over foramen ovale with questionable
functional patency. A ventricular defect involving the
anterior flap of the mitral valve through which the
flap wras attached to the endocardium of the other
ventricle. The defect also communicated above the
mitral valve with both atrial cavities.
Gastro-intestinal tract: Stomach tremendously dilated
and filled with undigested material. The proximal por-
January, 1950
7
Figr. 8. Case 9 — Stenosis of first portion of duodenum.
tion of the duodenum, 2.5 cm. from the pylorus, was
also greatly dilated and ended in a deep pouch 6 cm.
in diameter. There was a small valve-like flap in
the terminal end of the pouch through which a probe
could barely be passed. There was marked collapse
of the remainder of the tract. No other congenital
anomalies of the G.I. tract were apparent.
Case 3. T. G. D., a 3-day-old infant boy was ad-
mitted to the hospital August 16, 1945 with history of
vomiting since birth.
Family history: Father’s age 38 years, living and
well. Mother’s age 39; 9 former pregnancies, 7 chil-
dren living and well. 2 miscarriages and no stillbirths.
No history of tuberculosis or syphilis. Mother had
questionable asthma.
Past history: Infant born at home August 13, 1945.
Character of birth was apparently normal. Birth
weight was 7 lbs. Length of pregnancy was full-term.
Condition following birth was good.
Present illness: The infant had vomited everything
he had taken since birth. Retained water for about
15 to 20 minutes for first 2 days of life. The day
prior to admission, blood was noted in vomitus. He
had had no bowel movement since birth. There had
been mild jaundice noted for two days.
Physical examination: The general appearance was
that of an acutely ill, moderately dehydrated and
jaundiced infant with definite Mongolian appearance.
Skin and mucous membranes revealed mild jaundice
and moderate dehydration. The fontanels were open
and sunken. The nose revealed dried blood on mucous
membrane. The abdomen was not distended and
peristalsis was absent. The remainder of physical
examination was negative.
Laboratory: Blood: 5,040,000 RBC, 15.5 Gm., Hb.
90 per cent Hb., WBC 13,700, 78 pmn's, 22 lymphocy-
tes. Blood Kahn was negative.
X-rays: Aspiration of stomach and insufflation of air
under fluoroscopic observation revealed a markedly
dilated stomach following which a diagnosis of com-
plete obstruction in first portion of duodenum was
made.
Diagnosis of Mongolism confirmed. Despite suppor-
tive treatment by subcutaneous fluids, transfusions,
etc., the baby went steadily downhill and died on
the 11th hospital day without surgery.
Autopsy: Atresia of first portion of the duodenum.
Case 4. M. A. W., a 16-day-old infant girl admitted
to the hospital November 10, 1938 with history of
vomiting since fourth day of life.
Family history: Father’s age 35 years, living and
well. Mother’s age 32. No history of tuberculosis,
syphilis or allergy.
Present illness: The baby began to vomit immediately
after each breast feeding, beginning on the fourth day
after birth. During the week preceding hospitalization,
the baby began to lose weight, but retained one
to two feedings each day and continued to have
bowel movements.
Physical examination: The general appearance was
that of a well developed and fairly well-nourished 16-
day-old infant girl. Skin and mucous membranes revealed
only slight dehydration. The remainder of the physical
examination was negative.
X-rays revealed a large duodenal and gastric residue
four hours following barium meal. After 24 hours
there was still a small amount of barium present in
the stomach and duodenum, and the remainder was
scattered throughout the colon.
8
The Journal of the Medical Association of Georcia
Operation : November 11, 1938. Drop ether anesthesia.
Right rectus muscle-splitting incision. The stomach and
duodenum were dilated and the duodenum was found
to be obstructed after it bad passed through the fetal
mesentery of the ascending colon. A retrocolic duo-
denojejunostomy was performed.
The baby was taking a formula well by the fifth
postoperative day and was discharged from the hospital
on the 14th postoperative day in good condition. On
December 13, 1938, 32 days following surgery, tbe
baby returned to the hospital with history of vomiting
for the past 3 days. A laparotomy was performed the
following day and an adhesive band was found to
have completely obstructed the ileum. Following re-
lease of the adhesion, the child bad an uneventful
convalescence and was discharged on the 15th post-
operative day in good condition.
Case 5. M. C. B.. a 7-day-old infant girl was admitted
to the hospital August 22, 1944 with history of jaundice
and vomiting since birth.
Family history: Father's age 43 years. Mother’s age
34 years. Three former pregnancies which were appar-
ently normal. No stillbirths, no miscarriages. There
was no history of tuberculosis, syphilis or allergy.
Past history: Baby born August 15, 1944. Character
of birth was spontaneous, delivery on an unsterile field.
Birth weight 5 lbs.. 15 oz. Length of pregnancy was
nine months and condition following birth was good.
Infant had been jaundiced since birth.
Present illness: The infant was delivered at an-
other hospital where she remained for 5 days. Breast
feedings were attempted during that period but the
baby always vomited half an hour to one hour after
each feeding. The baby was taken home where it con-
tinued to vomit. During 48 hours prior to admission
to hospital, jaundice lessened.
Physical examination: General appearance was that
of a fairly well-developed but poorly nourished 7-day-
old infant girl. Skin and mucous membranes revealed
marked dehydration and slight jaundice. The anterior
and posterior fontanels were open and depressed
and the bones were overriding at the suture line.
Sclerae were moderately jaundiced. There was a
vertical nystagmus. Liver was palpated 2.5 cm. below
the costal margin on right side and the abdomen was
moderately distended. There was some spasticity and
intermittent convulsive movements of all extremities.
The baby had a small stool containing bile on the day
after admission.
Laboratory: Urine: sp. gr. 1020, reaction alkaline,
albumin 2 plus, sugar 1 plus, diacetic acid negative,
1-2 WBC, occasional RBC. Blood: 7,000.000 RBC, 165
per cent Hb., 25 grams Hb., WBC 22,800, 59 pmn’s.,
37 lymphocytes, 2 eosinophils, 2 lymphoblasts. Blood
Kahn negative. Stomach washings revealed bile to
be present.
X-rays: Thin barium meal revealed complete obstruc-
tion to barium at second portion of the duodenum.
There was a small gas pattern distal to the duodenum.
Operation: August 24, 1944. Drop ether anesthesia.
Right rectus muscle-splitting incision. The stomach
and first portion of duodenum were markedly dilated
and an obstruction was apparent in the third portion
of the duodenum at ligament of Treitz. A retrocolic
duodenojejunostomy was performed.
The baby did very well following surgery and was
taking a formula very satisfactorily by the 5th post-
operative day. Convalescence was without event except
for a wound infection which cleared rapidly and the
baby was discharged on the 13th postoperative day.
The child was seen again on November 15, 1944 at
which time she was developing normally, taking feed-
ings well with only occasional regurgitation. Weight
was 10 lbs., 6 ozs. When the baby was seen April 13,
1945 she was 8 months old, weighed 20 lbs. and had
not vomited since the last visit.
Case 6. B. M. B., a 6-day-old infant boy was ad-
mitted to the hospital June 12, 1946 with history of
vomiting since first day of life.
Family history: Father’s age 39, living and well.
Mother’s age 28. One brother and one sister living
and in good health. No history of tuberculosis, syphilis
or allergy.
Past history: Baby born June 6. 1946. Character of
birth was normal and birth weight was 5 lbs., 10 ozs.
Pregnancy was full-term, condition following birth
was good and baby was immediately put on breast
and formula.
Present illness: On the first day of life the infant
vomited a small amount of its feeding immediately
after nursing. There was only a small amount of
regurgitation on the second day; however, on the
third day all feedings were vomited immediately to
one-half hour after nursing. The baby refused breast
on the fourth day and subcutaneous fluids were given.
The infant continued to vomit each feeding on the
fifth and sixth days and it was necessary to maintain
nutrition by use of subcutaneous fluids. The vomitus
on almost all occasions contained some bile.
Physical examination : General appearance was that
of a well -developed, moderately well-nourished 6-day-
old baby boy. The skin and mucous membranes re-
vealed moderate dehydration and mild jaundice. The
remainder of the physical examination was negative
except for vigorous peristalsis which could be felt in
the upper abdomen.
Laboratory: Urine: sp. gr. 1025, reaction acid, sugar,
albumin and diacetic acid negative, occasional WBC,
hyaline and granular cast. Blood: 5,350,000 RBC,
89 per cent Hb.. WBC 12.650, 32 pmn's., 64 lymphocytes,
4 eosinophils.
X-rays: Thin barium meal revealed complete duo-
denal obstruction, dilatation of proximal duodenum,
stomach and esophagus and no gas pattern below the
obstruction. No barium had passed the obstruction
after 24 hours.
Operation : June 13, 1946. Drop ether anesthesia.
High right rectus muscle-splitting incision. Duodenum
was markedly dilated with obstruction apparent in the
third portion. The remainder of the gastro intestinal
tract was markedly collapsed and no other abnormalities
were evident. A retrocolic duodenojejunostomy was
performed.
The baby did well following surgery and on the
second postoperative day was taking a formula fairly
well, regurgitating only a small amount on three
occasions during the 24 hours. Infant developed a
moderate diarrhea on the fifth day, but recovered and
was discharged on the 7th postoperative day in good
condition. He was taking a formula well.
Case 7. M. R. L.. a 6-day-old infant boy admitted
to the hospital March 6, 1947 with history of vomiting
since birth.
Family history: Father's age 28 years, living and
well. Mother's age 20 years. Pregnancies: Male infant,
died at 3 months (of colitis); one girl 5 years old,
living and well. No stillbirths or miscarriages. No
history of syphilis, tuberculosis or allergy.
Past history: Infant born February 28, 1947. Char-
acter of birth was normal and birth weight was 8
lbs., 12 ozs. Length of pregnancy was full-term and
condition following birth was good. Feedings con-
sisted of breast and supplement for first day days.
There were no specific infections, no exposure to con-
tagious diseases and no immunizations. Bowels moved
meconium for 3 days.
Present illness: Baby had vomited everything since
birth, immediately after nursing and frequently be-
tween nursings. Vomiting was never with force, was
dark, almost black in color, with foul odor. Bowel
movements were meconium for first 3 days and during
48 hours prior to admission to hospital no bowel
movements were evident. Llrine was very scant during
January, 1950
9
2 clays preceding hospitalization.
Physical examination: Temperature 101.4 F. Height
20 inches. Weight 6 lhs., 1014 ozs. General appear-
ance was that of a well-developed, poorly nourished,
pale, dehydrated infant hoy. Skin and mucous mem-
branes were quite pale and moderately dehydrated.
Remainder of physical examination was essentially
negative. The baby was regurgitating black liquid
material at frequent intervals. The abdomen revealed
no distention or masses.
Laboratory: Urine: sp. gr. 1006, reaction acid, albu-
min 1 plus, sugar, faint trace; diacetic acid negative,
1-2 WBC and occasional RBC. Blood: RBC 5.610.000,
130 per cent Hb., 22 Gm. Hb., WBC 18,900, 82 pmn's,
11 lymphocytes, 3 monocytes, 4 eosinophils. Blood Kahn
negative.
X-ray: Thin barium meal revealed complete duodenal
obstruction, probably distal to entrance of common
duct. There was no evidence of gas distal to the
obstruction.
Operation: March 7, 1947. Drop ether anesthesia.
High right rectus muscle-splitting incision. The stom-
ach and proximal duodenum were dilated and obstruc-
tion was apparent in the second portion of the duo-
denum. The remaining gastro intestinal tract, including
the colon, was collapsed and no additional abnormali-
ties were evident. An antero-colic duodenojejunostomy
was performed.
The baby did well postoperatively. Hydration and
nutrition were maintained by parenteral route for first
two postoperative days. Formula was started on the
third postoperative day which the baby took fairly
well, had a fairly normal stool the same day. The
baby regurgitated several times during the next few
days and it was necessary to supplement formula with
subcutaneous fluids, but he continued to gain weight
and condition remained good. The baby was taking
formula fairly well by the 10th day, but continued to
regurgitate small amounts several times during the
day. Nevertheless, he was discharged on the 12th
postoperative day in good condition. Was seen again
Mav 22, 1947 at which time he was developing nor-
mally, was not vomiting and his weight was 12 lbs.,
5 ozs.
Case 8. M. P. C., a 6-day-old infant girl admitted
to the hospital June 16, 1948 with history of vomiting
since birth.
Family history: Father’s age 29, living and well.
Mother’s age 29. One former pregnancy, male, 2Vz
years, living and well. No stillbirths or miscarriages,
no history of tuberculosis, syphilis or allergy.
Past history: Infant horn June 9, 1948, non-instru-
mental vertex presentation. Birth weight was 8 lbs.,
3 ozs., and condition following birth was good. There
was no history of contagious diseases and there had
been no immunizations. Local pediatrician had given
the baby mild sedative prior to admission.
Present illness: The baby had vomited every feeding
since birth. The vomitus was always greenish in color
and projectile on only one occasion. Vomiting oc-
curred from 5 to 30 minutes following each feeding.
The local pediatrician began to give the child par-
enteral feedings 3 days prior to hospitalization. The
father stated that the child had never had a bowel
movement.
Physical examination: Weight 7 lbs. General appear-
ance was that of a well-developed and fairly well-
nourished 6-day-old infant girl. Skin and mucous
membranes revealed mild dehydration. The child was
very drowsy and cried only after painful stimulation.
The abdomen was slightly distended and no rushed
peristalsis was audible. The remainder of physical
examination was negative.
Laboratory: Urine: sp. gr. 1016, reaction alkaline,
albumin 1 plus, sugar 2 plus, diacetic acid negative,
1 to 3 WBC. Blood: 6,000,000, RBC, 18 Gm. Hb.,
WBC 13,900, 58 pmn's, 25 lymphocytes, 3 monocytes,
14 eosinophils.
X-ray: X-ray films were brought into hospital with
the patient. Barium meal and x-rays had been taken
24 hours previously and the barium was still pooled
in the stomach and first and second portion of the
duodenum. There was no barium or gas beyond the
obstruction.
Operation: June 17, 1948. Drop ether anesthesia.
High right rectus muscle-splitting incision. The first
portion of the duodenum was moderately distended.
Obstruction was apparent at second portion of duo-
denum. The remainder of the gastro-intestinal tract,
including the colon, was completely collapsed. An
antero-colic gastrojejunostomy was performed.
The baby did well following operation and was
given a formula on the 3rd postoperative day. She was
discharged on the 10th postoperative day in good con-
dition and regurgitating a small amount of her feed-
TABLE 1
CONGENITAL INTRINSIC DUODENAL OBSTRUCTION
Case
Sex
Type of
Obstruction
Site of
Obstruction
Operative
Procedure
Result
S.A.N
F
Atresia
2nd Portion
None
Died, age
6 days
R.V.R.
M
Stenosis
2nd Portion
None
Died, age
7 days
T.G.D.
M
Atresia
1st Portion
None
Died, age
14 days
M.A.W
F
Stenosis
3rd Portion
Retrocolic-
duodenojejunostomy
Recovery
M.C.B.
F
Stenosis
2nd Portion
Retrocolic-
duodenojejunostomy
Recovery
B.M.B.
M
Atresia
3rd Portion
Retrocolic-
duodenojejunostomy
Recovery
M.R.L.
M
Atresia
2nd Portion
Anterocolic-
duodenojejunostomy
Recovery
M.P.C.
F
Atresia
2nd Portion
Anterocolic-
gastrojejunostomy
Recovery
M.G.A.
F
Stenosis
1st Portion
Anterocolic-
gastrojejunostomy
Recovery
10
The Journal of the Medical Association of Georcia
ing once or twice each day. Was seen again July
21, 1948, at which time her weight was 7 lbs., IOV2
ozs., and she was doing well except for persistent
regurgitation of small amount once or twice daily.
Case 9. M. G. A., a 6-hour-infant girl admitted to
the hospital February 17, 1949 with history of cyanosis
since birth.
Family history: Father’s age 23. Mother’s age 18
years. This w-as the first pregnancy. No history of
tuberculosis, syphilis or allergy.
Past history: Baby born February 17, 1949. Char-
acter of birth was normal and birth weight was 6 lbs.,
10 ozs. The baby was markedly cyanotic following
delivery.
Physical examination : The general appearance was
that of a well-developed, fairly well-nourished white
female who was intensely cyanotic about the head and
neck. Cyanosis was most marked in skin of head and
shoulders. Hands and arms, trunk and lower ex-
tremities were of fair color. Lungs were poorly aerated
with many scattered rales and rhonchi. Remainder
of physical examination was negative.
Following admission to the hospital the baby vomited
everything taken by mouth despite change in formula
and antispasmodics.
Labortory : L'rine: sp. gr. 1010, reaction acid, sugar
and albumin negative, 1-2 W BC. Blood: 7,100,000
RBC, 26 grams Hb., 9.900 WBC.
X-ray: February 21. 1949. Almost complete obstruc-
tion at pylorus. About 25 per cent gastric residue
at 52 hours. Patchy atelectasis present in both lungs,
Operation : February 24, 1949. Drop ether anesthesia.
High right rectus muscle-splitting incision. Stomach
markedly dilated, no evidence of hypertrophic stenosis
of pylorus. Stenosis present in first portion of duo-
denum. An antero-colic gastrojejunostomy was per-
formed.
Patient did fairly well following surgery and a
formula was started on the 2nd postoperative day. The
baby continued to vomit three to four times each day
and it was necessary to supplement feedings with
parenteral fluids for the first seven postoperative days.
The baby continued to regurgitate once or twice each
day, but gained weight to 7 lbs., 12 ozs., and was
allowed to return home three weeks following surgery.
After the baby had been home for two weeks she
was brought back to the hospital with history of
continued regurgitation of one to two feedings each
day. After observation in the hospital for one week,
she improved, retained all of her feedings and was
allowed to return home again.
Summary
1. There is an increasing number of suc-
cessfully treated cases of congenital duo-
denal obstruction being reported in the
literature.
2. The embryology, pathology, clinical
findings and treatment of this anomaly are
discussed.
3. A total of 9 cases of congenital duo-
denal obstruction are presented. Six cases
underwent surgery and all survived and
were discharged from the hospital in satis-
factory condition. In this group there were
three atresias and three stenoses. Three
infants died prior to surgery.
4. A successful result depends to a very
great extent on the early recognition and
treatment of this condition together with the
absence of other congenital anomalies or
complications.
REFERENCES
1. Ernst, W. P. : A Case of Congenital Atresia of the
Duodenum Treated Successfully by Operation, Brit. M J
1:644-645 (May 6) 1916.
2. Swenson, O., and Ladd. W. E.: Surgical Emergencies
of the Alimentary Tract of the Newborn, New England J.
Med. 233:660 (Nov. 29) 1945.
3. Stetten. DeWitt: Duodenojejunostomy for Congenital
Intrinsic Total Atresia at Duodenojejunal Junction. Ann.
Surg. 111:583-596 (April) 1940. Discussion by W. E. Lee
and E. J. Donovan.
4. Brodsky. I.: Atresia of Duodenum. Report in Three
Cases Including Two in Consecutive Female Members of
the Same Family, Australian & New Zealand J. Surg.
9:405-422. 1940.
5. Jordan, H. E., and Kindred, J. E.: Textbook of
Embryology, ed. 5, New York, D. Appleton Century Com-
pany, 1948.
6. Kantz, F. G. ; Lisa, J. R.. and Kraft, E.: Congenital
Duodenal Obstruction; Report of Six Cases and Review
of Literature, Radiology 46:334-342 (April) 1946.
7. Mullins, H. Z., and Milman, Doris H. : Congenital
Duodenal Obstruction. Roentgen Diagnosis by Insufflation
of Air, Am. J. Dis. Child. 72:81-88 (July) 1946.
8. Ladd, W. E., and Gross, R. E. : Abdominal Surgery
of Infancy and Childhood, Philadelphia, W. B. Saunders
Company, 1941.
BURNS
J. D. Martin, Jr., M.D.
Richard Caudle, M.D.
J. M. B. Bloodworth, Jr., M.D.
Atlanta
During the recent war and immediately
thereafter, progress was made in the ther-
apy of burns. The knowledge of the funda-
mental pathologic processes has remained
the same. There has been essentially no
improvement in the mortality rate since the
formation of the concepts, which were estab-
lished by Underhill, Blalock, and later re-
emphasized by Davidson1. The therapy of
burns has varied to the present time with
foremost attention directed to the general
manifestations, giving the local lesion a less
importane role. The classification of burns
still holds an elementary but important
place in understanding the associated path-
ologic changes and the rendering of an
accurate prognosis.
Shock, which is essentially the same as
that manifested by most forms of trauma, is
of great importance in the treatment of
From the Whitehead Department of Surgery, Emory
University School of Medicine, Emory University, Georgia.
Read before the Medical Association of Georgia in annual
session. Savannah, May 12, 1949.
January, 1950
11
burns. The so-called toxic phase, or that
which immediately follows the shock, needs
little explanation except that it is limited in
a great measure hy the initial therapy, the
extent of the burn, and the depth of involve-
ment. The septic period has been lessened
by the use of sulfonamides and antibiotics.
Even with present therapy, complications
occurring in the third stage still are impor-
tant in the control of morbidity and mor-
tality.
The pathologic changes should be con-
sidered with reference to the various stages
of involvement. The first stage is essen-
tially that of secondary traumatic shock, the
clinical manifestations of which are well
known as comprising hemoconcentration,
decreased blood volume and diminished
cardiac output. There is a widespread loss
of the circulating fluid which carries electro-
lytes and proteins to the tissues, thereby de-
pleting the body of these essential elements
used in the maintenance of body nutrition.
A negative nitrogen balance soon occurs
which may proceed to a severe depletion.
The loss of blood chlorides may be signifi-
cant. Due to the hemoconcentration and the
inefficient oxygen carriage of the blood, the
tissue cells become anoxic and there follows
varying degrees of cell necrosis. The main
damage occurs in the liver, kidneys, brain,
and heart muscle. If the process is allowed
to continue, dysfunction of these organs
rapidly occurs. Toxemia may result from a
multiplicity of factors, such as anoxia,
acidosis, azotemia, infection, anemia, and
nitrogen imbalance. In addition, it is still
considered that toxin may be produced by
burn tissue.
The significance of the shock accompany-
ing burns cannot be underestimated. The
degree and the duration are of particular
impoi'tance in the prognosis. By Lund and
Browder’s classification', all children who
have an eight per cent or more body surface
burn and adults with greater than 15 per
cent body surface burn can be expected to
develop shock1. Burns involving the face
and neck are accompanied by greater shock
and have the additional hazard of a super-
imposed respiratory burn with laryngeal
edema or tracheal compression from sub-
cutaneous edema1 ’.
In the presence of local tissue destruc-
tion, the potassium ion is thought to be re-
leased from the cell4 ". The sodium ion mi-
grates into the damaged cells to replace the
potassium ion1', and is there bound and un-
available for body needs. This apparently
is more evident in deep burns, particularly
those involving muscles. Red cells are either
destroyed, sludged, or partially injured
with an increased fragility. Deep capil-
laries are damaged locally, causing extrav-
asation of serum. Iron becomes deposited
around the area of a burn'. Histamine-like
substances are liberated from the damaged
cells and may account for the hyperemia of
the gastro-intestinal tract. In the presence
of hyperemia and hemoconcentration in
dogs and rabbits, ulcerations of the gastro-
intestinal tract are much more readily pro-
duced with administration of histamine\
The diminution of circulating blood vol-
ume roughly parallels the surface area
burned. If the urine output is less than 25
cc. per hour in the early post-burn stage,
shock is considered. It has been shown that
renal circulation in shock may be reduced
as much as 1/20 of normal, while cardiac
output is reduced to 1/2 to 3/5 of normal9.
Blood pressure is a poor indicator of shock,
particularly in the presence of hemocon-
centration. The blood pressure may be held
to an apparently normal level until almost
complete circulatory failure intervenes from
decreased blood volume. Increased peri-
pheral resistance from the viscosity accom-
panying hemoconcentration allows the pres-
sure to remain elevated in the presence of
12
The Journal of the Medical Association of Georgia
diminished cardiac output .
Plasma loss is greater than red cell mass
loss, varying in degree with the depth of
the burn, since deeper burns cause propor-
tionately greater red cell loss11. A mild burn
may result in tbe loss of only five per cent
of tbe circulating blood volume, while a
severe deep burn may result in 30 to 35
per cent loss in a few hours12. If the hema-
tocrit is not increased, the degree of fluid
lost in the proportion of plasma to red cells
is not known. The same difficulty is encoun-
tered in the presence of anemia.
Hemoconcentration results in an in-
creased viscosity and decreased cardiac out-
put. In spite of the hemoconcentration, the
tissues are poorly oxygenated because of
sloweu blood flow. However, a patient may
live with a hematocrit as high as 60 if the
circulating fluid volume has been kept nor-
mal.
Hemoglobinemia may be present, which
may result in kidney damage and deposi-
tion of hematin pigment in the lower ne-
phrons and collecting tubules1'1. This con-
dition is described as tbe lower nephron
syndrome; clinically, it is manifested by a
reduction in urinary output to less than 500
cc. following the shock period. The urine
is usually acid with a low specific gravity.
Azotemia is present, largely made up of an
undetermined fraction14. Most patients with
hemoglobinemia surviving the initial 10 to
12 days, usually recover. Shock, dehydra-
tion, and kidney damage are contributing
factors to the frequently developed acid-
osis.
A false anemia of hemodilution and in-
creased plasma volume is seen after the
initial period of hemoconcentration. True,
anemia results from loss of red blood cells
at the site of the burn at the time of injury.
Blood is lost from the granulating surface
with drainage and redressings. There is
also a deposition of iron surrounding the
area of a burn, rendering it unavailable
for hematopoiesis. Low body proteins di-
minish the source of material for manufac-
ture of red cells. Prolonged shock, acid-
osis, uremia, infection, and toxemia all have
an effect upon the hone marrow'. Anemia
is frequently refractive to treatment until
granulating surfaces are covered and
chronic infection eliminated.
A decreased plasma protein may be
found as a result of loss in the tissue space;
decreased intake, and poor assimilation be-
cause of liver damage. A negative nitrogen
balance of proportionate severity will be
seen with most patients having greater than
10 per cent body surface involved1'. This
is thought to result from the sloughing of
destroyed tissue, excess excretion of pro-
tein waste products, and poor utilization of
available protein. Intestinal absorption of
protein diminishes in the immediate post-
burn period and remains diminished until
mucosal edema and hemorrhage are ab-
sorbed. Much protein is lost into the tissue
spaces and becomes unavailable for tissue
metabolism. As food intake is increased,
nitrogen excretion diminishes and usually
reverts to normal within three weeks11’.
Infection is almost always seen locally
and is usually limited to tissues devitalized
by the original burn. The majority of patho-
genic organisms present are staphylococcus,
alpha streptococcus, bacillus subtilis, diph-
theroids1', and usually bacillus pyocyaneus.
The necrotic slough of a burn offers excel-
lent media for growth of B. Tetani. Infec-
tion may become systemic, resulting in sep-
ticemia or multiple metastatic abscesses.
Organs distant to the site of the burn
undergo pathologic alteration, the kidney
being notable among these. The liver shows
marked cloudy swelling and focal necrosis18.
Also, focal hemorrhages of the gastrointes-
tinal mucosa, myocardium, brain, and
adrenal glands are frequently seen with the
January, 1950
13
more severe burns' '.
In a series of experiments, Cournard "
showed that whole blood restores oxygen
transportation to the tissues, thereby aiding
recovery better than plasma, saline, or con-
centrated serum albumin. Whole blood
transfusions have been used for many years
in the treatment of burns, shock, and subse-
quent anemia, but its widespread use was
hampered at first by lack of indirect meth-
ods of administration and later by the popu-
larity of plasma. Plasma was readily ac-
cepted since it appeared to be an exact re-
placement of the fluid lost.
Many investigators"' J J1 have pro-
claimed the value of whole blood. The bene-
fits of its use may be summarized as follows:
(a) Whole blood contains nearly twice as much
protein as plasma, thereby exacting a greater sparing
action on body proteins.
(b) There is less tendency to develop pulmonary
edema than when large amounts of electrolytes are
given.
(c) It restores all deficits of circulating fluid
volume better than any other single agent, since the
fluid lost is equivalent to anemic blood.
fd) It helps to prevent toxemia.
(e) In controlling shock, the possibility of kidney
damage, cerebral anoxemia, and damages to liver and
bone marrow are reduced.
Moyer, in 1944, using a group of experi-
mentally scalded dogs, found that the long-
est shock survival was in those given a com-
bination of two to five per cent body weight
of blood intravenously and 10 to 15 per
cent body weight of a mixture of two-thirds
normal saline and one-third M/6 sodium
bicarbonate by mouth'1.
Undue hemoconcentration can be avoided
if large amounts of electrolyte solution are
given orally to provide adequate interstitial
fluid. A small amount of plasma may be
given intravenously in the presence of hema-
tocrit over 60. The circulating fluid must
be adequately replaced, for it has been
shown by Blalock"1' and Seligman1 that
shock in the presence of hemoconcentration
is much more serious than simple shock
from hemorrhage.
Rosenthal, in a series of experiments with
burned mice4 5 27 found that normal saline
given orally in amounts of 10 to 15 per cent
body weight was very effective in controlling
shock. The National Research Council in
1945 recommended a mixture of two-thirds
normal saline and one-third M/6 sodium
lactate2/ These mixtures are formulated to
give isotonic concentrations of sodium and
chloride in order to prevent acidosis.
Following the initial shock period, the
daily intake of fluid should probably not ex-
ceed output until all evidences of acute
kidney damage have been removed. Trans-
fusions of whole blood should be continued
as long as there is evidence of anemia, par-
ticularly in preparation for grafting.
Penicillin, streptomycin, and sulfadia-
zine should be administered from the be-
ginning. There are certain organisms that
have a penicillinase effect, which may neces-
sitate the use of the sulfonamides, strepto-
mycin, and more recently, bacitracin in the
control of local infection. The local use of
penicillin, streptomycin'2’ and the sulfona-
mides has not been satisfactory. The newer
antibiotics may offer much in the control of
the local infection in a burn. The primary
aim is to prevent the spread of infection by
the administration of the antibiotics and
sulfonamides. Innumerable chemical agents
have been used locally to destroy the exist-
ing bacteria, none of which has been very
satisfactory. Most of these agents produce
more delay in wound healing than bacteri-
cidal effect. The use of furacin, 5-nitro-
2-furaldehyde semicarbazone, in a water-
soluble base, has proved to be beneficial in
diminishing local infection. Some patients
have a sensitivity to this drug, and it must
be cautiously used. Since all burns are
potentially infected, the fewer dressings and
more careful precautions, the possibilities
of infection are lessened. Tetanus antitoxin
or toxoid must be administered in all burns.
The presence of a negative nitrogen bal-
ance and the obvious need of proteins for
n
The Journal of the Medical Association of Georcia
tissue repair has made it necessary to give
large amounts of protein for rapid healing.
Protein in amounts up to 400 Gm. per day
and sometimes five Gm. per kilo body
weight has been recommended for some
burns30. Two to three times the normal daily
caloric requirement is necessary to prevent
serious weight loss. High amounts of car-
bohydrate up to 600 Gm. per day may be
necessary to prevent the use of protein for
energy metabolism.
There is an increased demand for ascor-
bic acid and riboflavin in the period of
epithelization and formation of granulation
tissue. Lund, et al 1 suggest that one to two
Gm. of ascorbic acid, and 10 to 20 mg. of
nicotinic acid be given daily to severely
burned patients.
To expedite the covering of large granu-
lating surfaces, pyruvic acid in a_ starch
paste at pH 1.9 as a chemical debridement32,
or early surgical excision of necrotic
slough, is helpful. Immediate excision and
split thickness grafting of deep burns is
recommended if the patient is in good physi-
ologic balance33.
Early grafting is essential to prevent sub-
cutaneous scarring or contracture, which is
always present when grafts are placed on
thick granulating surfaces. All the meas-
ures previously mentioned, such as ade-
quate control of shock, infection, fluid bal-
ance, anemia, and nutrition, are necessary
prerequisites to successful grafting.
Clinical Investigation
This report consists of a study of all
burned patients admitted to Grady and
Emory University hospitals since 1946.
The per cent burn was estimated on all
cases according to the method of Lund and
Browder’. The fluid intake, the output,
laboratory findings, clinical condition of the
patient, and therapy all have been recorded.
Blood volume determinations were per-
formed on 19 patients at crucial periods in
their course, using Evans blue dye ( T-1824)
and a Coleman Junior spectrophotometer.
Particular emphasis was placed on a survey
of each death with an attempt to determine
its cause and if it could have been prevented.
A total of 105 patients is included. Forty-
seven were colored, 58 were white, and there
were 64 male and 41 female patients. Twen-
ty deaths occurred, a mortality of 18 per
cent. The per cent burn and the distribu-
tion of deaths are shown in the accompany-
ing chart.
Per Cent Burn ,
Per cent Burn
0-9
10-19
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-100
TABLE 1.
Total Burns and Deaths
Total Burns Deaths
24 0
42 2
15 1
8 2
2 2
4 4
1 1
3 2
1 1
5 5
20 Total
It is noteworthy that only one patient with
burns of over 40 per cent lived, and his
burns were largely superficial. Of the 5
deaths occurring with burns of less than 40
per cent, 2 were intoxicated and did not
present themselves for treatment until six
hours post-burn, having been in shock most
of the intervening time. Neither patient ex-
creted more than 200 cc. of urine daily
prior to death. One of them had terminal
delirium tremens, and an autopsy per-
formed on the other patient showed lower
nephron nephrosis. Another was a known
cardiac patient who suffered severe respira-
tory burns. A 90-year old woman died of
congestive heart failure. The fifth patient
died 13 days after injury without a proven
cause of death. Nine patients died within
10 hours, 7 between the second and tenth
day, and 4 after the tenth day. Six patients
were severely burned, and death occurred
before adequate therapy could be admin-
istered.
Twelve of the deaths are presented with a
careful analysis of the clinical state, labora-
January, 1950
tory findings, and the causes of death. An
attempt has been made to point out those
factors which play a role in the morbidity
and the mortality.
It appears that if a burn of less than 40
per cent is promptly treated and no compli-
cations develop, the chances of survival are
good. Moreover, in burns of over 40 per
cent, the prognosis is grave regardless of
treatment.
Complications of the fatal burns were
numerous, and follow for our series:
1. Congestive heart failure developing approxi-
mately one month after hurn 1
2. Transfusion reaction 1
3. Probable previous kidney damage, uremia 1
4. Previous heart damage with pulmonary edema . 3
5. Delirium tremens 1
6. Pvocyaneus septicemia 1
7. Epilepsy 1
8. Shock (treatment delayed six hours) . 2
9. Staphylococcic septicemia; multiple metatasic
abcesses, nine months post-burn — 1
10. Severe lung damage from smoke inhalation.. 1
11. Lower nephron nephrosis 1
14
REPORT OF CASES
Case 1. E. L., white female, aged 37, 30 per cent
body surjace burned. This patient was admitted to
the hospital one hour after receiving third degree
burns of the face and mouth. There wras evidence of
respiratory involvement. Because of a history of hyper-
tension and previous cardiac failure, she was given
digitalis and placed in an oxygen tent. Blood volume
two hours after burn was essentially normal; hematocrit
reading was 45. The patient received 3,000 cc. of blood
and 1,200 cc. of plasma in the two days following the
burn. On the second day respiratory difficulty in-
creased; vomiting became severe; and the urinary
output became scanty containing hemoglobin and red
cells. Hemoglobin was 23.5 Gm. per cent. The
patient developed a cough productive of blood-tinged
sputum, went into shock and died. Necropsy was not
performed. *
Case 2. 0. L., Negro female, aged 70, 90 per cent
body surface burned. One hour after her clothes
caught fire, this patient was admitted to the hospital
with acute pulmonary edema. She was given % gr.
morphine sulphate and intranasal oxygen. Plasma was
administered intravenously. The patient did not respond
favorably and shortly afterwards lapsed into uncon-
sciousness with blood-tinged froth draining from her
mouth. Death occurred three hours after the burn.
Necropsy was not performed.
Case 3. J. P., white female, aged 10, 68 per cent
body surface burned. This patient was admitted to
the hospital in deep shock three hours after burn.
Because of vascular collapse, three hours elapsed be-
fore intravenous fluid therapy was begun. She was
given 1,350 cc. of blood and 1,000 cc. of plasma in
the 35 hours before death. A transfusion reaction
occurred two hours before death with temperature of
107.8° F. Vomiting began two hours after admission
and continued until death, the last 500 cc. of vomitus
being almost pure blood. Necropsy was not performed.
Case 4. E. C., white male, aged 32, 24 per cent body
surface burned. This patient was burned while in-
15
toxicated, when his bedclothes caught fire. He was
admitted to the hospital one-half hour later in appar-
ently good condition and was given fluids intravenously.
He had a history of peptic ulcer and was given a
Sippy diet. On the second day he went into a shock,
but was brought out of it four hours later with blood
transfusions. He appeared highly nervous and agitated
and was given paraldehyde. He became progressively
disoriented and restless by the fourth day, and died
with delirium tremens on the sixth day. Necropsy
was not performed.
Case 5. A. K., Negro male, aged 26, 70 per cent
body surface burned. This patient was admitted to
the hospital one-half hour after his gasoline-soaked
clothes became ignited. Shock was present, and the
blood pressure was imperceptible. He was given 2.000
cc. of blood and 2.000 cc. of plasma within the first
24 hours. Blood volume determination on the second
day showed a deficiency of 2.047 cc. of plasma and
an excess of 797 cc. red cell mass. The hematocrit
reading was 70. The patient never recovered from
shock. On the fourth day he became disoriented, his
temperature rose to 107° F., and he died. Necropsy
was not performed.
Case 6. A. B., Negro male, aged 18, 56 per cent body
surface burned. This patient was admitted to the
hospital one-half hour after an explosion had ignited
his clothes. Despite fluid therapy, the patient lapsed
into shock 12 hours after admission. Blood volume
studies showed a deficiency of 1,133 cc. and a red
cell mass excess of 293 cc. Hematocrit reading was
58. On the sixth day, blood volume showed an excess
of 403 cc. plasma and 330 cc. red cell mass, and the
hematocrit reading was 45. The patient remained
oriented and comfortable until the eighth day, when
his abdomen became distended. Vomiting and hyper-
ventilation then began, and he became disoriented.
Intravenous fluid therapy, which had been stopped,
was again started. However, his temperature rose to
107° F. and he died. Necropsy revealed marked infec-
tion of the surface burn. Cultures grewr bacillus
pyocyaneous from the surface burns and from multiple
internal organs.
Case 7. J. C., white male, aged 33, 50 per cent
body surface burned. Patient was admitted to the
hospital in a state of shock 16 hours after receiving
burn. The temperature was subnormal. On the third
day following admission, he became cyanotic and
edematous and was disoriented and restless. Vomiting
was prominent. Intravenous fluid (see chart 1) was
stopped because of the edema. The temperature rose
to 103° F. on the fourth day following Admission.
On the fifth day, patient became irrational and died.
Case 8. J. H. H., Negro male, aged 50, 42 per cent
body surface burned. Patient was admitted to the
hospital 45 minutes after receiving burn, and went
into shock three hours after admission. Laboratory
findings and therapeutic regimen are summarized in
Chart 2. Evidences of sepsis were manifested on the
third day following admission. On the eleventh hos-
pital day, the patient became disoriented and dehy-
dated. Tremors developed on the sixteenth hospital
day, and clinical uremia with uremic frost on the
eighteenth day. The patient’s temperature at this
time was 106° F., and death occurred on the same
day.
Case 9. B. R., white male, aged 15, 76 per cent
body surface burned. This patient was seen approxi-
mately 10 hours after having received the burn. No
therapy had been instituted up until this time. The
patient received 2,000 cc. of plasma and was trans-
ported 50 miles to the hospital. Temperature on
admission was 106° F. and the patient was having
convulsions. Nausea and vomiting were present. Adrenal
cortical extract and oxygen were administered. The
patient remained in the hospital for a period of over
eight months. During this time fluid balance was
16
The Journal of the Medical Association of Georgia
Figure I: Chart demonstrating laboratory findings and therapy administered to lethal hum
involving 76% body surface. Cause of death was brain abscess following staphylococcic
septicemia.
maintained. Frequent blood transfusions were admin-
istered, and vitamins were given. On the 249th day
tlie patient developed a headache, became drowsy,
lethargic, and had projectile vomiting. There was
moderate opisthotonos. Right frontal pressure by
trephine was 350 mm. of water. A lumbar puncture
was done, revealing a pressure of 530 mm. Spinal
fluid bad a ground-glass appearance with 500 polymor-
phonuclear leukocytes. On the 255th hospital day,
the pulse became first irregular and slow. Death oc-
curred on the same day.
Case 10. D. M„ white male, aged 49, 46 per cent
body surface burned. Patient was admitted to the
hospital 30 minutes after receiving burn. He was
in moderate shock and was irrational. The hematocrit
at this time was 45. A blood volume determination
was done five hours after admission, following ad-
ministration of 500 cc. of blood and 900 cc. of plasma.
The total blood volume was approximately 1,200 cc.
below normal. The patient received 900 cc. of blood,
900 cc. of plasma, one liter of 5 per cent glucose in
normal saline, and 700 cc. of oral bicarbonate in
normal saline. During this period he excreted 200
cc. of urine and vomited 400 cc. Shock progressed,
and the patient died 11 hours after the burn. Autopsy
examination revealed dry subcutaneous tissues, minute
myocardial hemorrhages, and cloudy swelling of the
collecting tubules of the kidneys. There wras no
evidence of severe respiratory burn.
Case 11. J. T., white male, aged 38, 16 per cent
body surface burned. This patient, a chronic alcoholic,
was admitted to hospital five and one-half hours
after receiving burn, and was in severe shock on
admission. Temperature at this time was 103° F. with
a hemoglobin of 20 grams per cent. Urinalysis re-
vealed a 2-plus albuminuria and 68 leukocytes. The
patient received 2 cc. of mercuhydrin intravenously
on admission. On the first hospital day, the patient
received 900 cc. of blood, 1,000 cc. of normal saline,
2,500 cc. of 5 per cent glucose in distilled water and
300 cc. of plasma. Output consisted of 2,000 cc. of
vomitus and 400 cc. of urine. On the second hospital
day, the patient became anuric and edematous, and
blood pressure could not be obtained. He was given
percortin and digitalis. A blood volume determination
revealed that the patient’s total blood volume was
1,000 cc. below his calculated normal. Plasma volume
was 1,350 cc. below calculated normal. The hematocrit
was 61, and the plasma proteins were 7.2 Grn. per
cent. The hemoglobin was 18 grams per cent. Im-
mediately prior to death, the patient became deeply
cyanotic and had a temperature of 106.6° F. Autopsy
examination revealed a lower nephron nephrosis, acute
central necrosis of the liver, pulmonary embolism,
and dehydration despite peripheral edema.
Case 12. M. F., white female, aged 90, 12 per cent
body surface burned. Patient was admitted one-half
hour after ignition of clothes by brush fire. She was
apparently in good condition and never went into shock.
The blood volume done was essentially normal, with
a hematocrit of 42. Total intravenous medication con-
sisted of 500 cc. of blood and 500 cc. of plasma on
January, 1950
17
J. c. AGE 33 W-M 50% BODY SURFACE BURN
0 AY OF BURN
1
2
3
4
5
FLU 10
6000
3000
4000
3000
2000
1000
0
nr
1 m
LEDGEND: B
3
U
A
■ 1
LOOD | PL
V. GLUCOSE IN
RINE U VOM
i
ASMaQ 5 %
N.S. H ORAL
ITUS H
■
GLUCOSE IN 0.
FLUIDS Q
□ _
M. 01]
BLOOD
RBC
6.7
HOB.
17.2 GM.
I7GM.
I7.4GM.
19.3 GM
HCRIT
58
NPN
94
Figure II: Chart demonstrating laboratory findings and therapy on patient J. C. who had 50% body surface burn.
It is noted that there was an increasing non-protein nitrogen on the third day with death on the fifth post-burn day.
Cause of death, probable lower nephron nephrosis.
the first hospital day. Recovery was progressive and
uncomplicated until 17th day post-burn, when depend-
ent edema was noted. Patient was digitalized, with
recovery from the edema. After a week, the symptoms
recurred and she died two months post-burn of
typical congestive heart failure, apparently unrelated
to the burn. Autopsy was not performed.
Summary
1. A review of the pathologic findings
of burns has been presented.
2. A critical study of 105 severely
burned patients has been presented with the
laboratory findings obtained, demonstrating
the indications for fluid therapy and sys-
temic care.
3. A mortality of 18 per cent was ob-
served in this group. The type of patient
seen was partially responsible for this high
mortality. It was noted that most patients
with as much as 40 per cent body burn
failed to survive.
4. Attention should be directed to bor-
derline cases which are considered insig-
nificant. It is this group that can be saved
if early and adequate care is given.
5. It was concluded that in spite of re-
cent advances, burns continue to he a large
problem.
6. The outcome of all burns will depend
on the enthusiasm and eagerness with which
this problem is attacked.
7. Complications can be avoided during
the first stage of a burn if estimations of the
blood volume lost are known and sufficient
replacement is made. Fluids should be ad-
ministered in a manner depending on the
needs of the individual patient rather than
by set rules.
8. The use of chemotherapy and anti-
biotics has been made beneficial, but does
not prevent the development of perhaps the
most disabling complication of infection.
Too great a stress cannot be placed on the
fact that burns are essentially infected from
the beginning and, in the light of the newer
18
The Journal of the Medical Association of Georgia
JHH AGE 50 C.N 42V. BOOT SURFACE BURN
DAT OF BURN 1 1
2
3
1 1
1 6
IB
FLUID
7000
«ooa
5000
400a
jooa
200C
1000
0
n
1 D
ledgend: bloo
PR0T
URINE
y
i g
0 I PLASMA
D LT SAT E P 0 [
I
5 7. 0 L IN
] NS - B ICARG
0 0
>.W. 131 5*4 01
0NATE P 0.Q)
H IS |
WATER p 0 [
1 b
s fg
]
BLOOD
R BC
6.1
HOB
198
HCRIT
48
58
56
45
36
NPN
47
78
T P
5.8
6 3
URINE
ALB
+ 3
BLOOO
VOLUME
DAY OF
BURN
TOT BLOOD VOLUME
PLASMA VOLUME
H’CRIT
PLASMA P R0TEIN
1
- 830 CC.
-5 90 CC
46
8 8
2
+ 2050 CC
+ 150 CC.
56
II
+ 680 CC.
■+ 370CC.
4 5
'
Figure III: Chart demonstrating laboratory findings and therapy on patient J. H. H. who had
42% body surfaee burn. Death occurred on the eighteenth post-burn day.
knowledge, this can be minimized to a great
deg ree. The hospital stay will he shorter
and the disability lessened.
9. Early skin grafting should he accom-
plished, which is made possible by the ad-
ministration of sufficient blood before the
patient develops the effects of sepsis.
BIBLIOGRAPHY
1. Davidson. E. C. : Tannic Acid in Treatment of Burns,
Surg.. Gynec. & Obst. 41:202-221 (Aug.) 1925.
2. Lund, C. C., and Browder, N. C. : Estimation of
Areas of Burns. Surg., Gynec. & Obst. 79:352-358 ((Oct.)
1944.
3. Levenson, S. M. ; Green, R. W.. and Lund, C. C.:
Outline for Treatment of Severe Burns. New England J.
Med. 235:76-79 (July) 1946.
4. Rosenthal, S. M.. and Tabor. H. : Electrolyte Changes
and Chemotherapy in Experimental Burn and Traumatic
Shock and Hemorrhage, Arch. Surg. 51:244-252 (Nov. -Dec.)
1945.
5. Tabor, H., and Rosenthal, S. M.: Experimental Chemo-
therapy of Burns and Shock; Effects of Potassium Admin-
istration of Sodium Loss, and Fluid Loss in Tourniquet
Shock. Pub. Health Rep. 60:373-381, 1945.
6. Fox, C. L. , Jr., and Keston, A. S.: Mechanism of
Shock from Burns and Trauma Traced with Radio-sodium,
Surg., Gynec. & Obst. 80:561-567 (June) 1945.
7. Moore, F. D.; Wendell, C. ; Peacock, Elizabeth Blake-
ly, and Oliver, Cope: Anemia of Thermal Burns, Ann. Surg.
124:811-839 (Nov.) 1946.
8. Friesen, S. R.. and Wagensteen, O. H.: Experimental
Burns Accompanied by Histamine Administration Abets
Ulcer Diathesis, Proc. Soc. Exper. Biol. & Med. 63:245-248
(Nov.) 1946.
9. Goodpastor. W. E. ; Levenson. S. M. ; Tagnon, H. J. ;
Lund, C. C., and Taylor, F. H. L. : Clinical and Pathologic
Study of Kidney in Patients with Thermal Burns, Surg.,
Gynec. & Obst. 82:652-670 (June) 1946.
10. Seligman, A. M. ; Frank, H. A., and Fine, J.: Trau-
matic Shock: Hemodynamic Effects of Alterations of Blood
Viscosity in Normal Dogs and in Dogs in Shock, J. Clin.
Investigation, 25:1-21 (Jan.) 1946.
11. Noble, R. P., and Gregerson. M. I.: Blood Volume
in Clinical Shock; Extent and Cause of Blood Volume
Reduction in Traumatic, Hemorrhagic, and Burn Shock, J.
Clin. Investigation, 25:172-183 (March) 1946.
12. Evans, E. I. : Significance of Blood Volume Altera-
tions in Surgical Patients, South. M. J. 38-:214-221 (March)
1945.
13. Lucke, B.: Lower Nephron Nephrosis (Renal Lesions
of Crush Syndrome, of Burns, Transfusions, and Other
Conditions Affecting Lower Segments of Nephrons), Mil.
Surgeon 99:371-396 (Nov.) 1946.
14. Walker, J., Jr.: Study of Azotemia Observed After
Severe Burns. Surgery 19:825-844 (June) 1946.
15. Abbott. W. E.: Metabolic Alterations Following
Thermal Burns; Effect of Altering Nitrogen and Caloric
Intake or of Administering Testosterone Proprionate on
Nitrogen Balance, Surgery 20:284-294, 1946.
16. Levenson, S. M. ; Davidson, Chas. S. ; Lund. C. C.,
and Taylor. F. H. L. : Nutrition of Patients with Thermal
Burns, Surg., Gynec. & Obst. 80:449-469 (May) 1945.
17. Lyons, C.: Symposium on Management of Cocoanut
Grove Fire Burns at the Massachusetts General Hospital;
Problems of Infection and Chemotherapy, Ann. Surg.
117:894-902, 1943.
18. Wells, D. B. ; Humphrey, H. D., and Coll, J. J. :
Relation of Tannic Acid to Liver Necrosis Occurring in
Burns, New England J. Med. 226:629-635 (April) 1942.
19. Mallory, T. B., and Brickley, W. J.: Symposium on
Management of Cocoanut Grove Burns at Mass. Gen.
Hosp. : Pathology, with Special Reference to Pulmonary
Lesions, Ann. Surg. 117:865-884 (June) 1943.
20. Cournand, A. : Noble, R. P. ; Breed, E. S. ; Lanson,
H. D. ; Baldw'in, E. DeF. ; Pemchat, G. B., and Richards,
D. W., Jr. :Clinical Use of Concentrated Human Serum
Albumin in Shock, and Comparison with Whole Blood and
with Rapid Saline Infusion, J. Clin. Investigation 23:491-505,
1944.
21. Moyer, C. A.; Coller, F. A.; Dale, Vivian; Vaughan,
Herbert H.. and Marty, Doris: Study of the Interrelation-
ships of Salt Solutions, Serum and Defibrinated Blood in
Treatment of Severely Scalded, Anesthetized Dogs. Ann.
Surg. 120:367-376 (Sept.) 1944.
22. Abbott, W. E.; Pilling, Matthew A.; Griffin, Grace
January, 1950
19
E. ; Hirshfield, John W., and Meyer, Frieda L. : Metabolic
Alterations Following Thermal Burns; Use of Whole Blood
and Electrolyte Solution in Treatment of Burned Patients,
Ann. Surg. 122:678-692, 1945.
23. Evans, E. I., and Bigger, I, A.: Rationale of Whole
Blood Therapy in Severe Burns; Clinical Study, Ann. Surg.
122:693-705 (Oct.) 1945.
24. McDonald, J. J.; Cadman, E. F., and Scudder, J. :
Importance of Whole Blood Transfusions in Management
of Severe Burns, Ann. Surg. 124:332-353 (Aug.) 1946.
25. Abbott, W. E. ; Meyer, Frieda L. ; Hirshfield, John
W., and Griffin, Grace: Metabolic Alterations Following
Thermal Burns; Effect of Treatment with Whole Blood
and Electrolyte Solution or with Plasma Following Experi-
mental Burn. Surgery 17:794-804, 1945.
26. Wood, G. O., and Blalock, A.: Effects of Uncompli-
cated Hemoconcentration (Erytherocytosis) with Particular
Reference to Shock, Arch. Surg. 42:1019-1025 (June) 1941.
27. Rosenthal, S. M. : Experimental Chemotherapy of
Burns and Shock; Effects of Systemic Therapy on Early
Mortality, Pub. Health Rep. 58:513-522 (March) 1943.
28. Harkins, H. N. ; Cope. Oliver; Evans, Everett I.;
Phillips, Lt. Com. R. A., and Richards, Dickinson, W.,
Jr., Fluid and Nutritional Therapy of Burns, J. A. M. A.
128:475-479 (June) 1945.
29. Howes, E. L. : Topical Use of Streptomycin in
Wounds, Am. J. Med. 2:449-456 (May) 1947.
30. Co Tui, Wright; Arthur Mullin; Mulholland, J. H. ;
Barcham, I., and Breed, E. S. : Nutritional Care of Cases
of Extensive Burns, Ann. Surg. 119:815-823 (June) 1944.
31. Lund, C. C. ; Levenson, S. M. ; Green, R. W. ; Paige,
R. W. ; Robinson, P. E. ; Adams, M. A.; MacDonald, A. H. ;
Taylor, F. H. L. , and Johnson, R. E.: Ascorbic Acid,
Thiamine, Riboflavin, and Nicotinic Acid in Relation to
Acute Burns in Man, Arch. Surg. 55:557-583 (Nov.) 1947.
32. Connor, G. J., and Harvey, S. C.: Pyruvic Acid
Method in Deep Clinical Burns, Ann. Surg. 124:799-810
(Nov.) 1946.
33. Cope, O. ; Moore, Francis D. ; Sweeny, Donald N.,
Jr.; Rawson, Rulon W., and Means, J. H. : Expeditious
Care of Fhill-thickness Burn Wounds by Surgical Excision
and Grafting, Ann. Surg. 125:1-22 (Jan.) 1947.
GOITER: HASHIMOTO TYPE
T. C. Davison, M.D.
A. H. Letton, M.D.
Atlanta
We have been impressed in the last few
years by an increase in the number of
goiters we have operated on that are classi-
fied as Hashimoto’s struma lymphomatosa.
We wish to bring this, as well as several
other of our observations about this disease,
to your attention. Let us introduce our sub-
ject by briefly reviewing the standard classi-
fication of goiter (Table 1). The diffuse
non-toxic goiters include adolescent goiter,
the colloid goiter and thyroiditis. The dif-
fuse toxic goiters are Grave’s or Basedow’s
disease (the exophthalmic goiter), acute
hyperthyroidism, (that is hyperthyroidism
without exophthalmos) and thyroiditis.
Under the nodular non-toxic goiters come
the adenomas, the cystic disease of the thy-
roid, cancer of the thyroid and thyroiditis.
Nodular toxic goiters include acute and
Read before the Medical Association of Georgia in annual
session, Savannah, May 12, 1949.
chronic hyperthyroidism and thyroiditis.
Chronic thyroiditis may come under
either the heading of diffuse or nodular,
non-toxic or toxic goiter. The fact that it
is toxic is shown in two of our cases, in
particular one of which had a B.M.R. of
plus 44 and another plus 50. More com-
monly, however, chronic thyroiditis is clas-
sified under the diffuse non-toxic goiters,
yet it may be nodular in that only a part of
the gland is involved, or one part is involved
more than another. Thus thyroiditis must
be differentiated from all other types of
goiters, and especially when only a portion
of the gland is involved it must be differ-
entiated from malignancy of the thyroid.
This differentiation is sometimes extremely
hard and usually must await microscopic
examination of the tissue.
There are three types of chronic thyroid-
itis: the first being one following an acute
inflammatory reaction; the second, the
Eisenharte Struma of Riedel; and the third,
Hashimoto’s struma lymphomatosa. This
paper primarily deals with the last of these
and yet, as we have shown above, this type
of goiter must be differentiated from all
other goiters.
Riedel’s struma is a replacement of thy-
roid epithelium by fibrous tissue which
makes the gland cjuite hard. Riedel1 orig-
inally described it as Eisenharte or iron hard
struma. The most popular theory concern-
ing the etiology of Riedel’s struma at pres-
ent was presented to the American Goiter
Society last year by Dr. L. C. DeCourcy,2
in which he believes that a perithyroiditis
causes a chronic ischemia of the gland,
which atrophies and is replaced by fibrous
tissue.
In 1912 Hashimoto2 described struma
lymphomatosa, which is an enlargement of
the gland due to an infiltration by lymphoid
and fibrous tissue. The first reported Hashi-
moto’s disease in Georgia was a patient of
20
The Journal of the Medical Association of Georcia
one of us (T.C.D.4) in 1935. Since then
we have collected 27 other cases. Of these
28 cases 26 were seen after January, 1943,
showing a marked increase in the incidence
in the last five and one-half years. The in-
cidence of Hashimoto's disease is usually
reported as being one per cent or less.
In 1922 Ewing ' reported Hashimoto, and
Riedel described, the early and late stages
of the same process. This has brought on
much controversy concerning the subject.
In 1931 Graham and McCullough'' brought
forth impressive evidence that they were
separate entities, and this was backed up
separately by serial biopsy of McClintock'
and Scarello.* Time does not permit a full
perusal of this controversy, except for us to
say that from our own experience and re-
view of the literature we feel that they are
separate entities. Struma lymphotosa is not
a respector of geographical or social boun-
dries, but is very predominately found in
the female. We have noticed only eight
cases in the male reported in the literature
while none of our own cases has been in the
male. The average age given by various
authors in the literature varies from 43.8"
to 57.61" years. In our series the average
age is 37.7 years. All but one of our pa-
tients had noted that they had a goiter for
varying lengths of time, some even since
girlhood. Without exception they had all
been nervous and gave a history of some
emotional unrest in the past. Seventeen
complained of choking and 18 had palpi-
tation of the heart. The B.M.R. ranged
from minus 5 to plus 50. The average was
plus 14V->. It is well to note that a basal
was not done on every patient, but in gen-
eral only those who appeared toxic had
B.M.R.’s run. The serum cholesterol varied
from 125 to 250 milligrams per cent.
The gland was usually described as being
diffusely enlarged, rather firm and had a
pebbly feel. The upper poles of the gland
are usually a little broader and, as Catted11
described it, more like the gland of the ex-
ophthalmic goiter that has been treated with
iodine. At operation the gland is usually
uniformly involved, hut in two instances in
our series apparently only one lobe was
involved. A biopsy of the other lobe was
not taken. There were no adhesions between
the gland and the surrounding tissue except
to the trachea, and the blood supply to the
gland was somewhat less than normal. The
color of the cut surface of the gland varies,
but is usually a lavender-tinted yellow. On
clamping the gland the clamp usually tends
to cut through, only clinging to blood vessels
and strands of fibrous tissue. A small
amount of clear fluid can usually be ex-
pressed from the gland. Microscopically
there is an acidophilic degeneration of the
thyroid epithelium with replacement by
lymphocytes and fibrous tissue. The lym-
phoid tissue usually forms many lymph
follicles.
Little is actually known of the etiology
of Hashimoto’s disease and to even list the
theories concerning it would take much
more than our allotted time this morning.
We would, however, like to point out that
the people in this series are a somewhat
younger group of individuals than those re-
ported in any other series that we have seen
and that all but two have been encountered
since 1943, which is two years after our
entry into World War II. A large majority
of these patients had husbands, sons or
sweethearts in the service and were thus re-
cipients of some anxiety in this regard. It
has occurred to us that this constant anxiety
and chronic emotional unrest may have re-
sulted in chronic stimulation of the thyroid
gland, resulting in an increase in all types
of goiters as well as Hashimoto’s disease.
We feel, at present, that the treatment of
Hashimoto’s disease is the surgical removal
of at least a portion of the gland. If left
January, 1950
TABLE 1. CLASSIFICATION OF GOITER
21
DIFFUSE
NON-TOXIC
TOXIC
| ADOLESCENT
COLLOID
l THYROIDITIS
t EXOPHTHALMIC
PRIMARY HYPERTHYROIDISM
1 (THYROIDITIS)
NODULAR
NON-TOXIC
( ADENOMA
1 CYSTIC
\ CANCER
I THYROIDITIS
TOXIC
i ACUTE HYPERTHYROIDISM
' CHRONIC HYPERTHYROIDISM
( (THYROIDITIS)
alone Hashimoto’s disease gradually causes
a constriction of the trachea, with increasing
difficulty in breathing along with hypothy-
roidism and even a myxedema in some
cases. In analyzing our results of our treat-
ment of Hashimoto’s disease, let us first
define myxedema and hypothyroidism. To
make the diagnosis of myxedema we feel
that there must be a puffiness of the face,
hands or eyelids and/or a signficant gain
in weight. The patient, of course, may also
have swelling of the tongue and larynx,
slowed speech, drying of the skin, fine hair,
etc. The diagnosis of hypothyroidism, how-
ever, depends upon feeling tired, low blood
pressure, noticing cold more than usual, a
decrease in the metabolic rate or an increase
in the cholesterol level. We have treated all
of these patients with either subtotal or total
thyroidectomies (Table 2). All 28 of our
cases have been followed and 9 have devel-
oped myxedema (32.3 per cent). Of the 28
patients, 13 had total thyroidectomies and
8 of these developed myxedema (61.5 per
cent), while of the 15 who underwent sub-
total thyroidectomies only one developed
myxedema (6.7 per cent). This is some-
what less incidence of myxedema than re-
ported in the literature, and we are wonder-
ing if those authors were not using the terms
myxedema and hypothyroidism synony-
mously. Twenty-five of the 28 cases devel-
oped hypothyroidism (89.3 per cent). The
average postoperative metabolic rate, all
performed at least six months after opera-
tion, was minus 6.6 per cent; the serum
cholesterol was 252.8 mg. per cent. We
have not given any of our patients irradia-
tion as advocated by Renton1' et al., who
claim that they have one patient who shows
no hypothyroidism after five years. You
will note that we have two patients who at
present are in the state of euthyroidism after
total thyroidectomy and one after subtotal
thyroidectomy. Others who agree with the
x-ray treatment of Hashimoto’s disease are
Means,13 Schilling,14 and George Crile, Jr.1
On the other hand Boyden, Coller and
Brugher,10 also Marshall, Meissner and
Smith,17 don’t use x-ray therapy, for in their
opinion it may further decrease the amount
of thyroid secretion. McSwain and Moore,”
however, state that x-ray does not cause
hypothyroidism as badly as the operative
procedures do.
In 1943 Polowe1 !l reported a case of
Hashimoto’s disease that had a B.M.R. of
plus 43. Crane,20 Polowe10 and Womack'1
all have proposed that hyperthyroidism
might be the first sign of Hashimoto’s di-
sease. In view of our younger individuals
with their higher B.M.R. and with their
microscopic pictures, we feel that we are
dealing with several early cases of Hashi-
22
The Journal of the Medical Association of Georcia
TABLE 2. SUMMARIZING THE AGE, PRE- AND POSTOPERATIVE STATE OF THYROIDISM
AND TYPE OPERATION PERFORMED.
Patient
Age
Preoperat
B. M. R.
ive
Choi.
Type
Subtotal
Operation
Total
Postoperative
Myxedema
Yes No
Follow-Up
B. M. R.
Choi.
E. T.
32
22
*
*
+ 18
272
K. T.
14
*
*
245
P. L. B.
38
—1
*
*
F. H.
33
*
*
247
J. H. M.
53
*
*
J.S.J.
54
*
*
- 7
212
F. H.
54
—5
214
*
*
W. E. F.
36
+44
125
*
*
—27
322
W. L.J.
29
*
*
—20
347
F. M.
43
+ 4
227
*
*
+20*
162*
G. R. F.
30
*
*
— 2
157
W. F. P.
45
+ 17
*
*
R. S. K.
42
230
*
*
—10
222
J.M.K.
22
*
*
P. H.
26
*
*
- 3
254
W. T. F.
27
250
*
*
—18
285
L. H. C.
48
+19
*
*
M. J.
27
+16
207
*
*
270
L. E. W.
37
181
*
*
T. W. M.
32
+ 9
180
*
*
- 9
176
E. B.
27
0
160
*
*
—11
380
A. B.C .
57
+50
153
*
*
+18*
300
.1. L. C.
35
— 3
*
*
M. R.2
32
*
*
C. B.'
62
*
*
L. S.4
50
*
*
S. E. R.3
31
*
*
B. H.1
30
*
*
•Taking thyroid extract
1. Patients Dr. W. A. Kelley
2. Patient Dr. B. L. Shackleford
3. Patient Dr. H. E. Steadman
4. Patient Dr. B. H. Clifton
moto's disease and are inclined to agree that
probably in the early stages of Hashimoto’s
disease there is a slight hyperthyroidism,
which later becomes euthyroid and then
hypothyroid.
Summary
1. We have reported 28 additional cases
of Hashimoto's disease, 26 of which have
been seen since 1943, the first in 1935.
2. We have pointed out the younger age
incidence in this group, the youngest being
14 years old.
3. We have pointed out the higher pre-
operative basal metabolic rate. One patient
was plus 44, another plus 50.
4. We have discussed the advisability of
biopsy of these glands to rule out malig-
nancy, as well as discussing the differential
diagnosis from other types of chronic thy-
roiditis and other types of goiters.
5. Analysis of the results of the type of
operative procedures used was made, and
it was pointed out that following total thy-
roidectomy 61.5 per cent developed mild
myxedema, while following subtotal thy-
roidectomy only 6.7 per cent developed any
myxedema; 89.3 per cent of all the cases
developed hypothyroidism.
6. Evidence that hyperthyroidism is one
of the early signs of Hashimoto’s disease has
been presented. The theory that Hashi-
moto’s disease may be the result of chronic
emotional unrest has been advanced.
BIBLIOGRAPHY
1. Riedel, Bernhard: Ueber Verlauf und Ausgang der
Strumitis Chronica. Munchen. Med. Wehnschr.
57:1946, 1910.
Die Chronische, zur Bildung eisenharter Tumoren
fuhrende Entzundung der Schilddruse, Verhand. d.
deutsch. Gesellsch. f. Chir. 25:101, 1896.
Vortstellung eines Kranken mit chronischer Strumitis,
Verhead. d. deutsch. Gesellsch. f. Chir. 26:127, 1897.
2. DeCourcy, L. C. : Etiological Factors in Riedel’s
Struma. Possible Roles of Perithyroiditis and Ischemia,
Tr. Am. A. Study Goiter, 1948.
3. Hashimoto, H. : Zur Kenntnis der Lymphomatosen Ver-
anderung der Schilddruse (Struma Lmphomatosa) Arch. f.
Klin. Chir. 97:219-248. 1912.
January, 1950
23
4. Poer, H. ; Davison, T. C., and Bishop, E. L. : Struma
Lumphomatosa (Hashimoto) — Report of a Case. Am. J.
Surg. 32:172-175. 1936.
5. Eiwng, J. : Neoplastic Diseases: A Treatise on Tumors,
ed. 2, Philadelphia, W. B. Saunders Company, p. 961,
1922.
6. Graham, A., and McCullough, E. P. : Atrophy and
Fibrosis Associated with Lymphoid Tissue in the Thyroid,
Arch. Surg. 22:248, 1931.
7. McClintock, J. C., and Wright, A. W. : Riedel’s Struma
Lymphomatosa (Hashimoto) — a Comparative Study, Ann.
Surg. 106:11-32, 1937.
8. Scarello, N. S., and Goodale, R. H. : Struma Lympho-
matosa; Report of a Case Complicated by Myxedema, New
England J. M. ed, 224:60-64 (Jan. 9) 1941
9. Patterson, H., and Starkey. G. : The Clinical Aspects
of Chronic Thyroiditis, Ann. Surg. 128: 756-769 (Oct.) 1948.
10. Joll, Cecil A. : The Pathology, Diagnosis and Treat-
ment of Hashimoto’s Disease (Struma Lymphomatosa) Bri.
J. S. 27:351-389 (Oct.) 1939.
11. Cattell, (Quoted by Lahey, F. M.): Thyroiditis:
Operative Procedure for Relief of Tracheal Constriction Due
to Thyroiditis, Surg., Gynec. & Obst. 60:969, 1935.
12. Renton, J. N. ; Charteris, A. R., and Heggie, J. F. :
Riedel’s Thyroiditis and its Treatment by Radium, Brit.
J. Surg. 26:54-70. 1938.
13. Means, J. H. : The Thyroid and Its Diseases, Phila-
delphia. J. B. Lippincott Company, 1937.
14. Schilling, J. A. : Struma Lymphomatosa, Struma
Fibrosa and Thyroiditis, Surg., Gynec. & Obst. 81:533-550
(Nov.) 1945.
15. Crile, George, Jr.: Thyroiditis, Ann. Surg. 127:640-
654 (April) 1948.
16. Boyden, A. N. ; Coller, F. A., and Bugher, J. C. :
Riedel’s Struma, West. J. S. Surg. 43:547-563. 1935.
17. Marshall, S. F. ; Meissner, W. A., and Smith, D. C.:
Chronic Thyroiditis, New England J. Med. 238:758-766
(May) 1948.
18. McSwain. B., and Moore, S. W. : Struma Lymphoma-
tosa (Hashimoto's Disease) Surg., Gynec. & Obst. 76:562-
567, 1943.
19. Polowe, David: Struma Lymphomatosa (Hashimoto)
Associated with Hyperthyroidism. Arch. Surg. 29:768-777
(Nov.) 1934.
20. Crane. W. : Chronic Thyroiditis. California and West.
Med. 35:443-446 (Dec.) 1931.
207 Doctors’ Building,
478 Peachtree St., N. E.,
Atlanta.
DISCUSSIONS
Note: The papers referred to in the following dis-
cussions were published in two numbers of The
Journal; namely , December, 1949 and January, 1950.
— Ed.
Discussion of papers “Two Years' Experience in
the Diagnosis of Uterine Cancer by Means of Vaginal
Smears by Dr. H. C. Freeh; “Tumors of the Salivary
Glands. ’ by Drs. J. Elliott Scarborough, Robert L. Brown
and C. S. Jones; “The Borderline Diagnosis of Carci-
noma of the Breast,” by Dr. Hoke Wammock.
DR. H. E. NIEBURGS (Augusta) : I would like to
congratulate Dr. Freeh on dealing so capably with
the enormous task of examining over 3,000 slides
on 1,2000 cases in his office.
Over the past two and a half years we have com-
pleted a series of 10,000 cases of unselected patients,
who were screened for uterine cancer. We found an
incidence of about 1 per cent of pre-invasive cancer
and 1.5 per cent of invasive cancer.
While I agree with Dr. Freeh that this matter is
an easy office procedure, I do not think that examina-
tion of the slides can be carried out in the physician’s
office. W e found that the cells, particularly those shed
from the cervix, appear in such a great variety that
the interpretation of these cells and the differential
diagnosis between invasive and pre-invasive cancer is
very difficult and requires many years of intensive
study on a large amount of material.
The reason whv Dr. Papanicolaou has such a small
percentage of false negatives is that he is grouping
his slides into five classes: 1, negative; 2, atypical;
3, suggestive of cancer; 4, abnormal cells, probably
cancer; 5, definite cancer. Group 3 he does not con-
sider a positive class but an equivocal one. Therefore
his percentage of error is very small. However, I under-
stand that 50 per cent of his Class 3 are negative.
In our analysis we have included our Class 3
as a positive class and call the negatives of Class 3
false positives. Our over-all percentage of accuracy
is about 80 per cent. However, if we exclude Class 3,
our accuracy reaches to about 98 per cent.
Discussion of papers, "Bleeding Duodenal Polyp;
Report of Case,” by Drs. McClaren Johnson and W.
S. Dorough; “Congenital Intrinsic Duodenal Obstruc-
tion: Report of Eight Cases,” by Drs. Lon Grove and
Earl Rasmussen; “Transverse Abdominal Incisions,”
by Drs. Harry Rogers and William G. Whitaker;
“Goiter: Hashimoto Type,” by Drs. T. C. Davison and
A. H. Letton, and “Treatment of Burns,” by Drs. J. D.
Martin, Jr., Richard S. Caudle, and J. M. B. Blood-
worth, Jr.
DR. LESTER HARBIN (Rome) : This series of
papers has been so good that I am not sure I have
very much to add. I think the essayists have covered
the subjects exceedingly well, and we ought to com-
mend them for the type of papers which have been
presented.
I do want to make a few remarks about a couple
of papers. I believe Dr. Grove and Dr. Rasmussen
once again have presented a series of very unusual
cases, and their surgical mortality of zero is indicative
of the skillful manner in which they have handled
these cases.
I can add very little to the discussion. I would like
to emphasize the good results they have had, due to
early accurate diagnoses and also to the detailed pre-
and postoperative care which they have given those
infants. I want to thank Dr. Grove and his associate
for bringing these unusual cases to our attention,
and we should look for them in the future.
Dr. Whitaker and Dr. Rogers have presented a
large series of consecutive cases using transverse
abdominal incisions, and I think the fact that they
have used the transverse incision in all of these cases
is the thing which makes their paper important.
I would like to ask Dr. Whitaker if he has ever
regretted making a transverse incision and wished,
after he had the transverse incision, that he had made
a vertical incision. I know I have had that experience.
I would like to know how’ he takes care of that situa-
vion.
Dr. Whitaker gave us a very mild impression about
the incidence of postoperative hernia following trans-
verse incision. I would be very much interested in
knowing if he could elaborate on that a little more
than he has.
The first paDer, by Dr. Dorough, was very interest-
ing, and I don’t believe I can add anything to it.
I want to thank the essayists again for presenting
such a nice series of papers.
Discussion of paper, “Goiter: Hashimoto Type,’ by
Drs. T. C. Davison and A. H. Letton, Atlanta.
DR. C. H. RICHARDSON (Macon) : Mr. Chair-
man, this discussion of Hashimotot’s disease is more
or less in the nature of a plea for an attempt to
diagnose this condition before operation, because this
condition is one of the things that contributes to the
heartaches of many of us who are interested in typroid
surgery.
We believe that struma lymphomatosa is a chronic
progressive degenerative disease of the thyroid which
is characterized bv degeneration of the glandular
epithelium and replacement with lymphoid tissue and
fibrous tissue.
Dr. Crile, of Cleveland, reports a series of 900 con-
secutive thyroidectomies, and just three cases of Hashi-
moto’s disease. In a series of approximately 150 con-
secutive cases we have found, in the last two years,
four cases of Hashimoto’s disease, and I wish briefly
to run over them with you :
The first was a patient 72 years of age. Her chief
24
The Journal of the Medical Association of Georcia
complaint was extremee fatigue. The preoperative
diagnosis was non-toxic, nodular goiter, and the basal
metabolic rate was plus 4. Subtotal thyroidectomy was
done, and the diagnosis was struma lymphomatosa.
She made a satisfactory recovery but she still com-
plains of extreme fatigue.
The second patient was Mrs. A. D., aged 51, whose
chief complaint was muscular weakness and tightness
in the throat. An examination showed a hard lump
in the right lower lobe, and her b.m.r. was minus 2.
The preoperative diagnosis was non-toxic adenoma,
and she had a hemithyroidectomy. The pathological
report was struma lymphomatosa. She has made a
fairly satisfactory recovery.
Mrs. G. W., age 49, had a chief complaint of pain
in her head. She had no energy and was tired all
the time. Examination showed a hard nodular goiter,
and the preoperative diagnosis was cancer of the
thyroid, or Hashimoto’s disease. Her b.m.r. was minus
4. We did a subtotal thyroidectomy, and she very
promptly developed myxedema and was very much
upset, and felt that she wished she had never had
the operation.
The next case was Mrs. H. M., aged 41, whose
chief complaint was a lump in the neck and fatigue.
Examination showed a hard nodule in both lower
lobes. Preoperative diagnosis was non-toxic nodular
goiter. Her b.m.r. was plus 2. Subtotal thyroidectomy
was done. The pathologic report was struma lymphoma-
tosa. She developed myxedema and her fatigue con-
tinued.
The point I want to make particularly is that this
is a progressive disease of the thvroid characterized by
chronic constitutional disorders. These people not only
have hypothvroidism but hypometabolism. and they
keep on having it after they are operated on. I do
not believe we cure them by operation. It is a question
if some better form of treatment might be undertaken,
particularly since there are very definite reports of
imnrovement under x-ray therapy.
We feel that the important thing, and the thing
we have not done and which we intend to do in the
future, is to make some effort to evaluate and diagnose
these cases in advance, particularly if they are hard
or discrete or nodular types of growth which suggest
cancer. This could verv well be done and can be
done by an aspiration biopsy with a liver needle.
This. I feel, is a thing that should be done, and if
these patients do have struma lymphomatosa we had
better think things over before wre operate on them.
Discussion of paper, "‘Congenital Intrinsic Duodenal
Obstruction: Report of Eight Cases,” by Drs. Lon
Grove and Earl Rasmussen. Atlanta.
DR. JULIAN K. QUATTLEBAUM (Savannah):
Mr. Chairman and gentlemen: I would like to say,
in discussing the paper presented by Dr. Rasmussen,
that it has been my observation that pediatricians are
never in any great hurry to have an infant operated
on simply because he is vomiting. This is understand-
able, because the risk is necessarily high and also
because many of these patients do get well on con-
servative treatment.
However, when an infant has a complete duodenal
obstruction, operation of course, offers the only possible
hope of survival, and it is interesting to note what
happens to some of these patients years later.
I would like to illustrate this point by citing a
case which I operated on July 10, 1935. fourteen years
ago. The patient was then ten days old and weighed
two and a half pounds, and was operated on without
any hope of its survival.
At the operation, the duodenum was found to be
completely atrophic in the third portion with an interval
of some 25 mm. betw-een it and the beginning of the
jejunum. A simple anterior gastroenterostomy was
done, anastromosing the beginning of the jejunum to
the anterior wall of the stomach. The jejunum was
about the size of a good, healthy earthworm. As I
say, no hope was entertained for the child’s recovery.
However, the child did recover, and it emphasizes the
experience of every surgeon, that these little infants
can stand a lot more than you think. That was
fourteen years ago. I saw the child and had it com-
pletely examined last year. Although all of the duo-
denal fluid, bile and pancreatic secretions have to
go retrograde through the duodenum into the stomach
and out through the new opening, the child is appar-
ently normal in every respect.
These are cases in which the duodenal obstruction
is only partial, the child suffering from intermittent
attacks of complete obstruction, which offer other
problems. I recently saw a child three years old who
had had such an experience and w'ho had been through
many bouts of acute high obstruction. Upon operation,
the duodenum was obstructed at the duodenal-jejunal
junction by failure of rotation at that point, and
the chronically dilated duodenum was larger than
the transverse colon.
I think it a mistake to make these children go
so long without exploration, because modern therapy,
antibiotics, plasma, blood, and so on, has reduced the
operative risk sufficiently to justify the effort. Cer-
tainly, the outcome is better than letting them go on
indefinitely.
I would also like to mention that everyone here
must consider himself fortunate to have heard such a
scholarly presentation on the subject of burns as that
given by Dr. Martin.
Discussion of paper, “Congenital Intrinsic Duodenal
Obstruction: Report of Eight Cases,” by Drs. Lon Grove
and Earl Rasmussen, Atlanta.
DR. THOMAS W. COLLIER (Brunswick): Mr.
Chairman and gentlemen: I have greatly enjoyed the
presentation of Drs. Rasmussen’s and Grove’s eight
cases of congenital duodenal obstruction. The occur-
rence of duodenal obstruction or atresia is usually
described in text books as a rarity, and left there.
However, since Ernst’s first successful operation in
1916, many cases have been observed, diagnosed and
treated successfully.
Most of the reports are those acute, spectacular
cases in which the obstruction is total and usually in
full-term infants. Because of its supposed rarity,
following a case of partial duodenal obstruction in
Brunswick, a survey of the literature was made.
I found one case each was reported by nineteen
men: Sumner, Peterson, Leitch., Diertch, Higgins,
Earner, Cranmer, Peterson, Stewart, Seidlin, Regnier,
Cutler, Stenson, Cole, Ernst, Porter, Reitscher, Jones,
and O’Neal. Ward had a summary of fifteen additional
cases, Forresner thirteen cases, and Ladd two reports
of thirteen and nine each.
Our patient, H. M., was a premature, female child
delivered by cesarean section on July 27, 1947, birth
weight 5 pounds 2 ounces. She was seen on the
thirteenth day of life, with history of projectile vomit-
ing of large amounts occasionally during the twenty-
four hours — not after each feeding. The vomitus did
not contain bile. She was having one to four small,
hard, yellow to dark tools daily.
Physical examination showed a tiny, emaciated, pre-
mature infant weighing about four pounds. There was
no subcutaneous tissue, and her skin was in very poor
condition. Peristaltic waves were visible over the upper
abdomen. The liver and spleen were palpable and
enlarged. There was no jaundice. The tongue and
mouth were reddened and dry. No duodenal mass
was palpable. There was a hemic murmur at the
base of the heart.
Impression: Partial obstruction, either pyloric or
duodenal. This was confirmed by x-ray.
Surgery was undertaken on the twenty-fifth day of
life, August 21st, hut on the table the child’s con-
dition became progressively worse and closure was
January, 1950
25
necessary after freeing adhesions about the duodenum
and incising the pyloric sphincter. Dr. T. V. Willis
did this surgery.
The postoperative course could only be described
as saying she survived. The weight dropped to four
pounds four ounces. In October it was evident that
surgery must be undertaken again, in spite of the
poor condition and tiny size. Therefore, on the eighty-
first day of life (October 23rd), she went to surgery
successfully, a posterior gastro-jejunostomy being
performed by Drs. Jack Avera and T. V. Willis.
The next several weeks were marked by feeding
problems, otitis media, and pneumonia. She survived
and was dismissed weighing five pounds seven ounces
on the 142nd day of life (December 16th).
We considered this four pound four ounce baby
to be extremely small to undergo major surgery.
However, Stenson likewise reports a twin who was
successfully operated on with weight four pounds,
and Stetner also reported a successful operation on
a four pound two ounce baby.
Therefore, we wish to add the third four-pounder
to successfully undergo major surgery for congenital
duodenal obstruction.
DR. JACK C. NORRIS (Atlanta) : Mr. Chairman,
when one is invited to discuss three papers such as
these this morning, it is a pretty big job, particularly
after one has enjoyed Savannah’s hospitality the night
before. (Laughter).) The hospitality has remained
consistent for about 200 years.
Dr. Freeh’s paper has emphasized an entirely new
field in the diagnosis of malignancy. I happened to
have the pleasure last October of hearing Dr. Papanico-
laou read a paper on this technique. Although not
the originator of it, he certainly has promoted it,
and has called attention to its possibilities.
I was amazed when I saw the slides he showed,
and then heard him say that his percentage of accuracy
in diagnosis was between 99 and 100 per cent. I
simply could not believe it. I think Dr. Papanicolaou
is an honest man and a fine man, and I certainly
believe he is a master pathologist, and he has been
working on this problem for more than twenty-five
years; but I have been doing some work for twenty-
five years, too, and I don’t believe there is such a
thing as a 100 per cent method for diagnosing anything
except death ! Even then there is some doubt, because
now they put the E.K.G. on one’s heart and find that
he died at ten o’clock, but the heart didn’t quit beating
until twelve! (Laughter).
This Papanicolaou business leaves me rather dis-
turbed when I study these smears, because sometimes
they just knock you down, and you know very well
you are dea'ing with a cancer — and another time you
look at a slide and you don’t know whether to tell
the doctor “Yes” or “No”. Then you go back to
your old system of taking an autopsy — I mean a biopsy
(Laughter) .
I have recently had an experience with one of our
leading surgeons in Atlanta, Dr. Gus Dorough. Dr.
Dorough sent me a Papanicolaou smear of a young
woman forty-one years of age, and I sent it back and
said it was suspicious. You know what that means.
(Laughter.) He got me another one, and I sent it
back and said it was a little more suspicious. Finally
Dr. Dorough nipped off a little piece of tissue and I
made a diagnosis of very early cancer.
He waited two weeks after he applied his magic
treatment, which is the electrical apparatus, he came
back and told me, ‘"That was the most normal looking
cervix I have ever seen.” The lady, however, was in
a bad fix. Her husband had recently died and she
was in a nervous state. Dr. Dorough had to do some-
thing for her.
On the basis of my slides he operated on this woman
and removed her cervix, and lo and behold! when he
cut the cervix open it was as normal as any you
ever saw; but they made serial sections, and a patholo-
gist reported from another hospital that it was early
intraepithelial cancer. We felt much better.
This brings up a question we can well wonder about:
When do cells become cancer? Are we going to
look at a few cells in an epithelial layer and call them
intraepithelial cancers, when we can’t see any cancer,
when we can’t feel any cancer, when everything looks
to be normal?
The problem is going to evolve upon what we are
going to call cancer. We have cancer cells, and we
have cells that may look like cancer cells, but may
not become cancer.
There are a lot of doctors around the country who
are making routine Papanicolaou smears, turning them
over to the technician, and telling the women they
don’t have cancer. I am very anxious to see where
all this is going to lead.
The parotid tumors are most interesting. I have
always considered parotid tumors to be very serious.
From 25 to 50 per cent of them recur, in my experi-
ence, so I always warn a man, when he sends me a
section of a parotid gland, “You must get them out
thoroughly.”
DR. J. K. QUATTLEBAUM (Savannah) : Mr. Chair-
man, members and guests of the Medical Association of
Georgia: Cancer in all its manifestations still continues
to be the greatest single problem confronting scientific
medicine today, and the results of treatment over the
duration of my career as a doctor certainly do not lead
me to see anything encouraging about this disease.
We have always harped on the fact that cancer must
be treated early and discovered early, and we must
get it early — yet we understand from Dr. Freeh’s paper
that cancer in situ, theoretically at least, can be present
for at least twelve years on the average before giving
rise to symptoms. So what is early cancer?
It is encouraging to see that we are beginning now
to look upon cancer as being early, not when we
have a small growth or when the symptoms have
been only noticed for a short duration of time, but
rather in terms of pathological earliness or infancy.
Certainly, the papers that have been presented by Dr.
Freeh and Dr. Wammock are encouraging in that it
brings our attention to focus upon cancer in its
very earliest pathological stage.
As Dr. Norris said, you can argue about it. There
is an old saying that when pathologists agree, the
patient dies. When they disagree, the patient survives.
I think we are justified through this technique of
examining slides, as Dr. Freeh has shown, in the
office, and as Dr. Wammock has shown in early slides
of the breast, in treating such lesions as early cancer,
although unquestionably, a large number of opera-
tions will be done, you might say, unnecessarily. I
have a feeling (theoretically, at least), and I want
you to understand that I am not advocating this, that
if every woman had a prophylactic complete hysterec-
tomy on the day she became forty years old, performed
by a capable surgeon, the number of cancer deaths
prevented would justify the operative mortality.
Our attention must be directed toward cancer in
its precancer stage, rather its doubtful stage. Even
if we make mistakes, they are safer mistakes, and
certainly, the uterus is a dispensable organ. I know
of nothing more regrettable than the necessity of doing
a radical mastectomy, on an attractive young woman.
It is a mutilating operation, and I hope eventually
some treatment will be developed that will make this
procedure needless. But when you see the same young
woman riddled with carcinoma, with the breast even-
tually coming off anyway — and, by the way, Sears-
Roebuck puts out a pretty good rubber breast that
looks very well under a dress — I still think the radical
procedure is justified even in doubtful cases.
One point I should like to emphasize is this: Who
is going to look at these slides? Certainly, I can’t
26
The Journal of the Medical Association of Georcia
tell anything about them. We have to place an unusual
responsibility on the pathologist if he is going to say
which is cancer and which is cancer’s grandfather and
which is not. So, it does leave us in a very puzzled
position.
I, for one, believe that if we are going to err, we
should err on the side of safety. It is better to operate
unnecessarily early, than it is to operate very necessarily
too late.
Concerning parotid tumors: 1 have had some experi-
ence with them, and I haven't seen the recurrences
that have been mentioned, unless the tumor was rup-
tured in removing it. If a parotid tumor is enucleated
intact and everything goes well, and if another tumor
occurs seven years later, I hesitate to say it is a re-
currence. It might be a new one, since we don’t know
what started it the first time. If the capsule is ruptured
in getting out a parotid tumor, you should be on the
alert for a recurrence, and I always treat such patients
with x-ray after operation. If the tumor involves the
submaxillary gland. 1 usually take out the gland entire-
ly. We make every effort to precerve the mandibular
branch of the facial nerve, and it usually can be
done.
If the parotid gland is involved with carcinoma you
can be sure of one thing — the facial nerve eventually
will be paralyzed anyway, and you will have facial
paralysis, so you might just as well go ahead and give
the patient facial Daralysis while he is living, because
he isn’t going to last very long, anyway.
I certainly have enjoyed the presentations.
DR. CATHARINE MACFARLANE (Philadelphia):
Mr. Chairman, ladies and gentlemen: I appreciate this
privilege. Unfortunately I missed the first twrn papers
this morning, and therefore I cannot speak about
them.
I should like to congratulate Dr. Wammock on his
most interesting and helpful presentation of the potenti-
alities of soreness in the breast, which is something
we have a tendency to overlook.
I should like to bring to your attention a matter
which is not new. but which may be tremendously
important, and that is the milk factor in the etiology
cf human cancer.
Dr. Bittner, first of the Bar Harbor Laboratory and
now" of Chicago, demonstrated beyond any possible
question the transmissibilitv of cancer of the breast
in mice by means of a virus which is termed “the
milk factor". It is perfectly possible that this is also
applicable to human beings, but this has not yet been
demonstrated. The only way we can demonstrate it
is from a clinical point of view, and if we make it
our business to inquire into the history of our preg-
nant women, if there is a history of breast cancer in
their background, that particular woman should not
be permitted to nurse her offspring even for a few
hours.
To dry up the milk, once upon a time, was some-
what of a procedure; but now the average woman
does not nurse more than a few weeks, anyway, and
the breasts in a woman with a cancer heredity could
readily be dried up at once. It would be a very inter-
esting clinical experiment if that were done on a
larse scale.
Thank you very much.
HEALTHGRAM
The incipient lesion of pulmonary tuberculosis of
limited extent is practically always of unstable char-
acter and that in a large proportion of the cases it pro-
gresses to advanced and destructive disease. There is
reason to believe that the majority of cases of manifest
clinical tuberculosis have their origin in these seemingly
inconspicuous, small lesions. David Reisner, M. D., Am.
Rev. Tuberc., March, 1948.
ACUTE PANCREATITIS
William G. Whitaker, Jr., M.D.
Atlanta
“Acute hemorrhagic pancreatitis is to be suspected
when a previously healthly person, or a sufferer from
occasional attacks of indigestion is suddenly seized
with violet pain in the epigastrium followed by vomit-
ing and collapse . . .”
In these words Fitz1 (1889) first de-
scribed this disease. Since that time numer-
ous authors have added with great vividness
to the clinical picture. Because of the dra-
matic and spectacular character of hemor-
rhagic necrosis of the pancreas, the more
frequently occurring milder episodes of
acute pancreatitis are often not considered
in the differential diagnosis of abdominal
pain. ElmaiT 1 called attention to a group
of cases demonstrating some of the signs
and symptoms of classical pancreatitis but
of a subdued or lessened intensity. With the
advent of accurate laboratory methods of
diagnosis, edematous or interstitial pancrea-
titis has become accepted as a definite
clinical entity.
It is the purpose of this paper to review
several aspects of acute pancreatitis and to
discuss the various factors concerned in its
management.
For purposes of description pancreatitis
may be divided into clinical groups,4 each
group differing from the other principally
in the extent of pancreatic involvement.
The classical portrait is that of the sud-
den occurrence of abdominal pain, vomiting
and collapse. The onset of symptoms usu-
ally comes on a few hours following a rich
meal and perhaps some alcohol intake. The
pain is of violent nature, usually confined
to the epigastrium but may radiate to the
loins or back. Lord MoynihanV descrip-
tion is that of illimitable agony, the worst
by far of all pain endured by the human
From the Department of Surgery. Emory University
School of Medicine and the Surgical Services of the Grady
Memorial Hospital, Atlanta.
January, 1950
27
body. Movement of the patient aggravates
the pain and he lies motionless, afraid to
make even the slightest move. Vomiting
occurs early and may he projectile in char-
acter. Violent retching and persistent hic-
cough are common. Vascular collapse is
often so marked as to suggest massive inter-
nal hemorrhage. Occasionally a peculiar
patch cyanosis, slate gray in color is noted.
Examination of the abdomen reveals gen-
eralized tenderness and rigidity, both being
more pronounced in the epigastrium. A
definite fullness may be found in the upper
abdomen often to the extent that the lower
quadrants appear sunken. Peristalsis is
usually absent.
Death may occur within 24 to 36 hours,
but the surviving patient may enter a period
of intractable vomiting, hiccough, chills,
fever and sepsis. The process may culmi-
nate in the formation of a large cyst, or an
abscess often associated with the signs of
pancreatic insufficiency.
Another group may simulate closely the
picture of acute coronary occlusion. Severe,
crushing substernal pain may predominate
and overshadow the abdominal component.
Necropsy in such instances has revealed
fat necrosis within the pericardium,4 pre-
sumably due to the presence of lipase in
the blood stream.
A fair number of cases closely mimics
acute cholecystitis. This group does not, as
a rule, demonstrate massive pancreatic ne-
crosis with its attendant shock. Jaundice is
noted occasionally but is usually mild. The
majority of these patients are operated upon
for cholecystitis and the diagnosis of pan-
creatitis is made at operation.
Another group may present a striking
similarity to acute intestinal obstruction.
Profuse vomiting with abdominal pain and
distention may lead to an erroneous diag-
nosis. A roentgenographic pattern of rather
marked ileus may further suggest obstruc-
tion. Fitz1 in his original description men-
tioned the significance of high intestinal ob-
struction in these cases.
A sizable number of patients are seen
during acute alcoholism or just following
an alcoholic debauch. This group has often
been labeled acute alcoholic gastritis. It
seems fairly certain that a considerable por-
tion of this group are cases of acute pan-
creatitis.
Finally, some patients when first seen
will have an epigastric mass and will volun-
teer a past history of recurrent episodes of
pain and vomiting. This mass usually rep-
resents a large indurated pancreas, a pan-
creatic cyst or less frequently a pancreatic
abscess.
Effects and Sequelae
Obviously those cases of massive hemor-
rhagic necrosis of the pancreas terminate
fatally in a few hours or days. Mild cases
of acute interstitial or edematous pancrea-
titis may undergo complete restitution to
normalcy within a short period. Pancreatic
pseudo-cysts are encountered with some de-
gree of frequency. Biliary obstruction may
be the result of edema and fibrosis in the
head of the pancreas. Acute and chronic
diabetes may be seen during and following
an acute episode.
Chronic recurrence of abdominal pain
may be noted following heavy meals or
intake of alcohol. Roentgenograms in such
cases frequently demonstrate calcification
of pancreatic acini and the formation of
duct calculi. Fibrosis and calcification may
progress to the extent of producing pan-
creatic insufficiency with its characteristic
boring pain and a sprue-like syndrome.
Portal hypertension resulting from throm-
bosis of radicles of the portal system may
follow a few cases of pancreatitis. Atten-
tion is usually directed to this condition by
ascites or by bleeding esophageal varices.
Finally, some cases result in extensive intra-
28
The Journal of the Medical Association of Georcia
abdominal adhesions, fibrosis and calcifica-
tion.
Etiology and Pathogenesis
In spite of extensive clinical and experi-
mental efforts to establish the cause of
acute pancreatitis, much remains to be
known. Many investigators have accumu-
lated considerable amounts of evidence to
substantiate an idea or a theory but no one
factor seems to be the explanation of all
cases of pancreatitis. The causes are appar-
ently varied and several factors may be able
to produce the disease.
The trigger mechanism or the initiating
agent is apparently one which will release
trypsin or its precursor into the interstitial
tissues of the pancreas1 ". It has long been
observed that bile salts set up an intense
inflammation when injected into the pan-
creatic duct. This is followed by edema,
ductal occlusion, and in severe cases cellu-
lar destruction with liberation of pancreatic
ferments. Bile may enter the duct of Wir-
sung when a common channel for bile and
pancreatic juices exists. This anatomic ar-
rangement has been observed in a consid-
erable number of instances’’ ' s 9 1". Obstruc-
tion of the sphincter of Oddi by spasm' 9 10,
stone' or edema1 would provide the neces-
sary structural pattern for the retrograde
flow of bile into the pancreas.
There is some evidence that intrapan-
creatic obstruction with increased intra-
ductal pressure and rupture of the actively
secreting acini is the factor in some
11 12
cases
Embolism, thrombosis, arterial rupture,
metastatic infection and direct trauma may
be responsible for the remaining cases1 .
The transition from pancreatic inflamma-
tion and edema to hemorrhagic necrosis has
aroused much speculation. The erosion of
blood vessels by trypsin has the backing of
considerable experimental evidence11. In-
tense local vasospasm with its resultant
ischemia and subsequent necrosis and
hemorrhage is also based on some experi-
mental evidence11.
Whatever the etiologic agents may be the
pancreas is usually enlarged, varying in
consistency from a stony hard organ to a
soft fluctuant mass. The surface frequently
shows whitish areas of fat necrosis. In more
severe cases the gland may demonstrate ex-
tensive hemorrhage or gangrene. A charac-
teristic serosanguineous or consomme type
of intra-peritoneal exudate is often encoun-
tered. This fluid contains pancreatic en-
zymes and is responsible for the areas of fat
necrosis found within the peritoneal cavity.
Laboratory Aids in Diagnosis
Elevation of serum amylase content is
considered almost pathognomonic when as-
sociated with the clinical picture of acute
pancreatitis. Those cases of rapid complete
pancreatic necrosis may have only a negli-
gible transient elevation of serum amylase
followed in a few hours by subnormal read-
ings. Amylase levels are usually increased
within 24 to 36 hours of the onset of symp-
toms and may return to normal after 48 to
72 hours.
Urinary diastase is considerably in-
creased after 24 hours and remains elevated
for as long as four or five days.
Blood calcium levels are often lowered
during the height of the disease. Ionizable
calcium escapes from the blood stream to
react with fatty acids liberated by pancreatic
ferments. Tetany may be seen in the severe
cases.
Blood sugar is at times elevated when the
process is extensive enough to involve many
islet cells. Glycosuria is more frequent than
is generally suspected. Roentgenograms of
the abdomen usually reveals a rather
marked segmental ileus. The transverse
colon is particularly dilated due to its prox-
imity to the pancreas and the vulnerable
January, 1950
29
position of its mesentery.
T reatment
The relief of the intense pain of acute
pancreatitis demands immediate attention.
The use of morphine is questioned by sev-
eral investigators in that it produces spasm
of the sphincter of Oddi and may in some
cases actually aggravate the condition*. For
this reason demerol in adequate dosage is
probably the treatment of choice; although
this drug may also exert a mild spastic effect
on the sphincter.
Complete gastro-intestinal rest utilizing
a duodenal tube with constant suction is in-
dicated for several reasons. Aspiration of
swallowed air and the gastro-duodenal se-
cretions provide prophylaxis against further
abdominal distention. Hydrochloric acid
is prevented from reaching the duodenal
mucosa where it takes part in the produc-
tion of an enzyme, secretin, which is a secre-
tory stimulant to the pancreas. Moreover,
hydrochloric acid in contact with the am-
pulla of Vater produces marked spasm of
the sphincter mechanism*.
The regular use of vagus depressants
such as atropine, promotes relaxation of
the sphincter of Oddi, decreases the volume
and acidity of the gastric secretions and
serves well in relieving to some extent the
epigastric pain.
Complete restoration of blood volume is
essential. In the more severe cases large
quantities of protein, water, salt and cal-
cium may be rapidly lost from the circulat-
ing volume. These losses must be met early
with adequate amounts of whole blood,
plasma and crystalloid solutions. Blood
transfusions are particularly indicated dur-
ing the period of vascular collapse.
There seems to be a definite indication
for splanchnic block in the treatment of
acute pancreatitis4 13. Paravertebral pro-
caine block of the 6th through the 12th tho-
racic ganglia often affords considerable re-
lief of pain. If the diagnosis of pancreatitis
is made at operation the celiac ganglia may
be injected while tbe peritoneal cavity is
open. Theoretically at least, procaine block
of the sympathetic nerve supply to the pan-
creas may in some cases alleviate vasospasm
and in doing so may prevent the transition
from the edematous pancreatitis to pan-
creatic necrosis.
The use of penicillin as prophylaxis
against the occurence of bacterial peritonitis
is recommended.
The detection and treatment of diabetes
and hypocalcemia requires repeated clin-
ical and laboratory examinations.
There remains considerable controversy
concerning the indications for surgery in
acute pancreatitis. There are many surgeons
who feel that all cases should be explored
and drainage established. Cholecystotomv
has long been advocated as emergency treat-
ment. Certainly no surgical dictum can be
established for all cases of pancreatitis, but
there seems to be a recent trend toward con-
servatism or non-intervention. The estab-
lishment of a correct diagnosis is of para-
mount importance and all clinical and lab-
oratory methods should be utilized. It is
felt that surgical drainage per se has little
to offer the patient and that the additional
anesthetic and surgical load may lie more
than many of these severely ill patients can
stand.
In the light of recent investigation it
appears that surgery finds its most definite
indications after the acute process has sub-
sided, and in the treatment of the sequelae
of this disease.
REFERENCES
1. Fitz. R. H:: Acute Pancreatitis, Boston M. & S. J.
70:181-187; 70:205-207; 70:229-233, 1889.
2. Elman, Robert; Acute Pancreatitis, Surg., Gynec. &
Obst. 57:291-309, 1933.
3. Idem: Surgical Aspects of Acute Pancreatitis, J.A.M.A.
118:1265-1268, 1942.
4. Paxton, J R., and Payne, J. H. : Acute Pancreatitis,
Surg. Gynec. & Obst. 86:69-75, 1948.
5. Moynihan, Sir Berkeley: Acute Pancreatitis, Ann. Surg.
81:132-142, 1925.
6. Opie, E. L. : The Etiology of Acute Hemorrhagic
Pancreatitis, Bull. Johns Hopkins Hosp. 12:182, 1901.
7. Archibald, E. : The Experimental Production of Pan-
creatitis in Animals as the Result of the Resistence of
the Common Duct, Surg., Gynec. & Obst. 28:529-545, 1919.
8. Doubilet, Henry, and Mulholland, John H.: Recurrent
30
The Journal of the Medical Association of Georgia
Acute Pancreatitis; Observations on Etiology and Surgical
Treatment, Ann. Surg. 128:609-636, 1948.
9. Doubilet, Henry, and Mulholland. John H.: The Surgi-
cal Treatment of Pancreatitis, S. Clinic North America
29:339-359, 1949.
10. Ravdin, I. S., and Johnston, C. G. : The Etiology and
Pathogenesis of Acute Hemorrhagic Pancreatitis, Am. J. M.
Sc. 205:277-301, 1943.
11. Rich, A. R., and Duff, G. L. : Experimental and
Pathological Studies on the Pathogenesis of Acute Hemor-
rhagic Pancreatitis, Bull. Johns Hopkins Hosp. 58:212-259,
1936.
12. Popper, Hans L. , and Necheles. H. : Edema of the
Pancreas. Surg., Gynec. & Obst. 74:123-124, 1942.
13. Popper. Hans L.. Necheles, H., and Russel, Kemper:
Transition of Pancreatic Edema into Pancreatic Necrosis,
Surg., Gynec. & Obst. 87:79-82, 1948.
RIGHT THORACIC APPROACH IN
COMBINATION WITH LAPAROTOMY
FOR RESECTION OF CANCER OF THE
ESOPHAGUS AT THE LEVEL OF THE
ARCH OF THE AORTA
Richard King, M.D.
Atlanta
The real denouement in surgery of the
esophagus occurred in 1938, when Adams
and Phemister presented a case of resection
of the lower third of the esophagus and
cardia and reestablishment of continuity by
esophagogastrostomy.1 During the past six
years the feasibility of esophagogastrostomy
up to the apex of the thorax has been
demonstrated numerous times.4 ® 10 Recently
esophagogastrostomy has been extended to
the cervical region with success.2 0011 In
1946, Ivor Lewis of London, reported the
use of the right thoracic approach in com-
bination with laparotomy in two stages to
resect lesions in the middle third of the
thoracic esophagus.'
This report is concerned with a right
thoracic approach and laparotomy in one
stage. No originality in technic is claimed.
REPORT OF CASE
R. H. S., aged 58, was admitted to Crawford W. Long
Hospital May 10, 1949 with a chief complaint of dif-
ficulty in swallowing. The patient stated that he
was in good health until ten months prior to admis-
sion when he developed a choking sensation in his
manubrial region. He began having a feeling that
food was sticking in his throat at the level of the
suprasternal notch. The choking sensation persisted
and swallowing gradually became more difficult. About
five months ago he developed a dull aching pain sub-
sternally and posterially between his shoulder blades
and this pain was present at all times. Also about
this time he spit up a dark clot of blood, and about
four hours later he awakened with a terrible pain
substernally, followed in about ten minutes with a
hemorrhage of about a pint of blood. There was no
hematemesis subsequent to this episode. One week
later he consulted a physician near his home town
and an esophagoscopy was advised. This was done
and the biopsy proved to be benign. At first he began
having trouble with solid foods and as his difficulty
increased he began having trouble swallowing liquids.
As a consequence, he lost his appetite and about
fifteen pounds in weight. The patient became fatigued
very easily.
Past history and family history were essentially
negative. Physical examination: temperature 98.6 F.,
pulse rate 88, respiration 20, B.P. 150/90. The patient
was well developed, fairly well nourished, middle-aged
white male who was alert and cooperative. Head
and neck: negative. Heart: negative. Lungs: negative.
Abdomen: soft and no masses palpated. Rectal: pros-
tate enlarged 1 plus, slightly boggy, symmetrical, and
non-tender. Extremities: essentially negative. Diognosis:
carcinoma of the esophagus.
Laboratory work: WBC 7.600, polys 54 per cent,
lymphs 46 per cent; RBC 3,450,000, Hg. 11.3 grams.
Urinalysis: negative. Bleeding time: 3 3/4 minutes.
Coagulation time 3 minutes. NPN 30 milligrams per
cent. Electrocardiogram: normal.
Roentgenologic examination revealed a lesion at the
level of the arch of the aorta. (Fig. 1).
On May 11. 1949 a bronchoscopy was performed
under sodium pentothal anesthesia and this procedure
was entirely negative. Then, with an 8-45 scope, an
esophagoscopy was done. At the level of the arch of
the aorta there was found a granulating mass partially
surrounding the lumen of the esophagus which was
definitely decreased in diameter. A biopsy was taken
from the tumor and was sent to pathologic department
for examination. The pathologic diagnosis was pre-
invasive carcinoma of the esophagus. The patient was
given 1000 cc. of blood. Due to the full operative
schedule, the patient was discharged May 13, 1949,
to re-enter May 17, 1949 for resection of the esophagus.
On this admission the Hg. had increased to 12.7 grams.
The patient was given another 500 cc. of blood and
was operated upon May 20, 1949. On the morning
of operation a Levin tube was inserted to the level
of the suprasternal notch and the esophagus was
cleansed. The Levin tube was left in place.
Technic: Under endotrachael cyclopropane-ether
anesthesia, the patient was turned upon his left side
and the right chest and abdomen were prepared and
draped. An incision was made over the entire length
of the right sixth rib which was removed from the
neck of the rib to the costal cartilage. The pleural
cavity was then opened. In order to obtain more
exposure a small segment of the fifth rib was removed
posteriorly and a rib spreader was inserted. The tumor
was easily visualized and palpated and was located
behind and above the azygos vein. The azygos vein
was ligated and divided between ligatures. Then the
whole mediastinal pleura was opened exposing the
esophagus. The dissection was begun several centi-
meters below the tumor and after the esophagus had
been freed at this point an umbilical tape was passed
around it for traction. Then the tumor was gradually
freed by blunt and sharp dissection and, although it
was very close to the arch of the aorta, it was freed
at this point without too much difficulty. There was
only one node present and this later proved to be
negative. The dissection of the esophagus then pro-
ceded up to the thoracic inlet. Attention was then
directed to the lower half of the esophagus which
was freed of its attachments down to the diaphragm.
While the right chest cavity was still open, the
patient was slowly turned on his back and a left
upper rectus incision was made and the abdominal
cavity was opened. The stomach was exposed and
there was no evidence of any nodes along the lesser
January, 1950
31
Fig- 1. Pre-operative x-ray film of carcinoma of the
esophagus.
curvature or at any other point. Then the stomach
was freed of all of its attachments from the junction
with the esophagus down to the pylorus except the
right gastroepiploic artery and the right gastric artery;
however, the right gastric artery was ligated and
divided after two branches entered the stomach wall.
As I worked above through the chest incision and
pulled gently, my assistant shoved the stomach through
the hiatus which had not been enlarged. When it was
determined that the fundus of the stomach reached
or could be pulled to the apex of the chest with ease,
the abdominal incision was closed in layers. It was
unnecessary to mobilize the duodenum in order to
obtain adequate length of the stomach. The patient
was slowly turned on his left side again and his
esophagus was divided between forceps at its junction
with the stomach. The stomach was then closed with
two layers of catgut and reinforced with several
sutures of silk. The stomach was pulled up to the
apex of the chest and was sutured laterally to the
pleura so that it would remain in this position. The
greater curvature of the stomach occupied the old bed
of the esophagus and the lesser curvature was in a
lateral position. An L-shaped anastomosis4 was per-
formed between the stomach and the esophagus well
above the lesion with a first layer of catgut and a
second layer of interrupted silk sutures. Following
this, the anterior stomach wall was lapped over the
anastomosis and held in place by interrupted silk
sutures. The Levin tube was inserted into the stomach
at the time of the anastomosis. The right chest cavity
was thoroughly irrigated with normal saline and a
large catheter was placed in the posterior gutter and
was brought out through the chest wall posterolaterally
and connected to a water trap for drainage. The chest
incision was closed in layers. The patient was given
3,000 c'c. of blood while on the table and withstood
the procedure quite well.
Pathologic diagnosis of the specimen was squamous
Fig. 2. X-ray film showing esophagogastrostomy in the apex
of the right thorax.
cell carcinoma. Grade I.
The post-operative course was essentially uneventful.
He was given one ounce of milk every two hours and
the Levin tube was clamped fifteen minutes each
time. Penicillin, streptomycin, vitamins, and an ade-
quate amount of fluids were given. The Levin tube
and a thoracotomy tube were removed on the fifth
post-operative day. Now the patient was given liquids
orally and his diet was gradually increased to a soft
food on the eighth post-operative day. He was allowed
a regular diet on the tenth post-operative day. Barium
swallow on the dav of discharge revealed there was
no obstruction to the passage of barium through the
anastomosis into the stomach and duodenum. (Fig. 2).
Follow-up: On July 8, 1949, seven weeks after
operation, barium swallow was repeated and there
was no evidence of obstruction at the site of anastomosis
and no deformity of the gastric walls. The barium
emptied slowly through the pyloric canal into the
upper small bowel. The patient was feeling quite well
on this date and his only complaint was occasional
spitting up of food. This was solved by having the
patient remain an upright position for a length of time
after each meal. He returned to his work in September,
four months after the operation, and has continued
to work even though part time to date. The only
discouraging feature has been a lack of weight gain.
Physical examination in November, six months after
the operation, was negative.
Discussion
The whole thoracic esophagus can be re-
sected with less difficulty on the right side
due to the fact that only one structure, the
azygos vein, prevents complete esposure
after the mediastinal pleura has been
opened. When carcinoma of the esophagus
32
The Journal of the Medical Association of Georcia
is located at the level of the arch of the
aorta, it is far safer and easier to resect the
lesion under direct vision than it is through
a left approach where it is necessary to do
some of the dissection blindly and for this
reason it seems to he a better cancer opera-
tion. There are two variations from Lewis’
technic: 1. The procedure was done in one
stage. 2. The thorax was opened first to
determine operability of the lesion. Resec-
tability of the lesion is determined first in
order to avoid an unnecessary laparotomy
if the malignancy proves inoperable. For
lesions of the lower third of the esophagus,
the procedure has become very well stand-
ardized by resection through the left thorax.
The only objection to the right approach
using the technic described is in turning the
patient twice on the table which may result
in a fall in blood pressure. In the case de-
scribed, there was a drop in blood pressure
both times the patient was turned but the
blood pressure returned to the original
level shortly afterwards. The question of
adequate blood supply to the stomach
usually arises, and in this particular case
the right gastroepiploic artery was left in-
tact hut the right gastric artery was ligated
and divided after two branches entered the
pyloric region of the stomach. A successful
case has been reported in which both the
right gastroepiploic and right gastric arter-
ies were separated from the stomach down
to the entrance of one branch to the pyloric
end of the stomach. ' The right gastroepi-
ploic or the right gastric artery should afford
an adequate blood supply to the stomach hut
it seems unnecessary to divide both vessels
down to the first branch in any case. The
right crus of the diaphragm was not divided
and although there was a snug fit, the stom-
ach was not constricted by the crura.
Summary
A case of esophagogastric anastomosis in
the apex of the right thorax using the right
thoracic approach and laparotomy in one
stage for carcinoma at the level of the arch
of the aorta has been presented.
REFERENCES
1. Adams, W. K. , and Phemister, D. B. : Carcinoma of
the Lower Thoracic Esophagus: Report of a Successful
Resection and Esophagogastrostomy, J. Thoracic Surg. ,
7:621, 1938.
2. Brewer, Lyman A. : One Stage Resection of Carcinoma
of the Cervical Esophagus with Subpharyngeal Esophago-
gastrostomy, Ann. Surg. 130:8-20, 1949.
3. Clark, D. E. : Transthoracic Esophagogastrostomy for
Carcinoma of the Middle and Lower Thirds of the Esopha-
gus, Ann. Surg. 121:65-73 (Jan.) 1946.
4. DeBakey, M. E., and Ochsner, A.: Subtotal Esoph-
agectomy and Esophagogastrostomy for High Intrathoracic
Esophageal Lesions. Surgery, 23:935-951 (June) 1948.
5. Garlock, J. H. : Reestablishment of Esophagogastric
Continuity Following Resection of Esophagus for Carcinoma
of Middle Third, Surg., Gynec. & Obst. 78:23, 1944.
6. Garlock, J. H.: Resection of the Thoracic Esophagus
for Carcinoma Located Above the Arch of the Aorta, Surgery
24:1-8. 1948.
7. Lewis, Ivor: Surgical Treatment of Carcinoma of
Esophagus with Special Reference to New Operation for
Growths of Middle Third of Esophagus, Brit. J. Surg.
34:18-31 (July) 1946.
8. McManus, J. E. : Combined Left Abdominal and Right
Thoracic Approach of Resection of Esophageal Neoplasms,
Surgery 24:8-16 (July) 1948.
9. Nissen. R. : Cervical Esophagogastrostomy Following
Resection of Supra-aortic Carcinoma of the Esophagus,
Ann. Surg. 130:21.
10. Sweet, R. H. : Surgical Management of Carcinoma of
the Midthoracic Esophagus, New England J. Med. 233:1-7,
1945.
11. Sweet, R. H. : Carcinoma of the Superior Mediastinal
Segment of the Esophagus, Surgery, 24:929, 1948; Ann.
Surg. 127:757-758 (April) 1948.
A.M.A. OFFERS HEALTH EDUCATION
SERVICE TO SCHOOLS
The American Medical Association’s Bureau of
Healtli Education is cooperating with school health
education programs on a national scale by issuing a
monthly sheet of classroom discussion questions.
The sheet is to be used in connection with Hygeia,
the health magazine of the A.M.A. Questions are
limited to subjects of a scientific nature and are based
on authoritative information contained in articles ap-
pearing in the magazine.
The questions cover a wide range of health topics,
with emphasis on practical information which students
can use for daily living, and are aimed at helping
solve mental and emotional as well as physical health
problems.
NEW YORK RANKS FIRST IN
HOSPITAL FACILITIES FOR POLIO
The number of hospitals in the state of New York
admitting poliomyelitis patients for treatment is nearly
twice that in any other state, a nationwide survey of
6,276 American Medical Association registered hos-
pitals shows.
The survey was completed by the A.M.A.’s Council
on Medical Education and Hospitals at the request
of the National Foundation for Infantile Paralysis,
according to a report of the council in November 19
Journal of the American Medical Association.
Statistics for 1947 of the 1,243 hospitals which re-
ported that polio patients are accepted for treatment
reveal that 146 of these hospitals are in the state of
New York.
Texas ranked second with 76 hospitals admitting
polio patients for treatment, and Illinois third with 70
hospitals. Pennsylvania and California followed with
62 and 59, respectively.
On the basis of control, 181 of the 1,243 hospitals
are listed as federal hospitals, 294 under state, city
or county control, 688 as church or other non-profit
associations, and 80 as proprietary hospitals.
The Medical Association of Georgia will hold its
1950 annual session in Macon, April 18-21.
January, 1950
33
PRESIDENT’S PAGE
PUBLIC RELATIONS: GOOD AND BAD
Three thousand, six hundred and sixty-six
full-time press agents or public relations
men are employed by the United States
Government. According to a Bureau of the
Budget estimate, the cost to the taxpayer
for this large group of publicity agents is
more than $13,000,000 each year. Eighty-
nine of these are employed by the Federal
Security Agency. Although consideration
of the activities of the Federal Security
group is of the greatest interest to the
medical profession, it is also important to
consider the publicity program of the Fed-
eral Government as a whole.
No one can deny that the people of the
United States should be informed about the
activities and operations of the different
departments of their National Government.
No one can deny that this information can
best be prepared and released by men well
trained and skilled in publicity technics.
No one doubts that a large number of these
publicity agents are engaged in completely
legitimate fields of endeavor. No one who
has read releases from government agencies
in the past year can fail to realize that at
least some of their efforts are intended to
influence legislation or to boost adminis-
tration officials. The purely political nature
of some of the releases is so disgustingly
clear it is apparent that these agents may
be used in a manner dangerous to the free-
dom of the press and to the liberties of
American citizens. There can be little doubt
that Oscar Ewing has used press agents in
the employ of the Federal Security Agency
not only to promote compulsory health in-
surance but also to stimulate prejudices
against the medical profession as a body,
and also as individuals.
From your taxes paid to the Federal
Government it can be assumed that a sum
considerably in excess of $25.00 a year
is being used for purposes detrimental to
your happiness and welfare.
It is very difficult to understand how any
member of the medical profession who is
opposed to the socialization of medicine
can fail to assume his or her share of the
necessary cost of the A.M.A. program.
Enoch Callaway, M.D.
34
The Journal of the Medical Association of Georgia
THE JOURNAL
<IK Til K
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
January, 1950
MEDICAL DUES, 1950
First, all dues — meaning your county
society, state medical association and AMA
— should be paid to the secretary of your
county medical society.
If you do not know what your county
dues are, then make inquiry of your local
secretary. After having the information re-
garding county dues, add $10 for the Medi-
cal Association of Georgia and $25 for the
American Medical Association.
Do you get the AMA journal with your
annual dues? The answer is “no”. You
subscribe to The Journal of the American
Medical Association, as usual, and the cost
is $12.
All dues should he paid promptly to the
secretary of your county medical society.
A.M.A. MEMBERSHIP NOT COMPUL-
SORY FOR ENROLLMENT IN
LOCAL GROUPS
Dr. George F. Lull, Chicago, secretary
of the American Medical Association, in a
letter to secretaries of constituent state and
territorial medical associations, emphasized
that membership in the A.M.A. is not neces-
sary for membership in component societies.
The explanatory letter was sent in con-
nection with a notice to the state secretaries
that the House of Delegates of the A.M.A.
at its meeting in Washington, Dec. 8, had
voted to establish dues of $25 for 1950.
The transmittal of the dues will he through
the state organizations.
Members of the A.M.A. delinquent in
dues payment for one year are subject to
loss of membership. However, Dr. Lull in
his letter pointed out:
“Forfeiture of membership in the Ameri-
can Medical Association due to failure to
pay dues will have no effect on membership
in the component or constituent medical
societies unless the component or constitu-
ent societies amend their respective consti-
tutions and by-laws. It is, therefore, pos-
sible that a physician may he a member of
his component and constituent societies and
at the same time not a member of the Ameri-
can Medical Association.”
Exempted from dues payment are retired
members, those who are physically dis-
abled, interns and those for whom the pay-
ment of dues would constitute a financial
hardship. The decision will rest with the
component societies.
WHOOPING COUGH YIELDS TO
ANTIBIOTIC DRUG
Chloromycetin, an antibiotic drug, is a quick,
easy, safe and exceedingly effective treatment for
whooping cough, clinical study shows.
The drug was tested last fall in Bolivia during
a severe epidemic of whooping cough which
caused death rates twice as high as those in
North America.
Dr. Eugene H. Payne, Detroit, of Parke, Davis
and Company, the pharmaceutical house which
developed the drug, and a group of Bolivian doc-
tors report their findings in the current I Dec. 31)
Journal of the American Medical Association.
The Bolivian doctors are Miguel Levy, Chief
Medical Officer, Inter-American Corporate Serv-
ice of Public Health; Gaston Moscoso Zamora;
Moises Sejas Vilarroel and Edwardo Zabalaga
Canelas, all of Cochabamba.
Seven children ranging in age from three
months to eight years were treated with chloro-
mycetin. All were clear of fever on the second
day after the first dose of the drug was given,
according to the doctors.
Coughing fits generally were greatly decreased
on the second day, and in all seven patients dis-
appeared on the fourth or fifth day.
“Since the supply of chloramphenicol (chloro-
mycetin I was limited and there was such a large
number of patients, only those who were seriously
ill were treated with the drug,” the doctors say.
“Chloramphenicol was given in varying doses
depending on the weight of the child, and was
administered by mouth in most cases. Untoward
reactions to chloramphenicol appear to be negli-
gible.”
January, 1950
35
‘TIRED FEELING’ IS MAJOR AMERICAN
DISEASE
Call it ‘"that tired feeling,” if you wish, but
doctors have a lot of more complicated names—
chronic nervous exhaustion, psychoneurosis, be-
nign nervousness, functional disorder, anxiety
state, neurasthenia, constitutional inadequacy
and others.
It is a major American disease which affects
perhaps one out of every two persons seen by
doctors, according to a Stanford University
physician.
“It is generally believed that from one third
to two thirds of all patients who seek medical
help have as the most significant cause of ill
health an emotional or neurotic disturbance,”
Dr. Dwight L. Wilbur of Stanford University
School of Medicine, San Francisco, writes in the
December 24 Journal of the American Medical
Association.
“This disturbance may manifest itself in a
large variety of ways, but nervousness and fa-
tigue are among the commonest symptoms.”
Other symptoms are insomnia, irritability, in-
ability to relax, fatigue in the morning, mental
conflicts, difficulty in making decisions, and all
sorts of aches and pains, particularly disorders
of the heart and digestive system, he says.
The usual causes include an emotional problem
or some situation in the victim’s life, overwork
with inadequate rest and relaxation, and inade-
quate recovery emotionally from an infection,
according to Dr. Wilbur.
“There is not just a single level, but a wide
range to the limits in structure and function of
the normal person,” he explains. “Acute fatigue
or nervousness can be induced in any normal
person by lack of sleep and sufficient threat to
security; recovery generally is rapid with sleep
or removal of the threat. When these symptoms
are chronic the period of recovery will be longer,
even after the cause is removed.
"Improving or relieving the patient’s symp-
toms is an individual problem in each case. It
cannot be accomplished until the patient under-
stands the nature of his symptoms and accepts
it reasonably well.
“If the cause of the symptoms is merely the
stress of anxiety over a nonexisting organic di-
sease or the result of overwork, relief usuallv
can be obtained rapidly by simple reassurance
or by adequate rest or a vacation.
"If, however, the distress is from a more com-
plicated and less easily solved external cause, or
if it deeply involves one of the major emotions,
more detailed treatment and psychotherapy will
be necessary.”
ATTRIBUTE RELIEF FROM SHAKING
PALSY TO PSYCHOTHERAPY
Panparnit, a relatively new synthetic drug, has
not fulfilled expectations as a treatment for shak-
ing palsy, according to a group of doctors from
Columbia University College of Physicians and
Surgeons.
The drug, known as parpanit until recently,
showed promise in early tests of becoming a
superior treatment for the disease.
Favorable results in treating shaking palsy
victims with panparnit seem to be produced to
some extent by psychotherapy administered con-
currently with the drug, the doctors say in the
December 24 Journal of the American Medical
Association.
The doctors — Daniel Sciarra, Sidney Carter
and H. Houston Merritt — treated 43 patients for
various neurologic conditions with panparnit.
Twenty-eight of the 43 had shaking palsy. In
only one of the 28 could improvement be at-
tributed to panparnit, the doctors say.
Of the entire group of 43, three showed 'some
improvement. Thirty-seven had dizziness, nau-
sea, vomiting, drowsiness, weakness, or other
undesirable symptoms caused by the drug.
“It may be concluded that panparnit is not
more effective than drugs previously in general
use,” the doctors point out.
“Favorable results obtained by other investi-
gators probably were influenced by the intrinsic
fluctuations of the patient with chronic disease
and by the many psychotherapeutic factors that
are inherent in the clinical investigation of any
drug.”
WORRY
Two psychiatrists of the University of Cali-
fornia Medical School have been studying worry,
“taking the emotion apart,” to see what happens
when people become anxious and how anxiety
can be relieved.
Reporting in the November 1949 issue of
Archives of Neurology and Psychiatry, published
by the American Medical Association, Drs. Jur-
gen Ruesch and A. Rodney Prestwood of San
Francisco give their conclusions.
When a person’s body is stimulated to prepare
for action, an unusual condition of blood vessels,
muscles, and other parts occurs, the doctors say.
As the body is persistently stimulated to prepare
for action which cannot be made, the resulting
effects are felt by the person as anxiety and
tension.
Anxiety is contagious, the doctors found. No
matter how much the worriers try to suppress
and conceal their emotion, other people become
infected from small indications, such as tone of
voice and gestures, and start worrying, too.
Some people try to compensate for anxiety by
overindulgence in eating, smoking, or drinking,
the study shows. Others try to suppress their
worry by making an effort to conceal it. Others
try to establish a feeling of “belonging” by social
contacts, ranging from conversation about the
weather to group activities, such as those of
36
The Journal of the Medical Association of Georgia
clubs.
Still others react by attempting to control the
actions of friends and acquaintances, to dictate
to them.
None of these are mature or effective reactions,
the psychiatrists found.
Successful management of anxiety generated
in daily life seems possible only through discus-
sing and sharing the problem or situation with
other persons, the psychiatrists say.
“The successful management of anxiety gen-
erated in daily life seems possible only through
the process of sharing and communication,” the
article points out.
“The process of communication is essential for
healthy functioning so that people may combine
efforts to cooperate, complement, and increase
their ability to cope with surroundings.
“Alleviation of anxiety through personal con-
tact is the process which is basic to all interper-
sonal relations from babyhood to old age.
“The ability to communicate and hence to
share anxiety seems to constitute that process re-
sponsible for feelings of personal security of
the individual.”
The study was supported by a grant from the
U. S. Public Health Service, Division of Mental
Hygiene.
NAME OF HYGE1A, HEALTH MAGAZINE,
TO BE CHANGED TO TODAY’S HEALTH
A change in name to Today’s Health, effective
with the March 1950 issue, is announced in the
current (January) Hygeia, health magazine of
the American Medical Association.
The masthead of the January number also
carries for the first time the name of Dr. W. W.
Bauer, Chicago, as editor, succeeding Dr. Morris
Fishbein, Chicago. Dr. William Bolton, Chicago,
is the new associate editor, succeeding Dr. Bauer.
Ellwood Douglass will continue as managing
editor.
Hygeia was established by the American Medi-
cal Association in 1923. Written for the layman,
it has come to be one of the most widely quoted
health education periodicals in the United States.
There will be no change in fundamental policy
under the new editorship or new name.
Dr. Bauer received his M.D. degree from the
LTniversity of Pennsylvania in 1917. He served
as a Captain in the Army Medical Corps in
World War I. After two years of service in the
Milwaukee Health Department he became health
commissioner of Racine, Wis., in 1923, serving
until 1931.
He joined the American Medical Association
headquarters staff in 1932 as director of the
Bureau of Health Education.
ARE WE NEGLECTING SKIN TUMORS?
It would appear to some of us that we encoun-
ter numerous people, many of whom are patients,
who have skin tumors: hemangiomas, verrucae,
nevi, melanomas, small basal cell lesions, who are
unconcerned about them. This fact would seem
at first hand to be not unusual because all of us
have become more or less used to such a state of
affairs. The thought arises, however, that we
might be guilty of neglect. Perhaps such growths
might be referred to as ones of minor significance
which do not demand much attention from the
busy doctor. We might further agree that most
of these growths are relatively harmless. But
only a few days ago I saw one of the supposed
“harmless types” which will ultimately destroy
the patient’s life!
The management of skin tumors, therefore,
suddenly becomes one of considelable signifi-
cance, especially when one must die. Most skin
tumors, as we have said before, are minor lesions,
often obscured or hidden in some skin recess of
the body. They are frequently covered up by
the patient on account of vanity, and are seldom
painful unless irritated, infected or traumatized.
We must reiterate that most of those we see prob-
ably will never give rise to serious difficulty, but
there is no question about their neglect. Almost
-every week we see people with moles, heman-
giomas, and basal cell tumors who say that some
person had advised them to “let them alone”.
Such advice is not in accord with the modern
concept about cancer elimination or control. It
is dangerous advice to give! Every doctor has
seen the most innocent appearing skin tumor
revert to metastatic cancer and create impossible
problems by invading local tissues, ending with
prolonged disability and death of the victim.
I have frequently asked myself why this state
of neglect exists. Apparently the answer is sim-
ple. The patients are not urged and informed
enough to take action. Doctors are hesitant to
insist that some small mole be removed. It is
often such a small matter. It is also troublesome
to fix up a small surgical tray with its necessary
accoutrements to remove these growths. The
family physician seems to forget that there are
at least a dozen or more dermatologists within
whistling distance of his office wffio are all very
skillful at removing skin tumors. On the other
hand physicians may think these people should
be sent to the hospital for such surgery, and here
we reach a problem in which a small matter
becomes a large one. No one likes to go to a hos-
pital and pay $5.00 for a room and $10.00 for
operating room service. The doctor bill added
and the pathologic report all sum up to about
$40.00. Otherwise a small dressing tray, a few
sterile instruments, a bit of novocaine or a cau-
tery in the hands of a physician with experience
in minor surgery , and a good clean sanitary office
are all one needs to take any skin lesion off which
measures 2.5 x 1.5 cm. or thereabouts. If there
should appear to be deep fixation to subcutaneous
areas, or should one find nodes nearby, then the
January, 1950
37
problem becomes one for the general surgeon,
and the hospital is the better place for its removal.
One must be brave when he encourages “office
surgery” and must be prepared to bare his chest
to the cold wave of criticism. We have developed
and are continuing to produce a group of doctors
who conscientiously feel that the hospital is the
only place for surgery of any tyye. One would
hesitate to take issue with their conception of
surgical responsibility, yet the patient must pay
the bill and until hospitals are subsidized, then
doctors must help eliminate the high cost of medi-
cal care by doing the best they can under the
circumstances; and I still think most small soli-
tary skin tumors can be removed in the office.
Now let us turn to other generalities. Such
tumors, in contrast to what has been said, are
being studied by pathologists more than ever be-
fore in order to understand the general character
and cell derivation of many of them. Effort is
being continually made to develop better stains
for the cells, with the hope in mind that someone
can unravel some of the mysteries of cellular po-
tentials so that some knowledge might be gained
as to why some tumors are very malignant and
others entirely benign. Why does one rapidly
metastasize while a similar one does not? We
also need to know more about how and why
malignancies metastasize. We know that some
spread by the blood stream, others by the lym-
phatics, while still others spread by continuity
of tissue. It is also felt that malignant cells are
transported by phagocytes. When these mysteries
are clearly unfolded, then prevention and de-
struction will be enhanced, to some extent any-
way.
To emphasize the common occurrence of skin
tumors, and to further call attention to their im-
portance, we recently reviewed our own material,
and were amazed to find that out of a total of
192 tumors of all varieties encountered in 12
months, 42 or more were skin types, such as
epitheliomas, hemangiomas, melanomas and
metastatic varieties. In several instances we could
not clearly classify them. We do not know how
many have invaded other organs.
The management of skin tumors will be briefly
touched upon here. It would seem that the con-
census of opinion is that surgical removal is the
best approach and wide and deep incision is best.
Irradiation and local cautery will destroy epi-
theliomas of a superfcial character, often graded
as grade 1; however, Cogniaux of the Belgian
Society of Surgery states that 8 per cent of those
tumors are fatal. In tumors that have infiltrated,
or those that have received radiation and re-
lapsed, the mortality is about 60 per cent. Those
growths which appear refractory to radiation
must be treated surgically. Electrosurgery with
electrocoagulation seems to be a highly recom-
mended surgical procedure. Nevocarcinomas and
sarcomas should always be surgically evicted.
Surgery and radiation combined also make a fine
therapeutic combination provided of course that
metastasis has not occurred.
One of the most common skin tumors is the
wart or varruca, which is very frequently en-
countered on the plantar surfaces. These lesions
give one a miserable existence at times. They
too can be managed. Carbon dioxide snow is
curative, but one should know the technic of its
application. All dermatologists are acquainted
with it. Silver nitrate applied by pressure for
15 minutes — five or ten weekly treatments — will
suffice. Podophyllin has also been tried with
good effect. Results are also obtained with tri-
choloroacetic acid applications. Electrosurgical
removal will delete them nicely and cure 75-90
per cent of the warts. Roentgen therapy is an old
stand-by in expert hands. Suffice to say, then,
that there is little reason why anyone should
suffer with verrucae, and a harmless verruca is
one that has been removed thoroughly.
Therefore, the general idea in mind is to urge
that we give more and more attention to skin
lesions. Let us resolve not to be too busy to
remove those tumors with the thought in mind
that every one we leave can be a dangerous source
of cancer. We should also resolve not to depend
upon your clinical judgment as to what consti-
tuted a benign skin lesion or a malignant one, for
by following this procedure we are treading on
thin ice. Every skin tumor should be subjected
to histologic evaluation regardless of one’s clin-
ical or gross impression, and we are certain that
when they are pathologically reviewed many will
be surprised to find that what they had thought
was innocent was actually malignant.
All that we here say and here recommend is in
line with all that is promoted in the field of
cancer control and prevention. One of the best
ways to control cancer and to cure cancer is to
unhesitatingly go after every suspicious lesion
with every possible aid at our command. A
cancerous area thoroughly removed is the only
dead cancer that we know!
Jack Norris, M.D.
PORTRAIT OF DR. FISCHER UNVEILED AT
THE CRAWFORD LONG HOSPITAL
On November 27, 1949 an oil portrait of Dr. Luther
C. Fischer was unveiled at the Crawford W. Long
Memorial Hospital, the gift of the medical staff and
nurses of the hospital, and the administrative personnel.
The very fine likeness of Dr. Fischer, three-quarters
length, was painted by the Atlanta artist, Milner
Benedict, who has made good portraits of several
prominent Atlantians.
The presentation was made by Dr. Edgar H. Greene
for the medical staff and Mrs. Macie Stephens for
the nurses. Dr. Wadley Glenn accepted the portrait
on behalf of the hospital. The unveiling was done
by Miss Frances Glenn, daughter of Dr. and Mrs.
Wadley Glenn, and Miss Laura Hill Boland, daughter
of Dr. and Mrs. Joseph Boland. Dr. Frank Boland
presided. Tea was served to the 300 guests present.
The portrait will be hung in the fourtain room of
the hospital. FRANK K. BOLAND, M.D.
38
The Journal of the Medical Association of Georcia
GEORGIA DEPARTMENT OF PUBLIC HEALTH
THE PREVENTION OF CONGENITAL
SYPHILIS
Rudolph W. Jones. Jr.. M.D.
Atlanta
Despite the widespread use of penicillin in the
treatment of syphilis in pregnancy, a substantial
number of children with congenital syphilis are
born each year in Georgia. During the past two
and one-half years, 1,843 new cases of congenital
syphilis were discovered in this State.1 The num-
ber of children in this group less than one year
ago has decreased from 17 per cent in 1947 to
approximately 8 per cent in 1949. Although the
incidence of children horn with congenital
syphilis will probably continue to fall, the per-
sistence of a significant number of children born
each year with this infection necessitates a con-
sideration of present day methods of prevention,
diagnosis and treatment.
Relation of Outcome of Pregnancy to the Dura-
tion of Syphilis in the Mother. The duration of
the maternal syphilitic infection has an appre-
ciable influence on the transmission of the disease
during pregnancy. Although women with
syphilis of ten to fifteen years' duration have
been known to deliver syphilitic infants, the in-
cidence of fetal infection is greatest among pa-
tients with early syphilis. Ninety-five per cent of
the women who delivered syphilitic infants in
this hospital were found to have had their infec-
tion less than five years. Since untreated pri-
mary or secondary syphilis during pregnancy
nearly always results in infected infants, these
women should be treated promptly and ade-
quately.
Essentials of Prenatal Care in the Prevention
of Congenital Syphilis. The necessity for sero-
logic tests early in pregnancy has been firmly
established. Syphilis is often acquired, however,
during the late stages of pregnancy, at which
time the primary and secondary manifestations
of the d isease are frequently suppressed. In
order to detect the infection in these patients,
repeated serologic tests should be taken during
the last trimester of pregnancy and at the time
of delivery. This is particularly important
among groups of patients having a high incidence
of the disease.
The need for repeating the serologic test in
the last months of pregnancy is demonstrated by
the following case history:
A th ree-month-old white male infant was re-
ferred to us in March 1949 with the diagnosis
From the Clinic for Genitoinfectious Diseases. Grady
Memorial Hospital, Emery University School of Medicine,
and the Georgia Department of Public Health.
of congenital syphilis. The infant showed a
diffuse skin rash, snuffles, roentgenographic evi-
dence of osseous syphilis and a high titer Kahn
reaction. Questioning of the 17-year-old mother
revealed that she apparently had a negative
serologic test for syphilis during the first tri-
mester of pregnancy. No serologic tests were
taken later in pregnancy or at the time of deliv-
ery. The father had developed a penile lesion in
1947 prior to marriage and had received two
injections, presumably of penicillin, with rapid
healing of the lesion. He was never informed
that he had syphilis and no serologic tests were
taken. Shortly after his marriage he developed
a recurrent penile lesion, which again healed
following a single injection of penicillin. At the
time the infant was found to have syphiis, exam-
ination of the parents revealed early latent in-
fection in the mother and a recurrent secondary
lesion, containing T. pallidum, in the father. The
father apparently had had early syphilis, which
had been inadequately treated on two occasions
and had recurred, infecting his wife late in her
pregnancy.
From this history it is evident that a single
serologic test for syphilis early in pregnancy is
not always adequate in preventing congenital
syphilis. Unfortunately, many patients do not
have even a single test during gestation, despite a
law in Georgia requiring that a serologic test
for syphilis be taken in every pregnant woman.
This is partly due to oversight on the part of
physicians and also to the fact that many of the
patients are cared for and delivered by mid-
wives.
Relation of Therapy to Outcome of Syphilis in
Pregnancy. Penicillin has now become the treat-
ment of choice for syphilis during pregnancy
and has supplanted almost entirely the use of
arsenical therapy. Penicillin has the advantage
in that one course of treatment not only protects
the fetus, hut also constitutes complete treatment
for the mother. It is also of value when admin-
istered in the late periods of gestation. The
minimal effective total dosage of penicillin in the
treatment of syphilis in pregnancy has been found
to be 2,400,000 units given in a period of not
less than seven days.2 Most authorities, how-
ever, now recommend at least 4,800,000 units
administered over a 10-day period. This may be
given in either aqueous solution of crystalline
penicillin in equally divided doses every three
hours, or by injection of 600,000 units of pro-
caine penicillin daily or three times a week.
Following penicillin therapy, these patients
should be observed very closely and serologic
tests should be taken every month. If there is a
definite rise in serologic titer or if clinical evi-
January, 1950
39
dence of syphilis re-appears, retreatment is indi-
cated.
Should Every Pregnant Woman with History
of Previous Treatment for Syphilis be Retreated?
Conservative opinion holds that all women with
syphilis should be retreated during each preg-
nancy. Several investigators, however, have
shown that retreatment can be safely withheld
during pregnancy in patients who have had pre-
vious therapy. The decision as to which patients
need not be retreated is often difficult. The height
of the serologic titer cannot be depended upon
entirely to determine the activity of the infection,
since a high titer may occur in patients having
seroresistance, while a recent or active infection
is not excluded by a low titer.
Therapy during pregnancy can be omitted
only in those patients in whom careful evaluation
indicates inactivity of the syphilitic infection.
Since frequent clinical observations and quanti-
tative serologic tests for syphilis to determine the
activity of the infection are not always possible,
it is probably best to retreat all syphilitic women
having positive serologic reactions during preg-
nancy.
Recognition of Infantile Congenital Syphilis.
Since all pregnant women with syphilis may
deliver syphilitic children, careful observation of
the newborn infant should be made for at least
six months. Infants with syphilis may not ex-
hibit obvious manifestations of the disease and
may even show a negative serologic test in the
neonatal period. Conversely, infants with posi-
tive serologic tests may not have a syphilitic in-
fection, since reacting substances 1 reagin ) may
be carried over from the maternal circulation to
the child. Ingraham1 reported that 40 per cent
of a group of nonsyphilitic infants had positive
serologic tests at birth, while only 7 per cent of
those with a positive serologic reaction had
syphilis. Thus, the recognition of congenital
syphilis in the newborn may be difficult. Fre-
quent clinical observations, repeated serologic
tests for syphilis, and roentgenographic exami-
nation of the long bones are all necessary for
early detection of the disease in the neonatal
period. Practically all cases of congenital syph-
ilis will be diagnosed if observation is made for
three to six months. The diagnosis of congenital
syphilis depends upon the demonstration of
(1) typical manifestations, such as skin lesions,
anal condyloma, snuffles, or pseudoparalysis;
(2) serologic tests for syphilis with a high titer
or rising titer; and (3) roentgenographic evi-
dence of syphilitic osteochondritis of the long
bones. When skin and mucosal lesions are pres-
ent, every effort should be made to demonstrate
T. pallidum by darkfield examination.
Penicillin Therapy of Infantile Congenital
Syphilis. With the introduction of penicillin, the
treatment of infantile congenital syphilis has now
become relatively simple. The total dosage of
crystalline penicillin for the treatment of infants
with syphilis should be not less than 100,000 units
per pound of body weight. This is usually admin-
istered in aqueous solution in equally divided
doses every 3 hours for 10 days.4 Although pro-
caine penicillin has not yet been completely
evaluated in the treatment of this condition, it
appears to be as effective as the aqueous solution
of the crystalline product. The daily injection
of 150,000 units of procaine penicillin for 8 to 10
doses should be adequate therapy for syphilitic
children under one year of age. Larger doses
should be used in older children, depending on
their weight. Since many of the infants w ith
congenital syphilis are premature and malnour-
ished, ambulatory treatment is often not advis-
able and hospitalization is indicated.
Post-treatment observation for infants with
congenital syphilis is similar to that in adults
with early syphilis. These children should not be
dismissed until the serologic tests and spinal
fluid have been demonstrated to be negative for
at least two years and preferably five years fol-
lowing treatment.
Summary
The finding of a significant number of new
cases of congenital syphilis in Georgia during
the past two and one-half years indicates the
continued prevalence of this disease. Increased
attention should be given to the prevention of
this condition, with particular emphasis on the
diagnosis and treatment of syphilis in pregnancy.
Serologic tests for syphilis should be obtained
on every pregnant woman at the initial prenatal
visit and during the last trimester. Penicillin
therapy should be given during pregnancy when-
ever there is any doubt as to the activity of the
syphilitic infection. All infants born of syph-
ilitic parents should have repeated serologic tests
for at least six months after delivery to rule out
the possibility of syphilitic infection.
BIBLIOGRAPHY
1. Special Report, Central Statistical Unit, Georgia De-
partment of Public Health, 1949,
2. Cole, H. N., et al: Penicillin in Treatment of Syphilis
in Pregnancy, Ven. Dis. Inform. 30:95 (April) 1949.
3. Ingraham, N. R., Jr.: Prenatal Management of Syphilis
with Special Reference to Penicillin Therapy, M. Clin.
North America 32:1647 (Nov.) 1948.
4. The Status of Penicillin in the Treatment of Syphilis:
Syphilis Study Section, National Institute of Health, J. A.
M. A. 136:873 (March 27) 1948.
NEWS ITEMS
Dr. Walter M. Bartlett, Atlanta, Veterans' Admin-
istration Southeastern Area Section chief of internal
medicine, was recently a principal speaker at a two-
day VA seminar on newest advances of internal medi-
cine in Tuscaloosa, Ala. Dr. Bartlett described a study
of cases incorrectly diagnosed as congestive heart
failure. He urged physicians to make an effort at
other treatment where illness believed to he congestive
heart trouble does not respond to usual treatment.
Staff members of VA hospitals over the Southeast at-
tended sessions, held at the Tuscaloosa VA Hospital.
Delegates were told by medical specialists that peptic
ulcers were best treated by rest and diet, despite
recent claims for new drugs and surgery.
40
The Journal of the Medical Association of Georgia
Dr. Helen Bellliouse, Atlanta, of the Georgia De-
partment of Public Health, recently addressed the
public health nurses of the Richmond County Health
Department in Augusta. She spoke on “Congenital
Syphilis.”
* * *
The Bibb County Medical Society held its annual
business meeting and election of 1950 officers at the
State Health Department Building. 811 Hemlock Street.
M aeon, December 6. The following officers for 1950
were elected: Dr. C. H. Richardson, Jr.. Macon, presi-
dent; Dr. R. W. Edenfield. president-elect; John I.
Hall, vice-president; Henry H. Tift, secretary-treasurer;
Drs. J. D. Applewhite and J. B. Kay, delegates; Drs.
C. N. Wasden and W. W. Baxley, alternate delegates.
* * *
Dr. Tully T. Blalock, Atlanta, was recently appointed
as a member of the Hospital Advisory Council to the
State Board of Health. Announcement was made by
Governor Herman E. Talmadge. This council will con-
sult with the state agency in carrying out the $70,000,-
000 program for building and equipping hospitals and
health centers in Georgia.
* * *
Dr. William S. Boyd, well-known Augusta physician,
has been named as a consultant from Georgia for the
Communicable Disease center of the U. S. Public
Health service. Dr. Boyd is one of 73 authorities from
21 states, Puerto Rico, Panama, and the District of
Columbia, who have been named to serve as consultants.
These appointments were announced by Dr. R. A.
Vonderlehr. medical director of the U. S. Public
Health Service Communicable Disease Center in
Atlanta.
* * *
The Bulloch County Health Department, Statesboro,
set a goal of 16,000 tests for the YD-TB drive held in
Statesboro and Bulloch County November 16-30. Dr.
V . D. Lundquist, Bulloch county health commissioner,
pointed out that it took only a few minutes to get a
blood test and x-ray. The State health officials stated
that 400 persons could be tested every hour.
* * *
Dr. Harley E. Cluxton. Savannah, was recently
awarded a master of science degree in medicine by the
1 niversity of Minnesota Medical School, Minneapolis,
Minn., and the Mayo Clinic, Rochester, Minn. This
honor came as the result of his research work on
patients with Addison's disease. Among the substances
uced in his study was the new hormone Cortisone
(Compound E) which later Dr. Philip Hench and his
colleagues found to be so beneficial in the treatment
of rheumatoid arthritis. Dr. Cluxton graduated from
Johns Hopkins University School of Medicine, Balti-
more. Md„ in 1941. He did special work in pathology
at ^ anderbilt University School of Medicine, Nashville,
Tenn., in 1939 and also special work in internal medi-
cine at Harvard Medical School, Boston. Mass., in
1940. He interned at the Baltimore City Hospitals.
Following the completion of his internship, he entered
Mayo Clinic as a fellow in internal medicine and
remained there until 1944 at which time he entered
the armed services. Following the completion of his
Medical Field Service course at Carlisle, Pa., he was
stationed at the Army and Navy General Hospital,
Hot Springs, Ark., where for one year he was in the
rheumatic disease section and was for two vears chief
of the general medicine section. Major Cluxton re-
ceived the Unit Citation award and also the Army
Commendation Ribbon for meritorious service. After
completing his tour of duty in the Army, in July 1947,
he went back to Mayo Clinic where he remained until
he returned to Savannah to open his office for the
practice of internal medicine in association with his
twin brother. Dr. Hayes Cluxton.
* * *
Dr. A. T. Coleman, Dublin physician and member
of the Georgia Senate, has been named to the advisory
Council to the State Board of Health as provided
under the provisions of the Hill-Burton Act for the
construction of hospitals with federal, state and local
funds. The appointment was made by Governor Her-
man Talmadge.
* * *
The Bibb County Medical Society held its meeting
at the State Health Department Building, Macon,
January 3. Important business meeting. Dr. Henry
H. Tift, secretary.
* * *
Dr. A. M. Deal and his wife. Dr. Helen Read Deal,
Statesboro, announce the opening of their offices for
the practice of medicine in Statesboro. Dr. A. M.
Deal graduated from the University of Georgia School
of Medicine, Augusta, in 1939. Dr. Helen Read Deal
graduated from New York University College of
Medicine, New York City, in 1940. Both interned at
Jersey City Medical Center and the Margaret Hague
Maternity Hospital.
* * *
Dr. George B. Dowling, of Atlanta, medical director
and assistant manager of the Southeastern division area
of the American Red Cross, recently spoke at the
regular meeting of the hospital staff of City-County
Hospital, LaGrange. Dr. Dowling gave a summary
of the magnitude of the Red Cross blood program
on a national scale, and urged close cooperation among
all those interested in its success. He is responsible
for the complete health program of the Red Cross,
which includes the blood program.
* * *
Dr. W. M. Dykes, Whigham, 84-year-old physician
who is still answering all calls. The venerable doctor
is unable to get a younger physician to come to
Whigham to “share the load.” He is the only doctor
between Cairo and Thomasville. Dr. Dykes began his
career some 58 years ago in what was then known as
Greenwood Village, northwest Atlanta, and traveled
horseback and in a two-wdieel cart through sections
of what is .now Atlanta. He and Mrs. Dykes recently
celebrated their sixtieth wedding anniversary with their
nine children. Congratulations to Dr. and Mrs. Dykes.
* * *
Dr. W. G. Elliott, Cuthbert, recently completed a
course in electrocardiography at Tulane University of
Louisiana School of Medicine, graduate school, in New
Orleans, La.
* * *
Dr. J. Rufus Evans, Decatur. DeKalb County health
commissioner, retired January 1 after 25 years’ service.
He will be succeeded by Dr. T. O. Vinson, Griffin,
who has served as public health officer of Griffin
and Spalding County health department for 12 years.
Dr. Vinson is largely responsible for the high rating
of the Health Department, and it is recognized as one
of the best and most efficient in Georgia. Dr. Evans’
retirement will come just after the DeKalb depart-
ment of public health moves into its new building on
Herring Street, Decatur. “The building, with its
added facilities, is the fulfillment of a dream for me,”
Dr. Evans said. He will practice medicine in Stone
Mountain, taking up where he left off 25 years ago.
* * *
The First District Medical Society held its regular
fall meeting at the Country Club, Statesboro. December
I. The meeting was called to order by Dr. W. O.
Bedingfield, Savannah, president. Scientific program:
"Surgery of the Sympathetic Nervous Svstem.” Dr.
A. M. Deal, Statesboro- discussion: Drs. Robert
Gottschalk, and Hayes Cluxton, both of Savannah;
“Today’s Indication for Cesarean Section.” Dr. M. M.
Schneider, Savannah; discussions: Drs. David Robin-
son, Savannah, Cleveland Thompson, Millen and John
Mooney, Jr., Statesboro; “General Principles of Al-
lergy”, Dr. E. R. Cook, Savannah; discussion: Dr.
Lawrence Lee, Jr., Savannah. Minutes of the last
meeting read and approved. Dr. Lee Howard, Sr., Savan-
January, 1950
41
nah, chairman of nominating committee, pre-ented the
following officers for 1950: Dr. Bird Daniel, Statesboro,
president ; Dr. Samuel F. Rosen, Savannah, president-
elect; Dr. William H. Fulmer, Savannah, secretary-
treasurer. Election was by unanimous consent. Banquet
at the Statesboro Country Club followed the business
meeting. Dr. William H. Fulmer, secretary-treasurer.
* * *
The Fulton County Medical Society held its dinner
meeting at the Academy of Medicine, Atlanta, December
1. Scientific meeting: Dr. W. M. Moncrief, moderator.
“Pre-Sanatorium Care of the Tuberculosis Patient”,
Dr. A. Worth Hobby; “Acute Suppurative Mesenteric
Lymphadenitis with Peritonitis”, Dr. Joseph C. Read.
Nomination of officers. Dr. A. Worth Hobby, secretary.
* * *
Dr. Daniel C. Elkins, Emory LIniversity Hospital,
Emory University, was recently elected president of the
Society of Medical Consultants in World War II at
the meeting held in Washington, D. C.
* * *
The Georgia Baptist Hospital medical staff dinner
meeting was held at the hospital in Atlanta, December
20. Dr. Lester Brown, chairman of clinico-pathologic
committee, announced the topic for discussion: “Late
Developments in the Treatment of Leukemia”. Discus-
sion was led by Drs. Milton Freedman and Harold W.
Adams. Dr. J. C. Blalock, secretary.
* * *
The Georgia Society of Ophthalmology and Otolaryn-
gology will hold its annual meeting at the General
Oglethorpe Hotel in Savannah, March 3-4, 1950.
Members and guests are invited to make their reser-
vations directly with the hotel. Registration fee for
the lectures is $20.
The distinguished lecturers and their subjects are:
Dr. Bayard T. Horton, Rochester, Minnesota, “Treat-
ment of the Dizzy Patient” and “Headaches — Common
Varieties and Their Treatment”; Dr. John M. Converse,
New York City, “Treatment of Acute Maxillofacial
Trauma and Rhinoplasty”; Dr. Mercer G. Lynch,
New Orleans, La., “Carcinoma of the Larynx and
Methods of Approach including Lynch Suspension”
and “Radical External Sinus Operations”; Dr. Meyer
Wiener, Coronado, Calif., “Medical Ophthalmology”
and “Surgical Ophthalmology”; Dr. Milton L. Berliner,
New York City, “Slit Lamp Microscopy”; Dr. Wendell
L. Hughes, Hempstead, N. Y., “Lid Reconstruction”
and “Personal Procedures in Ophthalmology.”
* * *
The Georgia Heart Association, Inc., in cooperation
with the State Health Department and the Upson
County Medical Society, presented a symposium on
cardiovascular diseases at the Upson Hotel. Thomaston,
December 13. Program: “Diagnosis and Management
of the Cardiac Arrythmias”, Dr. J. Gordon Barrow,
Atlanta; “A Discussion of Hypertension and Congestive
Heart Failure”, Dr. Walter Cargill, Atlanta; “A Dis-
cussion of Coronary Artery Disease and the Use of
Anticoagulant Therapy”, Dr. Charles F. Stone, Jr.,
Atlanta; “Congenital Heart Disease: A Diagnosis of
the Surgically Correctable Types”, Dr. Emmett Bran-
non, Rome. This was the first of a series of symposiums,
on cardiovascular diseases to be held throughout the
State under the sponsorship of the Georgia Heart
Association, in cooperation with the State Health
Department.
* * *
The Georgia Medical Society held its anniversary
meeting at 612 Drayton Street, Savannah, December 13.
Election of officers and final reports. The following
officers were elected for 1950: Dr. H. M. Kandel,
president; Dr. L. B. Dunn, president-elect; Dr. L. M.
Freedman, vice-president; Dr. Sam Youngblood, Jr.,
secretary-treasurer; Drs. John L. Elliott, Ruskin King,
and Ralph O. Bowden, delegates.
Dr. Harriet Gillette, Atlanta, recently addressed the
newly-organized Augusta chapter of the Georgia Society
for Cerebral Palsy. The meeting was held at the
Dugas auditorium of the University of Georgia School
of Medicine, Augusta. Dr. Gillette defined palsy as
an abnormal movement of muscle. Speaking specifically
of cerebral palsy. Dr. Gillette defined it as any abnormal
condition which occurs within the cranial vault and
which causes abnormal movement. Georgia is esti-
mated to have 4.000 children thus handicapped.
* * *
Dr. C. W. Harwell, Cordele, Crisp County Commis-
sioner of Health, has been appointed to a fellowship
in the American Public Health Association. This fel-
lowship is granted to those who have served efficiently
over a period of years with the American Public
Health Association. A fellowship certificate has been
awarded to Dr. Harwell.
* * *
The Georgia Medical Society held its regular meet-
ing at 612 Drayton Street, Savannah, January 10.
Program: “Rheumatic Fever”, Col. Charles Leedham,
Augusta, chief of medicine, Oliver General Hospital.
Discussion of change to meeting time and discussion
of change from one to two meetings per month. Dr.
Sam Youngblood, Jr., secretary.
* * *
Dr. M. M. Head, Zebulon, and Dr. Thomas W. Good-
win, Augusta, were recently appointed by Governor
Herman Talmadge as members of the State Board
of Health. Dr. Head will represent the Fourth District
and Dr. Goodwin the Tenth District. Dr. Head suc-
ceeds Dr. James A. Corry of Barnesville, and Dr. Good-
win succeeds Dr. D. N. Thompson of Elberton.
* * *
Dr. T. C. Davison, Atlanta, recently attended the
meeting of the Southern Surgical Association held in
Hot Springs, Va.
* * *
Dr. James M. Hicks, Brunswick, has been elected
chief of the City Hospital medical staff, Brunswick.
He succeeds Dr. J. B. Avera, who becomes a member
of the executive board. Dr. T. V. Willis was named
assistant chief of staff and Dr. J. Phillip Muse, secre-
tary. The medical staff sets up rules for physicians
using the hospital and must approve any change in
the rules. The purchase of a new piece of equipment
for the hospital was announced. It is a Leitz photo-
electric colorimeter, a machine which enables as
many as 36 different blood tests to be made at the
hospital.
* * *
Dr. William A. Hopkins, Emory University, and Dr.
William G. Whitaker, Jr., Atlanta, have successfully
completed the American Board of General Surgery
examinations held at Baltimore, Md. Congratulations!
* * *
Dr. Charles G. Jordan, Eatonton, announces the
addition of Dr. Hugh Crawford to the staff of
Jordan’s Hospital, Eatonton. Dr. Crawford graduated
from Emory University School of Medicine, Atlanta,
in 1941. He interned at Grady Memorial Hospital,
Atlanta, and entered the U. S. Navy and saw service
aboard a destroyer both in the Atlantic and Pacific
theaters of operation. After three and a half years
in the Navy medical corps he again served for a
year and a half in surgery at Grady Memorial Hos-
pital, Atlanta, and two and a half years at Winston-
Salem, N. C. Dr. Crawford will limit his practice to
surgery.
* * *
Dr. A. Worthy Hobby, Atlanta, presented a paper
entitled “Cough” at the third annual clinical session
of the American Medical Association, held in Washing-
ton, D. C., December 6-9.
12
The Journal of the Medical Association of Georcia
Dr. G. Lombard Kelly, Augusta, dean of the Univer-
sity of Georgia School of Medicine, recently attended
the Association of American Medical College's annual
convention held at the Broadmoor Hotel, Colorado
Springs, Colo.
* * *
Dr. J. M. Kenyon, Richland physician and surgeon,
celebrated his eightieth birthday, November 27. Dr.
Kenyon received congratulations from friends every-
where for his long and useful life, with many good
wishes for future health and happiness. Dr. Kenyon
graduated from Vanderbilt University School of Medi-
cine, Nashville, Tenn., in 1893. During his 57 years
of practice. Dr. Kenyon has attended courses at Tulane
and other universities which kept him abreast with
the latest medical treatments and remedies. He has
been a constant student throughout the years, and
holds an outstanding record as a physician and citiaen.
* * *
Dr. Steve P. Kenyon. Dawson physician and chair-
man of the section on general practice of the Southern
Medical Association, presented a paper before the
general practice session at the Cincinnati meeting
November 15. He spoke on “The Doctor’s Obligation
to His People.” He called upon the medical profes-
sion for a campaign “to curb and if possible control
the vicious and oftimes false publicity about drugs
through efforts of the press to glamourize them. Many
feature writers are daily glamourizing some new wonder
drug and stampeding the American people to rush to
their druggist or physician to obtain the lastest
medical remedy,” he declared. “American medicine is at
the cross-roads of uncertainty, with loss of liberty
and socialization on the left; and ' on the right, the
type of free medicine as we now know it today,” he
said. Dr. Kenyon outlined a series of what he called
the points necessary to be achieved “if we are to
survive as democratic doctors in a democratic country.”
He said the profession should maintain high ethical
standards, religious faith, responsibilities of citizenship,
and a personal relationship between the physician and
his patient.
* * *
Dr. Spencer A. Kirkland, Atlanta urologist, was
guest speaker at the Upson County Medical Society
meeting held at the Upson Hotel, Thomaston, December
6. He spoke on “Neoplasms of the Bladder", illustrated
with lantern slides.
* * *
The Macon Hospital. Macon, recently named some
60-odd active and associate staff members, as well as
the 1950 five-man executive committee. Dr. C. L.
Ridley, Sr., hospital superintendent, who announced
the new staff, said it is two or three men larger
than 1949. Dr. C. N. Wasden is chairman of the
executive committee, succeeding Dr. Ralph G. Newton,
who stepped down after 16 years on the body. Other
members are Drs. A. M. Phillips, M. B. Hatcher, Sam
Patton and Charles Boswell. A consultant staff con-
sisting of 19 doctors was further named along with a
four-man honorary staff. The honorary staff consists
of Drs. R. Frank Cary, A. R. Rozar, T. E. Rogers,
and Ben Bashinski. Dr. Rozar accepted the position
prior to his death, December 11. Dr. Ridley said
the hospital lost four members in 1949 through death,
and he named them as: Drs. Olin H. Weaver, C. L.
Penington. J. P. Holmes and A. R. Rozar.
* * *
Dr. M. H. Mason, who has been associated with
the staff of Stabler Clinic, Inc., Greenville, Ala., an-
nounces his association with the Joan Glancy Memo-
rial Hospital. Duluth, January 1. as head of the medical
staff. Dr. Mason graduated from the LIniversity of
Georgia School of Medicine, Augusta, and served his
internship at the U. S. Naval Hospital, Corpus Christi,
Texas. Following his internship he spent two years
as medical officer aboard ship in the Pacific, at Mare
Island Naval Hospital, and the Naval Training Center,
San Diego, Calif.
* * *
Dr. Harold W. Muecke, Waycross pediatrician, per-
formed an unusual operation on an Rh negative baby,
which saved the child from certain death and made
it normal and healthy. The replacement transfusion
was the first at the Ware County Hospital, Waycross,
and one of the few so far in Georgia, it has been said.
* * *
Dr. L. G. Neal, Jr., Cleveland physician, who has
been associated in the practice of medicine with his
father. Dr. L. G. Neal, Cleveland, announces the re-
moval of his offices to Dahlonega.
* * *
Dr. Samuel E. Patton, Macon physician, was recently
named president of the Bibb County Tuberculosis
Association. The association recently replaced the
Bibb County Anti-Tuberculosis Commission and is set
up to carry out a program of tuberculosis control.
* * *
Dr. Robert E. Perry, Jr., Valdosta physician, ad-
dressed the Exchange Club of Valdosta, giving an
inside picture of the medical profession. Dr. Perry
traced the origin of “grandma’s prescriptions” and
linked them with present-day drugs. He said that
science has found out how to use many drugs from
these old prescriptions.
* * *
Dr. Carl S. Pittman, Sr., Tifton physician and
representative of Tift County in the Legislature, did
not realize his own popularity until he got into politics.
It took a lot of urging to get the Tifton physician
and surgeon to run for the Legislature in 1948, but
when he did run he piled up more than a 500 majority
over two opponents. It was his first political race.
Dr. Pittman would not take any time from his practice
until son. Dr. Carl S. Pittman, Jr., completed his
medical education and became associated with him.
The Tift representative is a native of Brooks County,
a son of Charles and Mrs. Mary Minnie Reese Pitt-
man. He graduated from the old Atlanta College of
Physicians and Surgeons in 1913, and has practiced
in Tifton for 35 years. One reason the people wanted
Dr. Pittman in the Legislature was because of his
interest in the Georgia Coastal Plains Experiment
Station and Braham Baldwin Agricultural College,
both located in Tift County. Dr. Pittman is a veteran
of World War I. He is a charter member and past
president of the Tifton Rotary Club, a Mason and
a steward in the First Methodist Church.
* * *
Dr. David Quinn, manager of the Dublin VA Hos-
pital. speaking on “The Importance of the Tuberculosis
Control Program,” explained to members of the
Parnassus Club of Dublin that the tuberculosis control
program provides for detecting the disease, isolation
of the patient, the subsequent treatment of patients,
and finally, rehabilitaion.
* * *
Dr. Guy V. Rice, Alanta, director of maternal and
child hygiene and of mental hygiene clinics in Georgia
for the Georgia Department of Public Health, recently
spent two days in Augusta for inspection of the Rich-
mond County Mental Hygiene Clinic. Dr. Abe J.
Davis, Augusta, health commissioner for Richmond
County, said that the visit of Dr. Rice is a routine
inspection tour. The Richmond County Mental Hygiene i
Clinic is one of only two public health clinics of I
its kind in Georgia.
* * *
The Richmond County Medical Society held its
regular meeting at the old medical college building
on Telfair Street, Augusta, November 17. Members
of the faculty of the University of Georgia School of
Medicine presented a symposium on “Trauma.” Dr.
J. H. Sherman spoke on “The Treatment of Burns”;
Dr. Robert Major discussed “Chest Injuries”; and Dr.
January, 1950
43
W. A. Risteen described ‘‘Emergency Head Injuries”!
Dr. Peter B. Wright discussed ‘‘Emergency Manage-
ment of Fractures.” The program was sponsored hy
the Georgia chapter of the American College of Sur-
geons’ committee on trauma. Dr. Peter B. Wright
of Augusta is chairman of the committee. The
American College of Surgeons sponsors such programs
through county medical societies throughout the
country ‘‘in the interest of the best possible medical
care for injured persons.”
* * *
Dr. E. R. Cook. Ill, Savannah physician, was the
speaker at the monthly meeting of the Savannah
Society of Medical Technologists held at the Georgia
Medical Society Hall, Savannah, November 13. Dr.
Cook outlined the various procedures for making ex-
aminations for tuberculosis, emphasizing the import-
ance of an early diagnosis and advising periodic chest
x-ray examinations.
* * *
Dr. L. H. Shellhouse. beloved Willacoochee physician,
was honored by the citizens of Willacoochee and Atkin-
son County on Sunday. November 13. ‘‘This is Your
Life” was the theme of the program, with all phases
of the doctor’s life being represented by his pastor,
a Mason, a patient and a co-worker. Appreciation was
expressed by the speakers for his outstanding life
and service to the community. A beautiful six-piece
silver service was presented to Dr. Shellhouse by his
granddaughter. Susan Milton, of Jacksonville, Fla.,
on behalf of the community.
* * *
Dr. A. W. Simpson, Jr., Washington physician, an-
nounces the opening of a new and modern doctors’
office on Spring Street, Washington. The new office
building is a one-story brick structure with a floor
plan about 26x56 feet in dimension. It has four
offices, a laboratory, a white reception room, a colored
reception room, a ladies’ lounge and a men’s lounge.
Also a lounge for the colored. Since 1940 Dr. Simpson
has had his office in the Drs. Simpson, Wills and Adair
office building, Washington.
* * *
The Savannah Mental Hygiene Societv held its meet-
ing in the Gold Room of the Hotel DeSoto, Savannah.
November 21. Dr. W. G. Hollister, Atlanta, regional
consultant in mental health, was guest speaker. Dr.
Clair A. Henderson, Savannah, city-county health
director, introduced Dr. Hollister, who outlined three
present trends of mental hygiene programs. Dealing
with preventive and personality phases of mental hygiene
rather than “better care” phase, Dr. Hollister said
that the first trend is “away from clinic-centered pro-
grams toward programs aimed at milder emotional
problems of normal people.” The second trend re-
viewed bv the speaker is the “conversion of mental
health clinics to more consultative support of health,
welfare and educational facilities of the community.”
The third trend is toward the use of “sociodrama and
group therapy technics.” Dr. Hollister said he is
glad to note that each state of the United States is
building its own unique mental health program.
* * *
The Sixth District Medical Society held its winter
meeting in the State Health Department Building,
Macon, December 8. Program: “Present Treatment of
Appendiceal Abcess”, Dr. C. L. Ridley, Jr., and Dr.
Ear] Lewis, Macon; “Drug Sensitizing to Alcohol”,
Dr. Dawson Allen, Milledgeville; “Chronic Emphy-
sema”, Dr. Henrv H. Tift, and Dr. Derrell Hazlehurst,
Macon: “The Responsibility of the Surgeon”, Dr.
C. H. Richardson, Jr., Macon; Official Remarks, Dr.
Enoch Callaway, LaGrange, president of the Medical
Association of Georgia. Election of 1950 officers are
Dr. John I. Hall. Macon, president; Dr. George H.
Alexander, Forsyth, vice-president; Dr. A. M. Phillips,
Macon, secretary-treasurer, and Dr. Dawson Allen, Mil-
ledgeville, councilor. Dinner at the Idle Hour Country
Club, Macon, with Dr. C. H. Richardson, Sr., Macon,
toastmaster.
* * *
The Third District Medical Society held its meet-
ing in Carnegie Library, Cordele, November 17, with
Dr. Guy Dillard, Columbus, president, presiding. Pro-
gram: “Intramedullary Nailing of Fractured Long
Bones”, Dr. J. C. Patterson, Cuthbert; “Management
of Uncomplicated Diabetes”, Dr. Nathan DeVaughn,
Augusta; “Common Pituitary Disorders”, Dr. Robert
B. Greenblatt, Augusta; “Clinical Value of Electro-
cardiography”, Dr. Frank Wilson, 111, Leslie; “Trends
in Treatment of Cancer of the Cervix”, Dr. H. J.
Bickerstaff, Columbus. Officers elected are Dr. Carl
P. Savage, Montezuma, president, and Dr. Schley
Gatewood, Americas, re-elected secretary-treasurer.
The Woman’s Auxiliary to the Third District Medical
Society held its business meeting and installation of
district officers in the First Methodist Church. Mrs.
A. R. Sims, Richland, presided in the absence of Mrs.
Schley Gatewood of Americus. Officers installed
bv Mrs. J. R. S. Mays, Macon, first vice-president
of the Woman's Auxiliary to the Medical Association
of Georgia, were: Mrs. A. R. Sims, Richland, manager;
Mrs. L. H. Wolff. Columbus, manager-elect; and Mrs.
Franklin Edwards, Columbus, secretary. Mrs. Charles
McArthur, Cordele, welcomed the visitors, Mrs. Russell
Thomas, Americus, gave the response, and Mrs. J. R.
S. Mays, Macon, was principal speaker.
* * *
Dr. J. G. Standifer, Blakely physician, was advanced
to the office of Right Worshipful Senior Grand War-
den, the third highest office in the Grand Lodge, at
the 163rd annual communication of the Grand Lodge
of Georgia Free and Accepted Masons on October 26.
According to precedent. Dr. Standifer will become
Grand Master of the Grand Lodge in October 1951.
Dr. J. A. Thrash, Columbus, executive director of
the Muscogee County Health Department and of City
Hospital, upon his return from a three-month tour in
Europe, sounded a warning that “it is time to call a
halt on centralization of all sorts” in reference to
government. Dr. Thrash said he based his statement
on his observations in Europe. The first American
chosen by the United Nations World Health Organiza-
tion for the tour. Dr. Thrash studied medical and public
health affairs in several countries in Europe and will
compile a report for the WHO. He asked why the
United States should change “for something we don’t
know anything about” as he urged that welfare work
of all types be kept in the hands of local people . . .
If we are going to maintain our freedom in medicine
and public health and in other fields,” he continued,
“centralization must be curbed.”
* * *
The Tri-County Medical Society ( Calhoun-Early-
Miller Counties) elected the following officers for 1950:
Dr. W. W. Baxlev, Blakely, president; Dr. James H.
Crowdis, Jr., Blakely, vice-president; Dr. Hinton J.
Merritt, Colquitt, secretary-treasurer; Dr. J. G. Standi-
fer, Blakely, delegate; Dr. C. K. Sharp, Arlington,
alternate delegate. The Board of Censors is composed
of Drs. James W. Merritt, Colquitt, James B. Martin,
Edison, and W. H. Wall, Blakely.
* * *
The University of Georgia School of Medicine,
Augusta, recently sponsored an Obstetrics Seminar at
the University Hospital, Augusta, in cooperation with
the State departments of Public Health of Georgia,
Florida and South Carolina. Among the doctors from
the Atlanta area who read papers at the seminar
were: Drs. George A. Williams, R. A. Bartholomew,
W. W. Coppedge, Guy C. Hewell, E. D. Colvin, John
B. Cross, Charles B. Upshaw-, John R. McCain. C. S.
Glissen, Jr., R. K. Hancock and Guy V. Rice, director
of the Division of Maternal and Child Heatlh of the
Georgia Department of Public Health. Dr. Richard
44
The Journal of the Medical Association of Georgia
Torpin, Augusta, professor of obstetrics of the Univer-
sity of Georgia School of Medicine, was chairman
of the seminar. Dr. W. T. Tompkins, Philadelphia
obstetrician, discussed ‘‘Nutrition in Pregnancy” at the
meetings.
* * *
The Veterans Administration recently announced
the appointment of Dr. Richard L. Harris as manager
of the 1,965-bed veterans hospital under construction
at Peekskill. N. Y. Dr. Harris was formerly with VA
in Los Angeles, Calif., and is a member of the Laurens
County Medical Society and the Medical Association
of Georgia. He is a World War II veteran, and has
had 28 years of VA medical service. A graduate of
the University of Georgia School of Medciine, Augusta,
Dr. Harris has been active in the field of psychiatry
since 1920.
* * *
Dr. R. A. Vonderlehr. Atlanta, medical director in
charge of the communicable disease center of the U. S.
Public Health Service, Atlanta, recently announced
that the Public Building Administration allocated
$500,000 for plans and specifications for a new national
headquarters building in Atlanta for the communicable
disease center of the U. S. Public Health Service. It
is the first step in the construction of a five-building
center to be built adjoining Emory University at an
estimated cost of $10,000,000. The center helps in the
control and prevention of such diseases as poliomye-
litis, leprosy, rabies, typhus fever and malaria.
* * *
Dr. Hoke Wammock, Augusta, head of the research
department of the University of Georgia School of
Medicine, recently addressed the members of the
Augusta Kiwanis Club. He said, ‘‘There is more hope
today than ever before for victims of cancer.” A
growing knowledge of cancer symptoms and broadening
of education of the masses ‘ of the people is one
of the main factors in the increasingly hopeful out-
look where cancer is concerned. Dr. Wammock said.
* * *
The Ware County Medical Society held its annual
Christmas party at the Okefenokee Golf Club, Way-
cross, December 1, at which Drs. W. F. Reavis, Ed
Roe Stamps and Lovick Pierce were hosts. Officers for
1950 were elected. They are Dr. William A. Hendry,
Blackshear, president; Dr. William C. Calhoun, Way-
cross, vice-president : Dr. Leo Smith. Waycross, secre-
tary-treasurer; Dr. W. L. Pomeroy, Waycross, delegate;
Dr. Leo Smith, Waycross, alternate delegate. Board
of Censors are Drs. H. A. Seaman, Waycross; William
A. Hendry, Blackshear, and W. M. Flanagan, Waycross.
This was the 31st consecutive year in wffiich Dr.
Reavis has been host at the annual Christmas party.
The members voted to hold a similar meeting next
year which will make the 32nd time they have enjoyed
his hospitality. (Suggestions: Give Reavis a red necktie
and a bottle of Old Spice perfume. — Ed.)
* * *
The Fulton County Medical Society held its Forty-
Fifth Anniversary Banquet at the Biltmore Hotel,
Atlanta, January 5. Program: Call to order by Dr.
Stephen T. Brown. Invocation; Installation of Officers;
Inaugural Address of the President, Dr. A. O. Linch;
Announcement of Committees; Presentation of the
President’s Key to Dr. Stephen T. Brown by Dr. Hal
M. Davison; Report of the Committee on the Dr.
L. C. Fischer Award, Dr. Allen H. Bunce; Award of
25-Year Membership Certificates; Address, Dr. Josiah
Crudup, Gainesville, president Brenau College, and
miscellaneous business. Officers for 1950 are Dr. A. 0.
Linch, president; Dr. Hal M. Davison, president-elect;
Dr. Cyrus W. Strickler. Jr., vice-president; Drs. Hal
M. Davison. Stephen T. Brown, A. O. Linch, Cvrus W.
Strickler, Jr., A. Worth Hobby, Jack C. Norris, William
G. Hamm, John W. Turner, Eustace Allen, board of
trustees; Dr. Albert A. Rayle, judicial council; Drs.
Major F. Fowler, Shelley C. Davis, J. D. Martin, Jr.,
Purcell Roberts, ami hoard of trustees, delegates; Drs.
A. Park McGinty, Lester Brown. J. D. McDaniel, Mark
Dougherty, David Henry Poer, Tully T. Blalock, Harry
Rogers, George Holloway, Harold McDonald. J. C.
Blalock, H. Walker Jernigan, Hayward S. Phillips,
and W. Perrin Nicolson, alternate delegates. Annual
awards for research during 1949 were presented. The
presentations were made by the committee on the
L. C. Fischer awards. The committee members are
Dr. Allen H. Bunce, chairman. Dr. F. Phinizy Calhoun,
and Dr. Frank K. Boland. In the best original work
category, the award went to Dr. Darrell Ayer, Jr.,
Dr. Frederick H. Thompson, and Dr. Mary Gilliland.
The award for “best written paper” went to Drs. John
R. McCain and Samuel R. Poliakof.
* * *
The Milledgeville State Hospital. Milledgeville, an-
nounced lectures by Dr. Leland B. Hinsie, New York
City, professor of psychiatry, College of Physicains
and Surgeons, Columbia LTniversity, and assistant direc-
tor of New York State Psychiatric Institute and Hos-
pital, on the subject, “Psychopathology and Psycho-
therapy” at the hospital January 12-14. Invited to
hear Dr. Hinsie were hospital superintendents, medical
and nursing staffs, social workers, and other interested
personnel.
* * *
The Southeastern Surgical Congress will hold its
eighteenth Postgraduate Assembly at the Shoreham
Hotel, Washington, D. C., March 6, 7, 8, 9, 1950.
Guest speakers include 41 outstanding physicians of
the Southeast, including the following Georgia physi-
cians: Dr. Enoch Callaway, LaGrange, will present a
paper on “Carcinoma of the Cervix.” Dr. J. D. Martin,
Jr., Atlanta, will discuss “The Complications of
Splenectomies.” Dr. J. C. Patterson, Cuthbert, will
read a paper entitled “Gastrocholic Fistula.” Write
Dr. B. T. Beasley, 701 Hurt Building, Atlanta 3, Ga.,
for information about the assembly.
* * *
The Fulton County Medical Society held its dinner
and annual meeting at the Academy of Medicine,
Atlanta. December 15. Program: “President's Message”,
Dr. Stephen T. Brown ; Annual reports by the officers
of committees; Memorial Service, Dr. L. Minor Black-
ford. Election of new officers. “The Sterilization of
the Unfit”, Dr. Blake Van Leer, Atlanta, president of
Georgia Tech,.
* * *
The following members of the Fulton County Medical
Society were reported to the Medical Association of
Georgia after the 1949 membership roster was printed:
Dr. Samuel W. Norwood, 72 Eleventh Street, N. E.,
Atlanta; Dr. Carl A. Whitaker, Emory University Hos-
pital. Emory University; Drs. Alvan Glenn Foraker,
Grady Memorial Hospital, Atlanta (Asso.) ; and Thomas
Lumpkin Hodges, Jr., 209 Erie Ave., Decatur (Asso.).
COMMUNICATIONS
Birmingham, Ala., Dec. 22, 1949
Dr. Edgar D. Shanks, Secretary
* Medical Association of Georgia
478 Peachtree Street, N. E.
Atlanta, Georgia
Dear Dr. Shanks:
On February 21, 22 and 23, a Seminar on Cancer
will be conducted at the Medical College of Alabama
in Birmingham by some of the medical profession’s
most widely-recognized authorities in their respective
fields.
I am pleased to extend through you a cordial invita-
tion to members of your state society to attend.
The Seminar is sponsored by the Medical Associa-
tion of Alabama, the Jefferson County Medical Society,
the Extension Division of the University of Alabama,
and the Alabama Division of the American Cancer
Society.
We have drawn on the experience of other seminars
January, 1950
45
to formulate a program that we believe will be of
the greatest possible value and usefulness.
The dissimilar problems that confront the specialist
and the general practitioner have been taken into con-
sideration. Each speaker in his field will make a
comprehensive presentation of the latest advances and
most effective methods of detection, diagnosis and
treatment in such manner as to he of exceptional value
to both the specialist and the general practitioner.
An outline of the three-day program is attached.
We wrould like to extend an even more direct invita-
tion to the individual members of each county society
in your state. If you would be kind enough to send
us the names of the secretaries of your county societies,
we will write a special invitation through them to their
members and provide them with printed copies of
the program just as soon as they are off the press.
Those who attend the Seminar will have the added
opportunity of inspecting the research activity being
conducted by the Medical College of Alabama into a
mass screening test for the detection of cancer. The
research laboratories have been described by those who
have seen them as possibly the most modern in the
South.
There will be no registration fee for the Seminar.
The headquarters hotel will be The Tutwiler in Bir-
mingham. Excellent additional accommodations will
be available at Hotel Molton and Hotel Redmont.
We will deeply appreciate your bringing this notice
as quickly as possible to all members of your society
since we anticipate a large attendance and want to
accommodate all those who desire to attend.
Sincerely yours,
KARL F. KESMQDEL, M.D.
Chairman , Cancer Seminar
PROGRAM
Tuesday, February 21
11:00 to 12:30 — Cancer of the Pharynx-Hypo-pharynx
and Larynx — Dr. Louis H. Clerf, Jefferson Medical
School, Philadelphia.
12:30 to 1:45 — Lunch.
2:00 to 3:30 — Cancer of the Breast — ‘Dr. Frank Adair,
Memorial Hospital, New York.
3:30 to 5:00 — Cancer of the Mouth — Dr. Oliver S.
Moore, Memorial Hospital, New York.
7:00 p.m. — Dinner — Hotel Tutwiler.
8:30 — Address — Dr. Charles S. Cameron, Jr., Medi-
cal and Scientific Director, the American Cancer
Society, New York.
Wednesday, February 22
11:00 to 12:30 — Cancer of the Female Genital O grans
- — Dr. A. N. Arneson, Department of Gynecology, Ber-
nard Skin & Cancer Hospital, St. Louis.
12:30 to 1:45 — Cancer of the Lung — Dr. William F.
Reinhoff, Johns Hopkins Hospital, Baltimore.
3:30 to 5:00 — Cancer of the Colon and Rectum — Dr.
Harry Bacon and/or Dr. Lloyd F. Sherman, Temple
University Hospital and Medical School, Philadelphia.
8:00 to 9:30 p.m. — Lymphoblastomas — Dr. Sidney
Farber, The Children’s Hospital, Boston.
Thursday, February 23
11:00 to 12:30 — Radiation Therapy of Cancer of the
Pharynx and Larynx — Dr. Ralph W. Caulk, Garfield
Memorial Hospital, Washington.
12:30 to 1:45 — Lunch
2:00 to 3:00 — Cancer of the Stomach — Dr. Alexander
Brunschwig, Memorial Hospital, New York.
3:30 to 5:00 — Radiation Therapy of Lymphoblastomas
— Dr. Ralph W. Caulk, Garfield Memorial Hospital,
Washington.
AMERICAN ACADEMY OF GENERAL PRACTICE
The American Academy of General Practice
will meet in St. Louis February 20-23. Among
its distinguished guest speakers will be Dr. Paul
R. Beeson, of Atlanta.
Atlanta, Ga., Dec. 9, 1949
Dr. Edgar I). Shanks, Editor
Journal of the Medical Association of Georgia,
478 Peachtree Street, N. E.,
Atlanta, Georgia
Dear Dr. Shanks:
The Clay Memorial Eye Clinic and the Emory
University School of Medicine through the William
L. Crawley Fund have established an Eye Bank at
the Grady Memorial Hospital, 36 Butler Street, Atlanta
3, Georgia. The purpose of the Eye Bank is to collect
and dispense eyes for use in corneal transplantation.
This facility is available, without charge, to any co-
operating hospital or ophthalmologists throughout the
Southeast. Local transplantation in the Atlanta area
is provided by the Atlanta Chapter of the Red Cross
Motor Corps and regional transportation is provided
through the Capital, Delta, Eastern, and Southern
Airlines. All of these airlines serving Atlanta have
co-operated in this program by offering their facilities
without any cost. Hospitals and ophthalmologists who
are interested in using this facility may write to the
Eye Bank, Clay Memorial Eye Clinic, 72 Armstrong
Street, S. E., Atlanta 3, Georgia, for details and the
proper containers for transportation of eyes.
Thanking you and with the season's best wishes,
I am,
Sincerely yours,
MORGAN B. RAIFORD, M. D.
Clinical Director.
RESIDENCY TRAINING REQUIREMENTS
The American Board of Obstetrics and Gynecology
has not made nor is it contemplating any changes in
its residency training requirements, despite rumors
of an increase in training years. Eligibility require-
ments remain the same ; namely, three years of ac-
ceptable formal training, followed by at least two
years of post-training practice in the specialty.
Hospitals are inspected and approved for training
jointly by the Council on Medical Education and Hos-
pitals of the American Medical Association and this
board. Approvals are granted for training periods of
one, two and three years depending on the available
facilities and the findings of the survey inspections.
This board has no objection to residency services
being arranged by hospitals for periods longer than
three years, unless this dilutes the candidate’s clinical
training opportunities too much during the first three
years. However, the board does not accept a fourth
year, or more, of residency training as a substitute
for any part of the required two years of post-training
practice.
The importance of post-training practice in the
specialty is emphasized as an opportunity for maturing
of the candidate and for colleague appraisal of a
man’s ability when working on his own responsibility
in his chosen community. The only exception to this
ruling is in the case of men advancing from their
training into full-time teaching positions. These men
then must complete at least two years in such positions.
'Copies of the Bulletin of this board, outlining the
above requirements in more detail, are available to
hospital administrators or to candidates, upon appli-
cation.
PAUL TITUS, M.D., Secretary,
American Board of Obstetrics and Gynecology,
1015 Highland Building,
Pittsburgh 6, Pennsylvania.
MACON HOTELS
Macon hotels are: Dempsey, Lanier, Central,
Southland, Colonial, and Milner. Tourist courts
are: Magnolia, and Peach State. The dates of
our annual session are April 18-21. Get your
reservations now.
46
The Journal of the Medical Association of Georgia
OBITUARY
Dr. James Oscar Baker , aged 82, Savannah physician,
died in a Savannah hospital after a long illness, Decem-
ber 6, 1949. Dr. Baker, a native of Marion, S. C.,
and graduate of the University of Georgia School of
Medicine, Augusta, in 1902, had been a resident of
Savannah for 64 years. He was a member of the
Georgia Medical Society, the Medical Association of
Georgia, and a fellow of the American Medical Asso-
ciation. Survivors include his widow, a sister, Mrs.
Ransom Bryant Hare, Florence, S. C., and a brother,
Judge Gordon Baker, of Florence, S. C.
* * *
Dr. John Hiram Bowen, aged 83, prominent Cobb-
town physician, died at his home after a long illness,
December 4, 1949. Dr. Bowen was the son of the
late Andrew and Martha Cameron Bowen, and was
a charter member of the Cobbtown Methodist Church.
He graduated from the University of Georgia School
of Medicine, Augusta, in 1894. He retired from active
practice several years ago. Surviving are his wife,
the former Miss Pauline McGinty, and one sister. Mrs.
Annie Cowart, Miami, Fla. Funeral services were held
from the Cobbtown Methodist Church, with the Rev.
Allen V. Johnson, Glennville. the Rev. Vernon Rober-
son, Claxton. and the Rev. R. C. Joiner officiating.
Burial was in the Sunlight Cemetery, Cobbtown, with
the Masons in charge at the grave.
* * *
Dr. Clernmie C. Brannen, aged 61, prominent Moultrie
physician anti surgeon, died at his home following a
short illness November 16, 1949. Dr. Brannen was
born in Bulloch, Ala., anti graduated at Emory Univer-
sity School of Medicine, Atlanta, in 1944. He was
an intern and resident physician at St. Mary's Hospital
and Willard Parker Hospital, both in New York City,
lie began the practice of medicine in Moultrie in
1917, and a few months after he located in Moultrie
was called into service in the U. S. Army Medical
Corps of World War I. He held the rank of captain.
Discharged from the Army in 1919, he returned to
Moultrie. He was a member of tbe Colquitt County
Medical Society, the Medical Association of Georgia,
a fellow of the American Medical Association, and a
Shriner. Survivors are his wife, the former Anna
Warren Clark, two children, Dr. Joseph H. Brannen,
Atlanta, and Mrs. Erie Taylor, Moultrie, two brothers,
one sister and three grandsons. Funeral services were
held at the First Baptist Church, of which he was a
member. Dr. R. C. Gresham, assisted by the Rev. Roy
McTier, pastor of the First Methodist Church, officiated.
Burial was in Westview Cemetery, Moultrie.
* * *
Dr. Joseph Abner Camp, aged 72, Roberta physician,
died at his home following a long illness, October
22, 1949. Dr. Camp graduated from the Georgia College
of Eclectic Medicine and Surgery, Atlanta, in 1909.
He was a member of the Bibb County Medical Society,
the Medical Association of Georgia, and a fellow of
the American Medical Association. He was also a
member of the Roberta Methodist Church. He had
practiced medicine in many Georgia towns, and had
lived in Roberta for 19 years. He is survived by his
wife, the former Miss Frances Hollis; one brother and
a number of nieces and nephews. Funeral services
were held at the Knoxville Methodist Church. The
Rev. A. C. Pickette and the Rev. 0. B. Belmont of-
ficiated. Burial was in the churchyard of Knoxville.
* * *
Dr. Jackson T. Colvin, aged 69, beloved Jesup physi-
cian, died December 8, 1949. Dr. Colvin was born in
Locust Grove, anil graduated from the Georgia College
of Eclectic Medicine and Surgery, Atlanta, in 1903.
He first practiced medicine in Odum and later moved
to Jesup. In 1919, when Dr. T. G. Ritch of Odum
returned from World War I, he and Dr. Colvin began
a professional association that lasted 25 years. In
1924 they established the 25-bed Colvin-Ritch Hospital,
which has since grown to 60 beds. Dr. Colvin retired
in 1944 due to his health. He was a member of the
Wayne County Medical Society, the Medical Associa-
tion of Georgia, and a fellow' of the American Medical
Association. He was a Kiwanian, and chairman of the
board of deacons of the First Baptist Church for many
years. He is survived by his wife, Mrs. Mary Johnson
Colvin; a son, J. E. Colvin, Jesup; a daughter, Mrs.
Robert Paschal, Jesup, five grandchildren; two brothers,
Dr. Ernest Colvin. Atlanta, and Dr. Andrew Colvin,
Edinburgh, Texas. Funeral services were held at the
First Baptist Church, conducted by the Rev. Floyd
Jenkins, pastor, assisted by the Rev. W. C. McKibben
and the Rev. Irwin Hulbert, Jr. Burial was in Jesup
Cemetery.
* * *
Dr. Clarence Goolsby Cox, died December 2, 1949
in his home at the Milledgeville State Hospital, Mil-
ledgeville. An accidental death by carbon monoxide
poisoning. He was 62 years of age, the son of Mary
Frances Cohb Cox and Marcus LaFayette Cox. He
was born in Ellijay, Ga., December 18, 1886.
Dr. Cox attended tbe Dahlonega Junior College and
was graduated from the Liniversity of Georgia School
of Medicine, Augusta, in 1910. He interned at the
University Hospital, Augusta, and was a Veteran of
World War I. A past commander of the Morris Little
Post No. 6, American Legion, he remained active in
veterans' affairs until the time of his death. He was
a member of the staff of the Milledgeville State Hos-
pital for 23 years, served a short period as superin-
tendent of Georgia Training School for Mental Defec-
tives, Gracewood, Ga., returning to Milledgeville to
accept the position of clinical director. He resigned
this position later to work for the Dublin V. A. Hos-
pital as Chief of Neuropsychiatry. He had just been
recalled to Milledgeville the second time as clinical
director when he died.
He was a member of the Laurens County Medical
Society, Sixth District Medical Society, Medical Asso-
ciation of Georgia, American Medical Association, The
Southeastern Neurological and Psychiatric Association,
Atlanta Society of Neurology and Psychiatry, and The
American Psychiatric Association. He was a diplomate
of the American Board of Psychiatry.
He is survived by his wife, Ruth Edwards Cox; a
son, James Clarence; two daughters, Mrs. Z. S. Sikes,
Jr. of Durham. N. C.. and Mrs. J. L. Rothery of Boston,
Mass., and two grandchildren. Funeral services were
held at the First Baptist Church, Milledgeville, with
the Rev. James M. Terresi officiating. Burial was in
Ellijay Cemetery, Ellijay.
* * *
Dr. John Parham Holmes, aged 64. well-known Macon
physician, died at Emory University Hospital, Atlanta,
after an illness of several weeks, November 20, 1949.
Dr. Holmes was born in Macon, the son of the late Dr.
Walter Holmes and Leila Burke Holmes, pioneer
Middle Georgia family. He graduated from Vanderbilt
LIniversity School of Medicine, Nashville, Tenn., in
1911. He was a veteran of World War I and began
practicing in Macon after the war. He served for 30
years as a member of the staff of Macon Hospital.
He was a member of the Bibb County Medical Society,
the Medical Association of Georgia, and a fellow of
the American Medical Association. Survivors include
his wife, the former Catherine Blain; one daughter,
Mrs. Derry Burns, Macon; one son, J. P. Holmes, Jr.,
Macon, and one brother, Dr. Walter R. Holmes, Atlanta.
Funeral services were held at the Mulberry Methodist
Church. Burial was in Riverside Cemetery, Macon.
* * *
Dr. William Fay Lake, aged 61, Atlanta radiologist,
died at Clearwater Beach, Fla., December 20, 1949. A
native of Simpson. W. Va., Dr. Lake was a graduate
of tbe Atlanta College of Physicians and Surgeons, now
Emory University School of Medicine, Atlanta, in
January, 1950
47
1913. He was a member of the Fulton County Medical
Society, the Medical Association of Georgia, and a
fellow of the American Medical Association. Dr. Lake
had been radiologist at Crawford W. Long Memorial
Hospital for about 25 years. He was a Mason, a
member of Second Ponce de Leon Baptist Church, and
Phi Chi medical fraternity. Surviving are his wife,
a nephew, John D. Parmerlee, Atlanta; five sisters and
a brother. Funeral services were held at Spring Hill
with Dr. Monroe F. Swilley, Jr., officiating. Burial
was in West View Cemetery, Atlanta.
* * *
Dr. A. Madison Puckett, aged 59, Atlanta physician,
died at his residence, 3495 North Druid Hills Road,
Atlanta, November 27, 1949. Dr. Puckett graduated
from the Georgia College of Eclectic Medicine and
Surgery, Atlanta, in 1912. He had practiced medicine
in Atlanta for the past 25 years. He was a member
of the Longstreet Baptist Church. Cumming. Surviving
are his wife; a daughter, Mrs. C. A. Mayson; a son,
A. M. Puckett, Jr.; two brothers, three sisters and
several nieces and nephews. Funeral services were
held at the Underwood Memorial Methodist Church
with the Rev. J. Kenneth Brown officiating. Burial was
in Crest Lawn Cemetery, Atlanta.
* * *
Dr. Allen Robert Rozar, aged 62, prominent Macon
physician and surgeon, died at his residence, 336 E.
Jackson Springs Road, Macon, December 11, 1949.
Dr. Rozar was born in Macon, and graduated from the
Atlanta School of Medicine, now Emory University
School of Medicine, Atlanta, in 1911. He served as
intern at Georgia Baptist Hospital, Atlanta, and took
postgraduate work at Harvard Medical School, Boston,
M ass. He was a member of the Bibb County Medical
Society, the Medical Association of Georgia, and a
fellow of the American Medical Association. He had
been prominently connected with his profession and
hospitals in Macon since 1912. Funeral services were
held at the Mulberry Street Methodist Church. The
Rev. M. E. Peavy and Dr. Ed F. Cook officiated. Burial
was in Riverside Cemetery, Macon.
FIND STREPTOMYCIN EFFECTIVE
AGAINST BACILLARY DYSENTERY
Treatment of shigellosis, a major form of bacillary
dysentery, with streptomycin produces prompt relief
from the disease, according to a study made by five
Washington. D. C., physicians under a grant from the
U. S. Public Health Service.
Writing in the September 17 Journal of the American
Medical Association, Drs. Sidney Ross, Frederic G.
Burke, E. Clarence Rice, Harold Bischoff. and John A.
Washington say that lowering of temperature and re-
duction in diarrhea usually occurred in acutely ill
patients in 12 to 24 hours after oral streptomycin
therapy was begun.
All 34 patients treated with streptomycin were chil-
dren, ranging in age from three months to 12 years.
All had an uneventful recovery from the disease except
five patients who had either a relapse or a reinfection
within one month after discharge from the hospital, the
doctors say, adding:
“It would require a larger series than ours to state
that streptomycin is superior to sulfadiazine (in treating
this kind of bacillary dysentery). However, oral admin-
istration of streptomycin could be used advantageously
in patients with a sulfonamide-resistant strain of organ-
isms as well as in those cases in which there exists
a sensitivity to sulfonamide compounds.
“One may take cognizance of the relatively higher
incidence of shigellosis in military personnel, especially
in the tropical areas, coupled with the frequent hazard
of administering a sulfonamide drug to dehydrated
patients. In these conditions, orally administered strep-
tomycin may be found to be of considerable use as a
substitute drug.”
HELP YOUR MIND HELP YOU
With more than half the hospital beds in the United-
States occupied by mental patients, mental illnesses
are a real problem and now for the first time a
Presidential Proclamation marks a Mental Health
Week. April 24-30.
The manner in which an individual reacts to every-
day situations largely displays the state of his mental
health. In other words, his attitude to a given situation,
whether good or had, reveals the degree of his emo-
tional maturity, the Educational Committee of the
Illinois State Medical Society observes in a Health
Talk.
Worry, frustration and excessive anxiety are factors
that may influence a person's thinking. Jealousy, rage
and inability to adjust are other factors that may, if
uncontrolled, bring on, or manifest underlying psycho-
logic disorders. Some persons, through improper train-
ing and guidance in their early years, outwardly
express a normal mental attitude to everyday living,
but, when confronted with one or several incidents of
an unpleasant nature, “blow up.” These people, unfor-
tunately, constitute a large segment of our population.
Many persons who have physical complaints, such
as an abdominal pain, often have no physical basis
for that pain. This type usually shops from doctor to
doctor, insisting that the pain is organically based,
even when x-rays and other evidence point to the con-
trary. These individuals must be taught to understand
how emotions can cause pain, to check their attitudes,
and to help manage their own minds.
Essentially any virtue carried to excess becomes a
vice. A sense of proportion in one individual can easily
develop into excessive pride. Respect for others, poise,
self-confidence, self-discipline, generosity, understanding
and self-reliance are all positive factors in a well
balanced person, yet these same attributes, if not con-
trolled, can develop into unfavorable characteristics
of extreme egoism. On the other hand, excessive humil-
ity, self-pity, self-indulgence, selfishness, hypercriticism
and dependence are factors that express the inferiority
complex.
The common types of mental illnesses are schizo-
phrenia, commonly known as dementia praecox; the
manic-depressions; paresis, an affliction of the brain
caused by syphilis; paranoia, a condition characterized
by suspicions of persecution, of delusions, or grandeur.
Indeed, the classification of psychoses and neuroses
is a formidable one.
Many physical conditions could be prevented if
emotional upsets could be avoided. Facing the facts
is important. Many persons develop complexes by
“locking up" their disturbing thoughts. These people
would be better off to discuss the problem with some-
one, thus get it out of the system and then forget
about it.
Think it over. Don’t let the storm of conflicting
emotions create a mental illness which, very often,
might create physical impairments too, such as indiges-
tion, palpitation, headache, shortness of breath and
even ulcers. Much mental suffering can be avoided
by understanding your emotions. Don't feel sorry for
yourself if things don’t go your way. Take it in stride.
You’ll be happier as will those about you. By under-
standing yourself, you can help your mind help you.
Consult your physician and if he advises the help
of a psychiatrist do so. The help of a good psychiatrist
is as essential as that of a good internist or surgeon.
NURSES RECRUITED
Pinched by an alarming deficiency in nursing per-
sonnel, North Carolina has launched a unique (and
successful) recruitment campaign, which is designed
to catch the interest of high school girls before they
have made up their minds about their careers.
The N. C. Good Health Association and the State
Nurses Association agreed upon one thing — that nurses
invariably like their jobs, once they are in them, but
48
The Journal of the Medical Association of Georgia
few young girls could see anything glamorous in the
onerous duties, the starched uniforms and white cotton
hose.
Three years ago was launched the “Miss North
Carolina Student Nurse” contest which culminated in
a coronation, just like the beauty pageants. The con-
test was successful from the beginning, and last year
the goal of recruitment of 1,000 new student nurses
was exceeded by 100. A substantial percentage of the
new recruits attributed their decision to enter the
profession to interest aroused by the contest.
The contest is simple. Any senior nurse may enter,
and district elimination contests are held, with the
finals in Raleigh (this year on March 16). Kay Kyser
will preside, as usual, and the nine contestants will be
judged according to personal appearance, personality,
scholarship, aptitude for nursing, spirit of service and
speaking ability.
This last attribute is the gimmick in the matter,
because the winner is taken on a tour of the state,
speaking before high school and college groups in the
interest of nursing as a career. The recruitment pro-
gram is predicated on the idea that the effective time
to get girls interested in the profession is to arouse
their enthusiasm before they get into the senior class,
when many of the best prospects have already planned
their careers. Consequently, the Good Health Associa-
tion thinks the best results of the program will show
up this fall and next year.
The winner of the contest receives many courtesies.
She is invited to resorts for vacations. Year before
last, she was the guest of Mr. and Mrs. Kyser in
Hollywood, and this year the winner will be awarded
a trip arranged by Carolina Motor Club and Colonial
Air Lines to Harmony Hall. Bermuda. Inasmuch as
only seniors compete, and they immediately start on
their careers, the prestige and publicity they receive
is not calculated to hurt their advancement in the
profession, either.
This year, the nine finalists will each have a retired
nurse as a sponsor. These nine “grand old ladies” of
the nursing profession will be selected on the basis
of their service and all will be invited to attend the
finals as guests of the Good Health Association.
The contest, only one in the country to inject “glam-
our” into nurse recruitment, has the support also of
the State Medical Association and the Hospital Asso-
ciation. The Good Health Association director, H. C.
Cranford, emphasizes that the winner of this contest
is a real, genuine, 200 caret nurse, and not a cheesecake
artist.
But all hands agree that the recruitment hasn’t
been hurt any because the winners so far have been
good-lookers.
ARMY MEDICAL DEPARTMENT ANNOUNCES
DEVELOPMENT OF “DRAMAMINE” SEA-
SICKNESS PREVENTIVE AND CURE
Working in conjunction with civilian investigators,
the Army Medical Department has sponsored develop-
ment of a new drug, “Dramamine,” that acts as both a
cure and preventive of seasickness or motion sickness,
it was announced recently by Major General Raymond
W. Bliss, The Surgeon General.
Credit for the original research is given to Dr.
Leslie N. Gay, of the Protein Clinic of Johns Hopkins
University Hospital, Baltimore, Maryland, who first
began research on the drug in 1947, and Dr. Paul
Carliner, also of Johns Hopkins.
In experiments recently completed, almost total cure
or prevention of seasickness, in all degrees of severity,
was obtained among more than 400 passengers aboard
an Army transport in heavy seas.
Both the preventive and curative values of the drug
in relation to seasickness w7ere investigated during the
voyage. The physicians reported that of the men who
received preventive treatment, less than 2 per cent
became seasick. In the therapeutic tests, the drug
failed to give complete relief in only 5 per cent of cases.
During the extremely rough voyage, a total of 418
cases, including relapses of moderate to violent sea-
sickness, were treated with Dramamine. Complete relief
was obtained in 407 cases, with partial relief or failure
in 11 cases.
Careful observation was made for unpleasant symp-
toms, but in not one instance, even though thousands
of capsules were administered to more than 300 men,
was there a complaint or evidence of discomfort which
necessitated discontinuance of treatment.
Seasickness has been an important military problem
because of the frequent necessity of transporting great
numbers of men by air or sea and landing them in
excellent physical condition. Especial attention was
paid to the problem during World War II, in the course
of which many drugs were used in an attempt to control
its symptoms.
The drug was used extensively during the summer
of 1948 aboard the U.S.S. America. Sufficient data
were collected to warrant more extensive and intensive
study of the drug. A brief report on the study was
submittted to the Chief of Staff and The Surgeon
General of the Army.
The Army secured the services of the U. S. Army
Transport Ballou, a ship built for service in the rela-
tively calm waters of the South Pacific. In order to
try the drug under conditions most likely to produce
seasickness, the Ballou was commissioned to carry
1,376 troops from New York to Bremerhaven, Germany,
in November of last year. The North Atlantic is ex-
tremely rough and stormy at this season, and the
vessel, which has more pitch and roll than ships de-
signed for the rough waters of the Atlantic, experienced
lists up to 36 degrees, which would tend to cause
seasickness among even the hardiest sailors.
Four adjacent sub-level compartments, in which 485
men were quartered, were chosen so that all subjects
would be exposed to the same motion of the sea. The
men were divided into two groups. One group was used
in a study of the drug's preventive qualities, and the
other was studied to determine the curative qualities.
The men chosen for the preventive study were divided
in two groups. One of these received 100 mg. of
Dramamine in capsule form as the transport left New
Tork. A similar dose was given six hours later and
then one before each meal and one before retiring.
The other group received a capsule containing only
sugar on exactly the same schedule. Only Dr. Gay and
Dr. Caroliner knew who received the drug and who
the sugar.
This schedule was continued for 48 hours, and then
the administration of capsules was discontinued.
Of the 134 men who received Dramamine, none
developed nausea or vomiting while taking the drug;
only two men complained of dizziness. The physicians
reported that the men maintained excellent morale,
even complaining that they were unable to get enough
to eat.
Of the 123 men who received the sugar capsules,
thirty-five became seasick within 12 hours at sea.
When placed on the Dramamine schedule the men in
this grouj), with only one exception, derived complete
relief within three hours.
In the compartment where Dramamine had been
given from the start but its administration discontinued
after 48 hours, 41 men reported that seasickness had
developed 10 to 18 hours after the drug was omitted.
The drug again was given to these men and 40 regained
their normal state of health within 30 minutes to one
hour after the first dose.
The group selected for the therapeutic trial did not
receive any of the drug at the start of the voyage.
Fifteen men became seasick, and 12 of these were
immediately relieved after administration of Drama-
mine.
A sub-group of 33 men received sugar capsules.
Nineteen men whose complaints had been nausea and
dizziness were relieved within 12 hours by the sugar
January, 1950
49
capsules. They were taken off the sugar capsules and
remained well. Fourteen men became progressively
worse on the sugar capsules and complained of exces-
sive nausea, extreme dizziness, and prolonged vomiting.
After Dramamine was given, complete relief followed
within half an hour after the first dose.
Other men aboard the ship became ill, 195 reporting
severe symptoms of seasickness. Of this group, 187
were completely relieved within an hour after admin-
istration of the first capsule.
A number of men were so ill they could not retain
the capsule in the stomach. The drug was given by
rectum and within an hour they were able to retain
both fluids and solid food.
All previous remedies had been combinations of
various drugs, such as scopolamine, one of the barbit-
urate preparations. Dramamine is a single chemical
which is believed to have a direct effect on the vomiting
center in the brain. It is a member of the chemical
family of benadryl and pyribenzamine, which are used
in the treatment of certain allergic conditions. The
complete chemical name is beta-diaminoethyl benzo-
hydryl ether 8-chlorotheophyllinate.
Future plans call for broadening of experiments
with Dramamine to include such means of travel as
landing craft, small boats, and aircraft.
BREATHING THROUGH YOUR NOSE
Aside from its cosmetic effect, the nose has an
important function in the health of the body. Com-
posed of cartilage and small bones, the nose acts as
a conveyor of air to the lungs which are the breathing
apparatus of the body, the Educational Committee of
the Illinois State Medical Society states in a Health
Talk.
The lobule or tip of the nose is of a soft structure
and acts as a valve. Inside the nose is a partition
known as the septum. It separates the right from the
left side and maintains the rigidity of the pathway
through which the air passes as it goes through the
nasal structure, also helping to give force and direc-
tion to the air current, much like the nozzle on a
garden hose.
Very often, through accident or disease, these air
passages are obstructed. When this happens, one sees
the victim breathing through his mouth. This is not
a good sight, for there is something about the person’s
expression that suggests a vacuous or dull mentality,
a suggestion only and seldom true.
The lining or mucous membrane of the nose is
very sensitive and damage or injury renders it very
susceptible to infections that can easily impair the
general health of the body.
The hair serves to filter out dust or infectious
material that enters the nose from the air. The
breathing passages of the nose into the lungs are
quite small, curved and rigid and obstructions of
any kind may prove serious. When for any reason
the function of these individual units is impaired,
improper and inadequate breathing is apt to result.
Plastic surgery is utilized in the repair of the nose,
serving to restore good function and, frequently, im-
proved cosmetic appearance.
It is well recognized that an unsightly looking nose,
whether a congenital development or accidentally in-
curred, may be the source of deep-rooted emotional
conflict. A person who wishes a cosmetic repair should
not be criticized, for it is the feeling of well-being
in every man that gives him a sense of equality with
his associates. Indeed, it is this very cosmetic repair
that has returned many criminals and social out-
casts to a world of acceptance and competition.
In surgical repair, the required bones and martilages
are usually taken from some section of the patient’s
body. It is interesting that cartilage is the body tissue
most resistant to infection. It also requires less
nourishment than other tissues. Thus it can be safely
transplanted to another area with good results. Very
often in nasal repair, a skin flap from the forehead
is used.
When a nose has been destroyed by accident or
disease, a completely new nose has to be fashioned
from neighboring tissues. The most common repair,
however, consists of rearranging and remodeling the
nasal tissues still present to give the best function
and most pleasing effect.
Big deformities can grow from childhood injuries
and infections. Wise is the parent who detects breath-
ing difficulties in the child. Early correction will
obviate the development of later complications.
BOOK REVIEWS
Essentials of Obstetrical and Gynecological Pathology.
By Robert L. Faulkner, M.D., F.A.C.S., and Marion
Douglass, M.D. Published by C. V. Mosby Company,
St. Louis, Mo. Second edition, 1949.
The book is composed of 357 pages, containing 300
illustrations, including 3 color plates. The authors
are both practitioners and teachers in their respective
fields, have had years of clinical and surgical experi-
ence; therefore both are well fitted to write essentials
concerning the subject.
The volume is well-written and printed in large
readable type which not only obviates the necessity
of eye glasses, but makes the reader pleasantly com-
fortable. The illustrations are excellent. The treatise
is systematic beginning with the elementary histology
and ending with a chapter on pregnancy. I was im-
pressed with the discussions about the ovary, and the
cervix. It was surprising to note there was no mention
about Papanicolaou’s original methods for diagnosis of
cervical cancer. No cognizance has been taken either
about the use of the antibiotics in gynecology. Some
are using these substances to combat infections.
Physicians, and especially students who desire com-
petent information in gynecologic and obstetric path-
ology, will find this book very valuable. It is so compact
that much can be found without reading a great mass
of material elsewhere.
JACK C. NORRIS, M.D.
* * *
Social Medicine: Its Derivations and Objectives. By
The New York Academy of Medicine Institute on
Social Medicine, 1947. Edited by Iago Galdston, M. D.
Cloth. Price 2.75. Pp. 294. Published by The Com-
monwealth Fund, 41 East 57th Street, New \ ork 22,
N. Y., 1949.
* * *
Teaching Psychotherapeutic Medicine. An Experi-
mental Course For General Physicians. Given by
Walter Bauer, M.D., Douglas D. Bond, M.D., Henry W.
Bronsin, M.D., Donald W. Hastings, M.D., M. Ralph
Kaufman, M.D., John M. Murray, M.D., Thomas A.
C. Rennie, M.D., John Romano, M.D., Harold G.
Kolff, M.D. Edited by Helen Leland Witmer, Ph.D.,
Introductory Chapter by Geddes Smith. Cloth. Price
$3.75. Pp. 464. The Commonwealth Fund, 41 East 57th
Street, New York 22, N. Y„ 1948.
* * *
Trends in Medical Education. By The New Tork
Academy of Medicine Institute on Medical Education.
Edited by Mahlon Ashford, M. D. Cloth. Price $3.
Pp. 320. Published by The Commonwealth Fund, 41
East 57th Street, New York 22, N. Y., 1949.
* * *
Widening Horizons in Medical Education: A Study
of the Teaching of Social and Environmental Factors
in Medicine 1945-1949. A Report of the Joint Com-
mittee of the Association of American Medical Col-
leges and the American Association of Medical Social
Workers. Co-Chairmen, Jean A. Curran, M. D., Eleanor
Cockerill. Cloth. Price $2.75. Pp. 228. Published by
The Commonwealth Fund, 41 East 57th Street, New
York 22, N. Y„ 1948.
50
I he Journal of the Medical Association of Georgia
Ecology of Health. By The New York Academy of
Medicine Institute on Public Health. Edited by E. H.
L. Corwin, Ph.D. Cloth. Price $2.50. Pp. 1%. Pub-
lished by Tbe Commonwealth Fund, 41 East 57th
Street, New York 22, N. Y., 1949.
* * *
For the New Mother. By Mildred V. Hardcastle,
R.N. Illustrated hy Shirley Tattersfield. First edition.
The John C. Winston Company, 1010 Arch Street,
Philadelphia 7, Pa., Publisher, 1949.
This book "is a complete guidebook for baby's first
year. How to make formula, how to prepare baby’s
bath, what to feed baby, how to clothe him — the new
mother’s first questions are easily and thoroughly an-
swered. This book does not stop here. Mildred V.
Hardcastle, in a friendly, mother-to-mother manner, has
included suggestions on menus, schedules, diseases,
emergencies, baby sitting, thumb-sucking, plus friendly
advice for the mother to insure her health and her
happiness.”
* * *
Handbook of Medical Management. By Milton Chat
ton, A.B.. M.D., Instructor in Medicine, University of
California Medical School, San Francicso; Sheldon
Margen, A.B., M.D., Clinical Instructor in Medicine
and Research Associate in Medicine, University of
California Medical School, San Francisco; and Henry
D. Brainerd, A.B., M.D., Assistant Clinical Professor
of Medicine anil Pediatrics, University of California
Medical School, San Francisco, Assistant Clinical
Professor of Pediatrics, Stanford University School
of Medicine, Physician in Charge, Isolation Division
San Francisco Hospital. Price $3. Pp. 476. First
edition. University Medical Publishers, .Post Office
Box 761. Palo Alto, California, 1949.
This handbook looks good. It looks still better
when the authors say, "We believe that a book on
medical management can only be of greatest value
when it is revised at regular and frequent intervals.
This handbook will be revised yearly so that new
and accepted measures and methods can be incorpor-
ated. It is hoped that by this plan we can always
present a helpful and valuable pocket manual.”
* * *
The Origin of Medical Terms. Bv Henry Alan Skin-
ner, M. B., F.R.C.S. ( C. ) , Professor of Anatomy,
University of Western Ontario. Cloth. Price $7 Pp
379. The Williams & Wilkins Company, Baltimore,
1949.
This book should be a boon for every student of
medicine. It is attractive and will look well in any
library.
* * *
Antibiotics. By Robertson Pratt, Ph.D., Associate
Professor of Pharmacognosv and Plant Physiology,
University of California College of Pharmacy; Con-
sultant on Antibiotic Research and Jean Dufrenoy,
D. Sci. (Pharis), Research Associate in Antibiotics,
University of California College of Pharmacy. Cloth.
Price $5. Pp. 255, with 66 illustrations. J. B. Lippin-
cott Company, East Washington Square, Philadelphai,
Pa.. 1949.
This book truly portrays an honest effort to bring
to its readers the newer knowledge of antibiotics.
* * *
Physiology of Heat Regulation and The Science
of Clothing. Prepared at the Request of the Division
of Medical Sciences. National Research Council. Edited
by L. H. Newburgh. M.D., Professor of Clinical In-
vestigation. The Medical School. University of Michi-
gan. Cloth. Pp. 457. Illustrated. W. B. Saunders
Companv, Philadelphia. Pa., 1949.
1 his book, as stated above, was prepared at the
request of the Division of Medical Sciences of the
National Research Council. Various authors from
various sections of the world aided Dr. Newburgh.
The newer knowledge regarding the subjects covered
should be helpful to many people.
Human Pathology. By Howard T. Karsner, M.D.,
LL.D., Former Professor of Pathology, Western Reserve
University; Medical Research Advisor to the Bureau
of Medicine and Surgery, United States Navy. Seventh
edition. Cloth. Price $12. Pp. 927, with 562 luustra-
tions in Black and White and 22 Subjects in Color on
14 Plates. J. B. Lippincott Company, Philadelphia,
Pa., 1949.
Ripe with experience as a teacher and research worker
in human pathology. Dr. Karsner now brings to those
whose purpose it will be to use his book up-to-date
information. The book is attractive in every way.
* * *
An Atlas of Amputations. By Donald B. Slocum,
M.D., M.S., Orthopedic Surgeon, Sacred Heart General
Hospital, Eugene, Oregon; Member of American
Academy of Orthopaedic Surgeons; Member of the
American Society for Surgery of the Hand; Branch
Consultant in Orthopaedic Surgery, U. S. Veterans
Administration; Formerly Chief of the Amputation
Section, Walter Reed General Hospital, Washington,
D. C. Pp. 562, with 564 i' lustrations. Published by
The C. V. Mosby Company, St. Louis, 1949.
Every atlas must or should have numerous illustra-
tions. This one by Dr. Slocum, a recognized authority
on amputations and the subsequent handling of patients
who have had amputation performed, is in the opinion
of the reviewer complete in every detail and should
prove most helpful in solving many complex problems
both for the surgeon and amputee.
* * *
Fundamentals of Internal Medicine. By Wallace
Mason Yater. A.B., M.D.. M.S., Director Yater Clinic,
Washington, D. C. Third edition. Cloth. Price, $12.
Pp. 1451. with 315 illustrations. Appleton-Centurv-
Crofts Company, Inc.. 35 W. 32nd St., Newr York 1,
1949.
The first edition of this book appeared in 1938. It
originally was designed to present the essentials of
internal medicine in the simplest pos;ible form for
students and practitioners. This objective has been
achieved.
There are eighteen contributors in addition to Dr.
Yater. Nevertheless, the simple style and concise pres-
entation has been maintained throughout. The four
closing chapters are somewhat unusual and deal, re-
spectively, with "Symptomatic and Supportive Treat-
ment,” “Inhalational Therapy,” "Clinical Values and
Useful Tables” and "The Physician Himself,” the latter
including brief discussions of internships, licensure,
specailist certification, medical ethics and similar non-
scientific material, all of which is interesting and
useful.
Dr. Yater remarks in the preface to this edition that
he was struck with the tremendous number of changes
and additions necessary. Indeed, this problem must
have been faced hy everyone revising a textbook during
the past few years.
The attempt at simplification may have gone too
far in some cases. Most of the rarer diseases are dis-
cussed so briefly that they are hardly worth mentioning
at all. For example, David’s disease is dismissed with
the statement, "This is a rare condition of women in
which there are submucous and subcutaneous hem-
orrhages with normal blood factors.”
A convenient list of recommended texts appear at
the end of each chapter. It is difficult to keep these
ud to date. For example, on page 665 Means’ book.
"The Thyroid and Its Diseases,” is listed as published
in 1937 although the most recent edition appeared in
1948. Similarily, on page 1387 Wiprud has a new
edition of “The Business Side of Medical Practice.”
All in all, this book undoubtedly has met a real
need and should continue to be of help to the busy
practitioner and the overburdened medical student. —
J.A.M.A., Oct. 22, 1949.
THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia, February, 1950 No. 2
BREECH PRESENTATION:
IS FETAL EXTENSION AN ETIOLOGIC
FACTOR?
Guy L. Calk, M.D.
and
Richard Torpin, M.D.
A ugusta
Literature on the subject of breech pres-
entation is readily available from the stand-
point of management and treatment, but
very little has been written and still less re-
search has been done concerning the etiol-
ogy of this presentation. It is generally
stated that anything which disturbs the nor-
mal utero-fetal accommodation by altering
either the space in the uterine cavity or the
shape of the fetal ovoid, predisposes to
breech presentation. Little attention is given
to the intrauterine attitude and activity of
the fetus as a causative factor in breech
presentation because there has been a ten-
dency in the past to assign to the fetus a
passive rather than an active role in deter-
mining its ultimate position. Not until 1940,
when Vartan1 2 first suggested that an ex-
tended attitude of the fetus might be a cause
rather than effect of breech presentation,
due to interference with fetal activity, was
interest renewed in the causation of this
error of polarity.
Even today the popular textbooks of ob-
stetrics list various causes of the breech
presentation and these may be reiterated as
follows: contracted pelvis, polyhydramnios,
From the Department of Obstetrics and Gynecology, Uni-
versity of Georgia School of Medicine, Augusta, Georgia.
Read before the Medical Association of Georgia in annual
session, Savannah. May 12, 1949.
low insertion of the placenta, fetal malfor-
mations, especially hydrocephalus, tumors
obstructing the birth canal, abnormally
shaped uteri, including arcuate, bicornuate,
and septate configurations, prematurity, and
multiple pregnancy. In some textbooks it is
even stated that a satisfactory answer as to
the cause of most breech presentations can
not he given. With the exception of prema-
turity and multiple pregnancy, one is im-
pressed with the relative infrequency of oc-
currence of these alleged causes.
Prematurity has definitely been estab-
lished as a predisposing factor in breech
presentation. Weisman1 in studying fetal
polarity by roentgenographic methods at
certain stages of pregnancy, found that the
breech presentation was common until the
last month or so of pregnancy, having ob-
served in 100 primigravidous women at 5
months’ gestation the breech presentation in
24 cases and in two cases an oblique or
transverse presentation. Only seven of the
24 cases of breech persisted until the eighth
month of gestation. Both transverse presen-
tations turned to a cephalic presentation
spontaneously. Hence it is necessary to
separate the premature from the mature in
making a study of the causes of breech pres-
entations. The generally accepted dividing
line of the infant’s weight in differentiating
between maturity and prematurity is 2500
grams or 5.5 pounds.
Twin pregnancy should likewise be ex-
cluded from any study concerning the etiol-
ogy of breech presentation since most phy-
sicians will agree that the multiple preg-
nancy predisposes to a breech presentation
in one fetus. This may he due to interfer-
52
The Journal of the Medical Association of Georgia
ence with fetal activity but more likely to
natural accommodation.
A critical analysis of the suggested causes
of breech presentation with the exclusion of
prematurity and multiple pregnancy was
made by Tompkins4 from hospital records
in 677 deliveries by the breech mechanism.
He could account for only 15 per cent of
these deliveries on the basis of accepted
etiology, having placed contracted pelvis as
a causative factor in 11 per cent, gross fetal
malformations in 1.4 per cent, placenta
previa in 1.2 per cent, and pelvic tumors in
0.6 per cent of the cases.
As we review the alleged causes of breech
presentation, we find that some causes were
used in their loosest sense and others were
difficult to define. For instance, concerning
contracted pelvis a standard could be set
down to denote whether or not a' pelvis is
contracted but with such a standard we
would be incorrect in saying that some in-
fants could not deliver through a small
pelvis. Neither would we be correct in say-
ing that a pelvis is adequate when the infant
is exceedingly large and could not deliver
due to cephalo-pelvic disproportion.
Polyhydramnios is another reputed cause
of breech presentation but there is no uni-
versal agreement concerning the amount of
anmiotic fluid necessary to constitute this
condition. It has been our policy at the
University Hospital to denote by polyhy-
dramnios an estimated volume of anmiotic
fluid of more than 2000 cc.
Abnormality of the uterus as such is a
rather infrequent occurrence. We do not
doubt, however, that any abnormality of the
uterus in which there is encroachment on or
modification of the uterine cavity will cause
breech presentation by altering fetal activity
to the extent that it is impossible for the
fetus to assume a cephalic presentation.
This point also speaks in favor of uterine
tumors being causative where interference
with fetal activity exists, but not because
the birth canal is obstructed.
Gross fetal malformations have been
noted to increase the incidence of faulty
presentation in large series of cases. Young'’
has pointed out that two thirds of infants
w ith gross fetal malformations will deliver
by the occiput presentation, while the re-
maining one third will deliver by combina-
tion of breech, transverse and other cephalic
presentations. It should be mentioned, how-
ever, that fetal malformations may cause
diminished activity within the uterine cav-
ity, since it is frequently observed that mal-
formed infants have a tendency to be lan-
guid after birth.
Our study was undertaken at the sugges-
tion of Dr. Eugene L. Griffin of Atlanta,
Georgia, as an effort to investigate the rela-
tionship, if any, of fetal extension to breech
presentations persisting at term.
Our original study was based on a total
of 118 cases of breech presentation on which
roentgenograms were available. However,
the hospital records could be found to com-
plete this study in only 88 cases. We have
included only mature single breech cases,
since prematurity and multiple pregnancy
are admittedly predisposing causes. The
majority of the 88 roentgenograms were
taken with the patient in the right lateral
position because it has been routine for the
past ten years to take lateral films of the
abdomen in all staff pregnancy patients ad-
mitted to the hospital, in order to determine
the exact position and site of placental in-
sertion whenever possible. This study is
thought to be the only one which deals di-
rectly with the roentgenograhic interpreta-
tion of intrauterine fetal attitude, although
in 1941 Stein1' reported that the extended
attitude of the fetus was generally observed
in roentgenograms of breech presentation,
but gave no statistical analysis to prove his
statement. The roentgenographic interpre-
February, 1950
tation in making a study such as this must
he done with extreme care in order to avoid
errors. Particular attention has been placed
on accurate visualization of the extremities
so that the bones of the upper and lower
extremities would not be confused. More
emphasis has been placed on the position
occupied by the lower extremities, for it is
our opinion that extension of the legs at the
knees, as seen in frank breech deliveries,
has the most important role of interfering
with fetal activity by its splinting effect.
In some cases, as would be expected, the
lower extremities were difficult to visualize
due to the low station of the breech in the
pelvis. Whenever difficulty was encoun-
tered in the interpretation, the fetal attitude
was assumed to be full flexion with no fur-
ther argument. In order for the fetal atti-
tude to be designated as extension, one or
both lower extremities had to be extended
at the knees more than an angle of 90 so
that a splinting effect was demonstrable.
Only full extension of the head is tabulated
in the results, since a simple military atti-
tude of the head is not considered of sig-
nificance in obstructing fetal activity to the
extent of being causative in breech presen-
tations persisting to term.
In analyzing the 88 roentgenograms of
breech presentations at term, we observed
an extended fetal attitude as depicted above
in a total of 61 instances, or 69.32 per cent.
A differential study revealed both lower
extermities extended as in frank breech
presentations in 40 instances, or 45.46 per
cent, one lower extremity extended in 18
instances, or 20.46 per cent, and the head
extended in 3 instances, or 3.42 per cent.
The flexed attitude was observed in 27 in-
stances, or 30.68 per cent.
An equal number of unselected films in
which the cephalic pole presented was
studied for comparative purposes. The
same requirements which were used to de-
53
note extension in the breech group of films
are maintained in this study. In the 88
cephalic presentations, the extended atti-
tude of the fetus was observed in a total of
12 cases, or 13.64 per cent. None of this
group revealed extension of both lower ex-
tremities or extension of the head, but one
lower extremity was extended in all 12
cases.
From the foregoing study it appears that
an extended fetal attitude has a causal rela-
tion to breech presentation persisting at
term.
An additional study was made from the
roentgenograms to determine the role
played by the site of placental insertion in
causing the breech presentation, since low
insertion of the placenta was given as an
alleged cause. In lateral films of the abdo-
men, we have found that the site of placental
insertion can be visualized in approximate-
ly 85 to 90 per cent of the cases. We were
able to visualize the site of insertion of the
placenta in 88.64 per cent in the breech
group and in 93.20 per cent of the cephalic
group of films. The results of this study
revealed the placental location to be high
on the posterior uterine wall in 51.14 per
cent in the breech group, as compared to
56.82 per cent in the cephalic group. The
placenta was located high on the anterior
uterine wall in 34.09 per cent in the breech
group, as compared to 36.37 per cent in the
cephalic group. In so far as a low insertion
of the placenta is concerned in the breech
presentations, one film demonstrated a low
insertion of the placenta on the posterior
uterine wall and two films demonstrated a
low insertion of the placenta on the anterior
uterine wall. From this study we conclude
that the site of placental insertion has little
significance in causing the breech presen-
tation.
A review of the hospital records in the 88
cases of breech presentation serves to com-
54
The Journal of the Medical Association of Georgia
plete our study. In 18 cases, as is generally
done when practical, prophylactic external
version was performed and the infants were
delivered from a cephalic presentation. In
4 cases, with the splinting effect of the legs
prevailing, prophylactic external version
met with failure, even after repeated at-
tempts. I he diagnosis of polyhydramnios
was made clinically in only one case. The
hospital records confirmed the only case of
hydrocephalus in which the diagnosis was
initially made by roentgenographic inter-
pretation. Cesarean section was performed
in 3 cases. In one, the patient was a staff
case and cesarean section was performed be-
cause of an exceedingly large infant weigh-
ing 12 pounds 4 ounces at birth. The two
remaining cesarean sections were per-
formed on private patients, the indication in
both being given as a small pelvis with a
large infant. No mention was made in any
case record of placenta previa, uterine tu-
mors, or deformities of the uterus.
In summary, the alleged causes of breech
presentation wrere critically reviewed and
were found to play very little part in the
etiology in reported series studied. A roent-
genographic survey of 88 cases of breech
presentation was made to determine the inci-
dence of an extended intrauterine fetal atti-
tude. The investigation revealed an extend-
ed attitude in a total of 61 instances, or
69.32 per cent. Both lower extremities were
found to be extended in 40 instances, or
45.46 per cent, one lower extremity extend-
ed in 18 instances, or 20.46 per cent, the
head extended in 3 instances, or 3.42 per
cent, and a full flexion attitude of all appen-
dages was observed in 27 instances, or 30.68
per cent. A comparable study was made in
a similar number of roentgenograms in
which the cephalic pole of the fetus was pre-
senting. In this group of films the extended
attitude was observed in a total of 12 in-
stances, or 13.64 per cent. In no incident
was an attitude of extension of both lower
extremities or extension of the head noted.
One lower extremity was extended in all 12
cases. The site of placental insertion from
a study of the roentgenograms was found to
have no statistical significance in causing
breech presentation.
BIBLIOGRAPHY
1. Vartan, C. Keith: Cause of Breech Presentation, Lancet
1: 595, 1940.
2. Ibid: Behavior of Fetus in Utero with Special Reference
to the Incidence of Breech Presentation at Term, J. Obst. &
Gynec. Brit. Emp. 52:417 (Oct.) 1945.
3. Weisman, A. I. : An Antepartum Study of Fetal Polarity
and Rotation, Am. J. Obst. & Gynec. 48:550, 1944.
4. Tompkins, Pendleton : An Inquiry Into the Causes of
Breech Presentation, Am. J. Obst. & Gynec. 51:595 (May)
1946.
5. Young, R. L. : Abnormal Presentation Among Mal-
formed Infants, Am. J. Obst. & Gynec. 52:419, 1946.
6. Stein, I. F. : Deflection Attitudes in Breech Presenta-
tion, J.A.M.A. 117:1430, 1941.
BICORNATE UTERI: OBSTETRIC
COMPLICATIONS
T. Schley Gatewood, M.D.
Americus
This congenital anomaly exists more fre-
quently than realized. Everyone doing ob-
stetrics should consider this anomaly when
complications of pregnancy or labor occur.
I have had three known cases of bicornate
uteri in my practice during the past six
years. The complications arising in one
case were the stimuli for this paper. A re-
view of the complications found in the litera-
ture has been made. To bring these to our
attention should make us more conscious of
this anomaly and its complications, thus
improving our diagnostic acumen as ob-
stetricians and as surgeons.
The occurrence of this maldevelopment is
better understood when we realize how the
vagina and the uterus develop in embryo.
There is a fusion from below upwards of the
two mullerian ducts. Improper fusion can
result in varied anomalies. Any variation
observed in the lower genital tract, such as
vaginal septa or cysts, or double cervices,
should bring to mind the possibility of mal-
fusions in the upper genital tract. (Show
slide of anomalies).
Very able investigators’ J have estimated
Read before the Medical Association of Georgia in annual
session, Savannah, May 11, 1949.
February, 1950
55
the frequency of occurrences in pregnancy.
Their estimates vary from one case in 100
pregnancies to one case in 1500 pregnan-
cies.
Complications
1. Bleeding During Pregnancy. The non-
pregnant horn may continue to menstruate
at monthly intervals — this may be very con-
fusing. Mrs. B, one of my cases did this.
Gill stressed that bleeding with pregnancy
and adnexal mass, as presented by rudimen-
tary horn, may cause false diagnosis of
tubal pregnancy.
2. Ectopic Pregnancies. Beaver and Ab-
bott4 report one case but found in reviewing
the literature from 1922 to 1936 there were
over 40 such cases in 246 cases of malfor-
mations of the uterus.
3. Incarceration or Torsion of Nonpreg-
nant Cornu. A case of unilateral hysterec-
tomy of the nonpregnant cornu (enlarged
due to hormonal influence) that had become
incarcerated in the pelvis has been reported
(Moore5) successfully carried out without
interruption of a 2x/l months pregnancy in
the horn.
4. Repeated Miscarriages. Aldridge1’ re-
ports a case that aborted four times then had
excision of the extra cornu and then aborted
the fifth time, but carried a sixth pregnancy
to term, being delivered by cesarean section;
a seventh pregnancy reached term but the
uterus ruptured. The baby was asthenic and
died four hours after birth.
5. Mummified Fetus. Pearson' reported
an interesting case where the fetus had died
and became mummified, a supracervical
hysterectomy being done the 13th month of
gestation; the other horn, which appeared
normal at operation, delivered a 9 pound
boy one year and four days following opera-
tion. Labor was without serious complica-
tions.
6. Passage of Decidual Cast. Corbett8
reported a decidual cast of the nonpregnant
cornu being expelled three weeks before
term; an uneventful delivery occurred ten
days later.
7. Accompanying Other Malformations.
Rogers and Blocksom" reported a case of
pregnancy in a bicornate uterus, who also
had a congenital absence of arms with a
rectovaginal fistula and a congenital heart.
Browne1" had a vaginal wall cyst, either
arising from Gartner’s duct or the Wolffian
duct, that prolapsed in front of the baby’s
head, necessitating aspiration.
8. Twins and Superfetation. Moncure11
reports one case that was with twins again
4V2 months after cesarean for twins. Other
authors have reported twin pregnancies.
Pregnancy in both horns may cause poor
contractures, malpresentations, and necessi-
tate cesarean section. Such a case was re-
ported by Bailey14. Brase14 delivered twins
from separate cornu weighing 5 lbs. 12 ozs.
and 6 lbs. 9 ozs.
9. Dystocia. Here the nonpregnant cornu
prolapses under the pregnant portion caus-
ing obstruction. The nonpregnant horn un-
dergoes considerable enlargement during
pregnancy due to an accompanying hor-
monal influence. Adam15 reports such a
case. The patient’s first child was a still-
born due to difficult labor. The second preg-
nancy was terminated by cesarean opera-
tion. (One of my cases was similar to this —
Mrs. B). He also reports another case who
miscarried once and then with the second
pregnancy the nonpregnant cornu was ex-
cised at five and one half months and at term
the delivery was uneventful.
10. Rupture of Uterus. Moore" states
that rupture of the pregnant horn and tor-
sion or incarceration of the nonpregnant
horn in the pelvis are the more common
abdominal emergencies occurring during
pregnancy. He cited 9 cases found in the
literature of rupture of the uterus during a
ten-year period. Ritter10 describes Benoit
Vassal’s case in 1669, “a woman of 32 years
of age who gave birth to eleven children
56
I he Journal of the Medical Association of Georgia
spontaneously and who died suddenly dur-
ing the third or fourth month of her twelfth
pregnancy. At postmortem examination a
bicornate uterus was found with rupture of
the rudimentary left horn of the uterus,
with hemorrhage and extrusion of the fetal
contents into the peritoneal cavity. It seems
that the previous pregnancies were in the
right uterus.” Robinson1 ' has reported a
case of rupture of the bicornate uterus at 38
weeks of pregnancy caused by lying on the
stomach for x-ray studies. Titus1s states that
“pregnancy in bicornate uterus or uterus
didelphys is as serious as that in a tube be-
cause of the danger of rupture.” Ewer1'1
warns that pregnancy in the rudimentary
horn is more dangerous because sometimes
there is no connection between the horns
and rupture will occur. He also observed
that breech presentations seem more fre-
quent.
11. Retained Placenta. Two cases have
been reported.
12. Postpartum Hemorrhage. Caused by
atony in the third stage has been reported.
REPORT OF CASES
Case 1. A. P. B., aged 26, white female, para 1,
grav 1, reported 11 weeks after the last menstrual
period complaining of nausea and vomiting. Pelvic
examination revealed a soft, blue cervix that felt
continuous to a mass in the left adnexa, and in the
right adnexa was a larger orange-size mass with nodular
projection into the vagina. Impressions: Pregnancy
( 1 ) uterine and right tubal, (2) right tubal, (3)
uterine with dermoid cyst. A consultant saw her and
thought she had a (4) uterine pregnancy with right
pyosalpinx. Two weeks later she was feeling better
but reported having noticed a dark bloody discharge
for past four to five days. Pelvic findings were essen-
tially the same; speculum examination revealed “an
old blood clot or piece of placental tissue” lying in
the os. (In retrospect she must have been bleeding
from the nonpregnant cornu and perhaps shedding
a decidual cast). At the next two weeks' visit pelvic
examination revealed the fundus seemingly symmetrical
and the cervix running unusually posteriorly. She was
seen at two-week intervals to term, no further pelvic
examinations being done as her prenatal progress
appeared to be normal. At term she went into labor;
vaginal examination showed a large thick mass about
6 cm. diameter in the left posterior pelvis; a con-
sultant examined the patient and agreed that the
patient had a fibroid of cervical orgin, that it was
blocking the passage sufficiently to prevent vaginal
delivery and that a cesarean was indicated. At opera-
tion a bicornate uterus was found; the right cornu
was 8 cm. in diameter and was rotated and prolapsed
into the posterior pelvis; a small benign pedunculated
fibroid arose between the two cornu.
The multiplicity of impressions and the threat of
abortion caused much concern during the first few
weeks, all because the proper diagnosis was not made.
Case 2. Mrs W. M., aged 37, white female, para 111,
grav 111, was first seen by me at home on a cold
rainy night in February 1941 in hard labor with breech
presenting; delivery terminated spontaneously and
quickly. Two previous labors had been normal also.
On April 21, 1948 she reported her last menstrual
period March 12-18, and slight spotting on April 17
and 18, with pain in left side as at last parturition
in 1941, and continues to have slight abdominal pain.
Pelvic: cervix soft; fundus slightly enlarged and pushed
to right by bard mass which extends almost half
way to umbilicus. Three weeks later, on May 11,
she reported having spotted on May 5 and May 10,
and that pain and soreness in the left side continued.
She was explored with these preoperative impressions:
(1) ovarian cyst, (2) ectopic, (3) bicornate uterus-
pregnant. Operation revealed a bicornate uterus; the
left cornu was 8 cm. in diameter, soft and blue con-
taining a 7 weeks embryo, and the right cornu was
4 cm. diameter. A supracervical hysterectomy was
done. Convalescence was uneventful.
This case illustrates how spotting with pregnant
bicornate uteri confuses the diagnosis, and that normal
pregnancy and labor occurs.
Case 3. Mrs. T. J. R., white female, aged 31, para
1, grav 1. Chief complaint: sterility and dysmenorrhea
of long standing — seven years previously had normal
delivery of full term male infant. Pelvic examination
showed a large hard stellately lacerated cervix with
erosion and acute tenderness to motion. Palpation of
fundus unsatisfactory. Biopsy cervix: no evidence of
malignancy. Eight months later in left angle of
cervical laceration a sinus about 3 cm. deep could be
probed ; the lower broad ligaments remained tender.
The fundus was normal size and to the right; the left
adnexa contained a firm mass somewhat larger than
a golf ball. Dysmenorrhea continued marked, and
patient complained severely of a heavy bearing down
feeling in the lower abdomen. At laparotomy a bicor-
nate uterus with many adhesions throughout pelvis
was found and a total hysterectomy was done. Con-
valescence was uneventful.
Preoperatively, this patient was thought to have
an ovarian cyst, though a bicornate uterus was con-
sidered. Three years postoperative a large vaginal
fold 3x5 cm. was noted in the posterior proximal
half of the vagina. This fold undoubtedly represented
poor fusion of the lower mullerian ducts. This case
demonstrates that I failed to examine the vagina proper-
ly preoperatviely. I failed to discover this diagnostic
clue until I became more conscious of bicornate uteri.
Discussion
Authors vary in their respect for preg-
nancies in bicornate uteri. Mengert22 writes
“although duplication of the generative
tract is not uncommon, its obstetrical sig-
nificance has been greatly overemphasized.
It should he remembered that most animals
possess double uteri which practically never
give rise to dystocia. So also, duplication in
the human is a rare cause of dystocia, and
most double uteri remain undiagnosed”.
Smith' who reported 35 cases of double
uterus with pregnancy, occurring at the
New York Lying-In Hospital from 1899 to
1930, made these five conclusions: (1) fre-
February, 1950
57
quency, once in 1500 pregnancies, (2) an
increased tendency to abortion, (3) a great-
er liability to premature labor, (4) mater-
nal morbidity and mortality are higher, (5)
fetal and infant mortality are higher and
(6) the necessity for operative correction
has been greatly exaggerated. He had no
case of rupture of the uterus and yet the
literature is full of them. DeLee-' says
“labor is often normal” and then lists the
complications that occur. Titus1 s wrote that
“pregnancy in bicornate uterus or uterus
didelphys is as serious as that in a tube
because of the danger of rupture”. Moore0
wrote “rupture of the pregnant horn and
torsion or incarceration of the nonpregnant
horn in the pelvis are the more common ab-
dominal emergencies occuring during preg-
nancy”.
Summary and Conclusions
1. Attention has been called to some of
complications occurring during pregnancy
and labor. Three case reports have been
presented.
2. Bicornate uterus with pregnancy oc-
curs more frequently than commonly real-
ized.
3. Accurate diagnosis is difficult.
4. Pregnancy and labor are frequently
normal.
5. Complications are common and dan-
gerous.
BIBLIOGRAPHY
1 Falls, F. H. : A Study of Pregnancy and Parturition
in Primiparae with Bicornate Uteri, Am. J. Obst. & Gynec.
15:399. 1928.
/2. . Smith, F. R. : The Significance of Incomplete Fusion
of— the Mullerian Ducts in Pregnancy and Parturition, with
Report on 35 Cases: Am. J. Obst. & Gynec. 22:714-728,
(Nov.) 1931.
3. Gill, J. J. : Pregnancy in Bicornate Unicollis Uterus
with the Child Occupying Both Horns: Am. J. Obst. &
Gynec. 19:553-554 (April) 1930.
4. Beaver, M. G., and Abbott, K. H. : Normal Pregnan-
cies and Deliveries in Bicornate Uteri, California & West.
Med. 47:41-42 (July) 1937.
5. Moore, G. A. : Bicornate Uterus with Report of an
Unusual case, New England J. Med. 208:887-890 (April)
1933.
6. Aldridge, A. H. : Pregnancy in One Horn of a Bicornate
Uterus Following Extirpation of the Other Horn, Am. J.
Obst. & Gynec. 24:137-140 (July) 1932.
7. Pearson, M. W., and Angier, H. W. : Pregnancy in
Bicornate Uterus: Case Report, New England J. Med.
214:583-584 (March 19) 1936.
8. Corbett, R. M. : Pregnancy in a Uterus Bicornis,
Brit. M. J. 2:894 (Dec. 22) 1945.
9. Rogers, M. P., and Blocksom, B. H., Jr.: Pregnancy
in Double Uterus, Illinois M. J. 76:270-271 (Sept.) 1939.
10. Browne, O'D.: Pregnancy in a Bicornate Uterus,
Irish J. M. Sc. 165-167 (April) 1938.
11. Moncure, St. L. P. : Anomalies of Generative Organs,
with Report of Rather Remarkable Case (Uterus Bicornis
Duplex with Twin Pregnancy). Virginia M. Monthly,
66:593-596 (Oct.) 1939.
12. Rowlett, W. M.: J. Florida M. A. (July) 1925.
13. Bailey, R. B. : Twin Pregnancy in a Bicornate
Uterus. Proc. Staff Conf. Wheeling Clin. 9:29 (Feb. 1)
1939.
14. Braze, A.: Bicornate Uterus with Pregnancy in Each
Horn, J. A. M. A. 123:474-476 (Oct. 23) 1943.
15. Adam. G. S. : Pregnancy Complicated by a Double
Uterus; a Report of 2 Cases, M. J. Australia 2:649-650
(Dec. 6) 1941.
16. Ritter, S. A.: Case of Bicornate Uterus, with Double
Cervix and Double Vagina, M. Times & Long Island M. J.
61:373-375 (Dec.) 1933.
17. Robinson, D. W. : Pregnancy in a Uterus Bicornis,
Brit. M. J. 1:836 (June 1) 1946.
18. Titus, Paul: Management of Obstetric Difficulties,
St. Louis, The C. V. Mosby Company, 1945, p. 139.
19. Ewer, J. M.: Genital Anomalies with Pregnancy,
West. J. Surg. 51:94-101 (March) 1943.
20. McDonald. R. E. : Retained Placenta in a Bicornate
Uterus, Minnesota Med. p. 579 (Sept.) 1927.
21. Michael, W. A.: Pregnancy in Uterus Bicornis Uni-
collis with the Child Occupying One Horn and the Placental
Site a Portion of Both, Am. J. Obst. and Gynec. 21:133-135
(Jan.) 1931.
22. Mengert, W. F. : Postgraduate Obstetrics, New York,
Paul B. Hoeber, Inc., 1947, p. 269.
23. DeLee, J. B. : The Principles and Practice of Obstet-
rics. 1933, p. 559.
DIABETES IN PREGNANCY
John R. McCain, M. D.
and
William M. Lester, M.D.
Atlanta
Diabetes mellitus is one of the serious
complications of pregnancy. Prior to the
discovery of insulin pregnancy was infre-
quent, the maternal mortality was about 25
per cent, and the infant loss approximately
50 per cent. By the use of insulin to control
diabetes the maternal mortality has been
reduced sharply and is now about 2 per
cent. The fetal salvage under insulin ther-
apy has improved to a less marked degree.
Most investigations have reported a survival
of 40 to 70 per cent although some have
indicated a stillbirth and neonatal mortality
of only 10 to 20 per cent.
Our study is a review of the diabetic preg-
nancies in a clinic that has not had facili-
ties for close coordination of the obstetric
and diabetic services, during a time when
no special emphasis was placed upon this
complication. These circumstances resem-
ble the limitations experienced by many
physicians and obstetricians in their man-
From the Department of Obstetrics of Emory University
School of Medicine and Grady Memorial Hospital.
Read before the Medical Association of Georgia in annual
session, Savannah, May 12, 1949.
58
The Journal of the Medical Association of Georgia
agement of such patients. Our investigation
indicates the results that they may expect.
This report is a study of 21 pregnancies,
occurring in 20 diabetic patients, that have
been delivered at Grady Memorial Hospital
under the supervision of our department
from July 1932 through December 1948.
We have also included 6 diabetic pregnan-
cies of three women that were not delivered
on our service. The findings in these two
groups are similar and the cases are com-
bined for this review. In addition, we have
evaluated 97 pregnancies that occurred in
19 women before their diabetes was diag-
nosed.
Diabetic Pregnancies
Incidence : One of the most surprising
features of our report was revealed as we
studied the incidence of this condition. Prior
to July 1945 the department of medicine
had limited facilities for the management of
diabetic out-patients; but since that date the
Diabetic Clinic has had more adequate
supervision of these cases. Between July
1932 and January 1946 there were only
three diabetic pregnancies in approximate-
ly 29,000 deliveries. However, concomitant
with the improved control of diabetes, preg-
nancies complicated by this disease have
increased. Since January 1946, 18 diabetic
patients have been delivered. Fourteen of
these were among 10,446 deliveries of col-
ored women, while four were among 3,290
deliveries of white patients.
Diabetic Status: Diabetes mellitus had
been diagnosed before the onset of preg-
nancy in 18 instances. The known duration
of the disease before conception varied from
one month up to eighteen years. Nine pa-
tients were found to he diabetic for the first
time during the pregnancy involved, four
having the diagnosis established during the
admission upon which they delivered. Three
of the patients that aborted had no prenatal
care, and 7 mothers had no supervision of
the diabetes in their antepartum course. The
severity of the diabetes was classified for
each pregnancy as suggested by Joslin.1 The
distribution was equal, 9 patients having
mild diabetes, 9 moderate, and 9 severe.
Only five of the diabetic mothers were
over 35 years of age at the time of their
delivery. Nine patients weighed more than
175 pounds, and five of these weighed more
than 225 pounds. This was the first preg-
nancy for 9 of the women.
Antepartum Course: Spontaneous abor-
tions occurred four times. Acidosis was
present in 11 pregnancies but no diabetic
coma developed. One patient had a mild
hypoglycemic reaction, but there was no
hypoglycemic shock. Mild polyhydramnios
was present in three cases. Serious infec-
tions associated with the acidosis compli-
cated the antepartum course of two patients.
One of these was an abscess of the thigh,
while the other was a severe laryngitis ne-
cessitating a tracheotomy. Fetal death ap-
parently occurred at this time in both preg-
nancies.
Late toxemias developed in 13 preg-
nancies. Mild preeclampsia accounted for
11 of these cases, one patient had severe
preeclampsia, and another one had eclamp-
sia. Four patients had mild essential hyper-
tension, hut in only one of these was there a
superimposed preeclampsia.
Labor: The onset of labor was at term in
14 pregnancies while in 8 patients it oc-
curred between the thirty third and thirty
seventh week of gestation. The premature
labor began spontaneously in five of the
cases, but three of these delivered macerated
fetuses before the thirty sixth week. The
three premature labors induced artificially
delivered babies that survived.
Breech presentations occurred five times,
but only one infant lived. The other four
had been dead more than three days before
the onset of labor.
Cesarean section was performed for ob-
stetric indications alone. Three pregnancies
February, 1950
59
were terminated in this manner and the
three infants lived. In one case an elective
repeat cesarean section was done at thirty
seven weeks. The breech presentation that
resulted in a living child was delivered by a
low cervcial cesarean because of the failure
of the frank breech to engage. The third
patient was admitted at term in moderately
severe acidosis with the membranes rup-
tured. Intrauterine infection became evi-
dent twenty four hours later with tempera-
tures of 101 to 102 F. An unsuccessful at-
tempt was made to stimulate labor by means
of a Voorhees’ hag. After a latent period of
forty eight hours and a fifty two hour labor,
with mild acidosis still present, a Porro
cesarean section was done. The 4300 gram
infant survived, but the mother died of ex-
tensive bronchopneumonia and pulmonary
edema on the second postoperative day.
Puerperium: Two patients had a septic
endometritis postpartum. Three other cases
had a temperature elevation of 102 F. on
the second postpartum day, the cause of
which could not be found. The postoperative
death has been discussed.
Results for Infant : The infant mortality
for the 27 pregnancies was 55.6 per cent.
This total was composed of 4 spontaneous
abortions, 7 macerated stillbirths, 2 fetal
deaths in labor, and 2 neonatal deaths. Ob-
stetric reasons could be found to account for
the loss of 5 of these infants. The mother of
one had eclampsia and another patient had
severe preeclampsia. Three babies weighed
over 10 pounds and their deliveries were
quite difficult.
Factors that complicated the diabetes
mellitus may have contributed to the death
of many of these infants. These have been
summarized in Table 1. All of the 5 pa-
tients over 35 years of age lost their infants.
One of these mothers had essential hyper-
tension and three others had mild pre-
eclampsia. There were 6 patients under the
age of 35 years whose diabetes was of 10
years duration or longer (10 to 18 years).
Six infants from the seven pregnancies in
these mothers were lost. Eclampsia compli-
cated one case in which the fetus died, and
mild preeclampsia occurred in another.
Certain other conditions associated with
the diabetes may have increased the hazard
to the child. Only two babies survived of
the nine born to patients with severe dia-
betes. The nine obese mothers lost six of
their infants. Five of these six pregnancies
were complicated by the patients being
over 35 years of age or by the diabetes being
of 10 years duration. Acidosis may have
contributed to the occurrence of fetal death
before the onset of labor as it had been
present before the delivery of six of the
seven macerated fetuses. Late toxemias or
acidosis developed in 19 of the pregnancies
that went to viability and in five of these
cases both conditions were present. Ten of
the 11 deaths of viable infants occurred in
patients with one or both of these complica-
tions.
The infants weighed over 3,650 grams
(over 8 pounds) in 13 of the 23 pregnancies
TABLE 1. FETAL RESULTS
Maternal Factors
Complicating Results
Number
of Cases
Living
Babies
Abortions
Macerated
Stillbirths
Intrapartum
Deaths
Neonatal
Deaths
Per Cent
Infants Lost
Total Number of Pregnancies ....
... 27
12
4
7
2
2
55.6
Age: 35 years or older
..... 5
0
1
2
0
2
100.0
Diabetes 10 years or longer
.... 7
1
2
3
1
0
85.7
Severe diabetes ... ..
..... 9
2
1
5
0
1
77.8
Obesity
..... 9
3
3
1
0
2
66.7
Acidosis -
... 11
4
0
6
0
1
63.6
Toxemia
.... 13
7
0
3
1
2
46.2
Acidosis and/or Toxemia
..... 19
9
0
7
1
2
52.6
60
The Journal of the Medical Association of Georgia
TABLE 2. PREDIABETIC PREGNANCIES
Years before Total Neonatal Total Fetal Per Cent
Diabetes Diagnosed Pregnancies Abortions Stillbirths Deaths Loss Fetal Loss
I- 5 years 30 6 8 2 16 53.3
6-10 years 26 2 5 1 8 30.8
II- 15 years 20 3 3 0 6 30.0
16 years and over 21 1113 14.3
that went to viability. Five babies weighed
less than 2,500 grams. No significant con-
genital anomalies occurred.
Prediabetic Pregnancies
The prediabetic pregnancies of 19 pa-
tients have been reviewed. These mothers
had 97 pregnancies before they were diag-
nosed as being diabetic, and the results of
these are summarized in Table 2. The in-
fant did not survive in 34.0 per cent of the
cases.
The fetal weight was definitely known in
only 18 of the deliveries during the ten
years before diabetes was diagnosed. Eleven
of these were in the preceding 5 years, and
63.6 per cent of these infants weighed 8
pounds or more. Seven delivered more than
5 years before the diagnosis was established,
and none of these babies weighed as much
as 8 pounds.
Discussion
The fetal birth weights and the infant
mortality rates of the cases of this report
were abnormally high prior to the onset of
clinical diabetes. For the five years preced-
ing this diagnosis the rates were about the
same as those found in diabetic patients.
The infant mortality was increased above
normal, however, for more than ten years
before the diagnosis was made. The results
in the prediabetic pregnancies of our study
are in agreement with the reports of oth-
2 3
ers.
Until the diabetic patient is fairly well
controlled with insulin or by diet alone, the
problem of diabetes mellitus as a compli-
cation of pregnancy is rare. From 1932 to
1945 the infertility of the diabetic women
being treated at Grady Memorial Hospital
suggests that the regulation of their diabetes
was not adequate. The incidence of preg-
nancy increased as soon as the control of
the diabetes improved in 1945.
After pregnancy has occurred, the dia-
betic and obstetric supervision of the pa-
tient must be carefully coordinated if an
excessive infant mortality is to be prevented.
The control of the diabetes and its compli-
cations must extend throughout the entire
pregnancy. Regulation of these patients is
more difficult because of the changes in
insulin requirement during pregnancy. In
addition, urinary sugar levels become un-
reliable for determining insulin dosage.
This is caused by the frequency with which
lactose appears in the urine and by the
lowered renal threshold for glucose during
pregnancy.
Several factors related to the diabetic
status seemed to contribute to the fetal loss.
Of the 12 pregnancies in which the mother
was over 35 years of age, or in which the
diabetic condition had been known to exist
for 10 years or more, only one child lived.
Conversely, of the 13 pregnancies in which
the patient was under 35 years of age and
the duration of diabetes was less than 10
years, only 4 infants were lost. Two of
these might have lived if the management of
their deliveries had been altered, and one
of the others was a spontaneous abortion.
The significance of the age of the patient
and of the duration of the diabetes has been
observed by other investigators.4 a The tox-
emias of pregnancy and diabetic acidosis
during the antepartum course appeared to
increase the hazards of the infant.
February, 1950
61
Fetal mortality in diabetic pregnancies
increases greatly in the last few weeks before
term. Obstetric management attempts to
improve the fetal salvage by selecting the
most favorable time and manner for the de-
livery of the child. Our recommendations
are similar to those suggested by Eastman.'
The patient should be admitted to the hos-
pital for study and control three weeks be-
fore the estimated date of confinement. If
the cervix is favorable, labor should be in-
duced by rupture of the membranes. If it is
not, induction is delayed until it becomes
favorable, or the patient is allowed to go
into labor spontaneously. Cesarean section
is done for obstetric indications. Such fac-
tors as obesity, the duration of the diabetes,
previous infant loss, or the presence of tox-
emia may modify the decision as to the time
of delivery and the manner by which preg-
nancy is to be terminated.
Facilities should be available at delivery
for the careful supervision of the infant.
We lost no babies because of neonatal com-
plications other than those related to the
delivery itself, but such deaths have been
reported frequently in other studies.
Summary
Twenty seven diabetic pregnancies are
reviewed. Twenty one of these occurred
among 42,925 deliveries at Grady Memorial
Hospital from July 1932 through December
1948. The infant mortality was 55.6 per
cent.
The incidence of diabetic pregnancies on
our service prior to 1946 was 1 in 9,733
deliveries. After January 1946 the inci-
dence was 1 in 763. The increased fertility
of these women began after the control of
diabetic patients improved. This control
became better in July 1945 when the Dia-
betic Clinic obtained more adequate facili-
ties for the supervision of diabetic out-
patients.
The duration of the diabetes and the age
of the patient seemed to be important fac-
tors in influencing fetal survival.
Acidosis or late toxemias of pregnancy
developed in 10 of the 11 patients who lost
their infants after viability.
The increased fetal mortality in the preg-
nancies of diabetic women began over 10
years before the clinical evidence of their
disease.
REFERENCES
1. Joslin, E. P. ; Root, H. J. ; White, P. ; Marble, A.,
and Bailey, C. C. : The Treatment of Diabetes Mellitus,
ed. 8, Philadelphia, Lea and Febiger, 1946, p. 313.
2. Allen, E.: Gylcosurias of Pregnancy, Am. J. Obst. &
Gynec. 38:982-992, 1939.
3. Miller, H. C. ; Hurwitz, D., and Kuder, K. : Fetal and
Neonatal Mortality in Pregnancies Complicated by Diabetes
Mellitus, J. A. M. A. 124:271-275, 1944.
4. White, P. : Pregnancy Complicating Diabetes of More
Than Twenty Years Duration, M. Clin. North America
31:395-405, 1947.
5. Palmer, L. J. ; Crampton, J. H., and Barnes, R. H. :
Pregnancy in the Diabetic, West. J. Surg. 56:175-177, 1948.
6. Eastman, N. J. : Diabetes Mellitus and Pregnancy — a
Review, Obst. & Gynec. Survey 1:3-31, 1946.
DISCUSSION
Discussion of papers, “Breech Presentation: Is Fetal
Extension an Etiologic Factor?” by Drs. Guy L. Calk
and Richard Torpin; “Bicornate Uteri: Obstetric Com-
plications,” by Dr. T. Schley Gatewood, and “Diabetes
in Pregnancy,” by Drs. John McCain and William
Lester.
DR. EDMUND BRANNEN (Macon) : Drs. Calk and
Torpin have accepted the challenge of previous investi-
gators who hinted that fetal extension might be an
etiologic factor in the causation of breech presentation.
They have gone about proving this is true in a very
accurate and scientific manner.
There are some practical points that can already be
drawn from their paper, and it is to be hoped that
in the future, as their investigations continue, other
facts may arise that will be of practical benefit.
The most significant thing, as it might be applied
to one’s daily practice, is this: If ex-rays show a frank
breech presentation with full extension of both lower
extremities and the head, efforts to do an external
podalic version should not be pressed to th,e utmost,
because failure will inevitably result in a certain num-
ber of these cases. I presume that does not mean
that version should not be tried, but one’s efforts should
not be forced if version does not occur easily. Perhaps
more careful attention should be paid to the fetal
heart tones in those cases in which considerable pres-
sure is necessary to bring about a version.
Another factor is that most breeches and most
transverse presentations are going to become cephalic
presentations by the time the pregnancy enters the last
month. Some do not, and this paper shows the prin-
cipal reason for failure of spontaneous version.
The paper by Dr. Gatewood is a very excellent and
complete analysis of the literature and an objective
evaluation of his own cases. I would like to mention
two cases from my own limited personal experience
that are of interest at this point:
One case was seen in an Army general hospital. The
ptaient came in as a sterility problem. For the first
time it was found that she had a completely septate
vagina. Hysterosalpingograms proved that she also had
a completely double uterus. Fallopian tubes were patent.
Three months later the septum was removed from the
vagina. The woman conceived two months post-opera-
tively and delivered uneventfully and spontaneously at
term.
The second case was one that I saw at Grady Hos-
pital, who had had complete failure of fusion of the
62
The Journal of the Medical Association of Georgia
vagina and uterus. This patient was interesting in that
she had had two normal pregnancies on one side, and
when seen at the third pregnancy she was pregnant on
the other side. Her labor involving that side of the
uterus was essentially a normal primiparous delivery,
except that the second stage was somewhat short.
I have also drawn on the experience of Dr. O. R.
Thompson, with whom I share offices in Macon. He
points out that, on at least three occasions, he has
seen patients who had partial vaginal septa. He con-
siders this much more of a complication than those
who have complete vaginal septa, in that the head is
likely to be arrested by the supper edge of a partial
vaginal septum. If such a septum should be discov-
ered prenatally, it would probably be advisable to
excise it.
Dr. Thompson now has a patient who has had two
cesarean sections for transverse presentation, who is
pregnant for the third time and who again has a
transverse presentation. She has a partial septum of
the uterine cavity. He believes that this partial divi-
sion of the uterine cavity has caused her three mal-
presentations. All these fall into the category covered
by Dr. Gatewood under the general heading of dystocia.
The paper by Drs. McCain and Lester points out very
dramatically the problems that will now be encountered
in practice more and more frequently in the “insulin
age.” Dr. Holloway is going to mention one phase of
the treatment of pregnant diabetes that has evolved
recently, and I will mention very briefly another phase:
Dr. Priscilla White, in Boston, has shown con-
vincingly that hormonal imbalance may explain in-
creased maternal and fetal mortality, even though the
diabetes itself is under very good control. Basic ab-
normalities are: (1) an increase in chorionic gonado-
tropin, and (2) a decrease in the serum estrogen. To
correct this, she gives graduated doses of intramuscular
stilbestrol and progresterone, a series that, given par-
enterally, costs the patient between $150 and $200.
Before the patient enters into this expensive routine,
she should have studies to see if such therapeutic
measures are necessary, because about 25 per cent of
diabetic women do not have this hormone imbalance
during pregnancy. On the other hand, the oral diethyl-
stilbestrol routine instituted by Drs. Smith and Smith,
of Boston, using Lilly and Squibb products, costs about
$70. Practically speaking, therefore, this is a form
of treatment that might be used in any diabetic preg-
nant patient, whether or not the physician has facilities
for detailed hormone studies.
DR. G. A. HOLLOWAY, (Atlanta) : All three essay-
ists are to be congratulated on their presentation of
three interesting obstetric subjects. My comments
will be brief, since time only permits a limited dis-
cussion.
Drs. Calk’s and Torpin’s paper is quite interesting
and well presented and I sincerely hope they will
continue their work and study in trying to determine
the etiology of breech presentations, as the overall
fetal mortality and maternal morbidity is 2 to 3 times
greater in breech deliveries than in cephalic births.
It would be interesting to know if all their frank
breech presentations, on x-ray, actually delivered as
such. On several occasions I have seen breech presenta-
tions at term in the office and have them deliver a
cephalic presentation a few days later. Let me say
here that I try to convert all breeches to cepalics
when found prior to delivery. In primaparas it is a
difficult task and is impossible at times.
I’m afraid I can be of little help in formulating any
theory or suggesting anything new as to the etiology
of breech presentations.
Dr. Gatewood’s paper on bicornate uteri is complete
and instructive. His review of the literature brings to
us the difference in opinion of a large number of
outstanding men and tbeir method of handling such
abnormal conditions . I’m sure all of us will be more
conscious of this entity after hearing this paper and
will be better prepared to handle such cases in the
future.
Drs. McCain's and Lester’s paper on diabetes in
pregnancy is one of the first ever to be presented on
this subject at our Stale meetings. In private practice
one does not have the opportunity of seeing many of
these cases and we are fortunate in having such a
paper to enlighten us on such an important subject.
The most interesting work and best results obtained
in the last few years, relative to improving our over-
all care of diabetes complicating pregnancy, is that of
Dr. Priscilla White and Drs. Smith and Smith of
Brookline, Mass.
Drs. Smith and Smith have done most of the experi-
mental work along these lines and have published a
most enlightening article, “Diethylstilbestrol in Preg-
nancy” in the Obst. and Gynec. Journal, November,
1943 issue. I would recommend this to all doctors
who do obstetrics.
In 1941 Drs. Smith and Smith summarized their
findings on estrogen and progesterone metabolism in
women, and concluded from their results that estrogen
oxidation products rather than estrogen per se were
responsible for the progesterone stimulating effect
of estrogen, through pituitary stimulation in the non-
pregnant women, and through causing an increased
utilization of chorionic gonadotropin in pregnancy.
It was also found that diethylstilbestrol, unlike the
natural occurring estrogens, was not depressed in its
pituitary stimulating effects by the presence of pro-
gesterone and might theoretically provide an ideal
agent from preventing progestesone deficiency in preg-
nancy. Therefore, they state, the concept seems tenable
that stilbestrol causes an increased secretion of progest-
erone in human pregnancies (probably by the placental
syncytium) through causing increased utilization of
chorionic gonadotropin. An important part of the
understanding of this concept is the realization that
stilbestrol is given not because it is estrogenic but
because it stimulates the secretion of estrogen and
progesterone.
The dosage schedule proposed by the Smiths is
based upon their quantitive determination of hormonal
levels throughout normal pregnancy and is planned
to approximate physiologic condition as closely as
possible; 5 mg. daily by mouth is started during the
6th week (counting from the start of the last period).
The dosage is increased by 5 mg. at two week intervals
to the 15th week when 25 mg. is taken daily. There-
after the daily dose is increased by 5 mg. at weekly
intervals. Administration is discontinued at the end
of the 35th week since a drop in estrogen and progest-
erone normally precedes the onset of labor.
Their results on 11 patients, all classified as severe
diabetes, with this form of therapy, were as follows:
Three patients were primparas, the other eight multi-
paras, had previous obstetric complications in 13
previous pregnancies as toxemia, intrauterine death
or prematurity. Only 2 of the 13 previous pregnancies
resulted in living babies. There were only 3 fetal
deaths in this series of 11 patients treated with stil-
bestrol but only one of these could be considered a
failure. This was a psontaneous delivery at 26 weeks.
The other two deaths were due to placenta praevia,
and an Rh negative patient induced at the 37th week
due to a rising anti-Rh titer. There were no toxemias
in these 11 cases.
Their series of 11 cases is too small to warrant
any conclusion concerning the value of stilbestrol as
a preventive measure in pregnancy complicated by
diabetes, but it is hoped it will be given a trial by
more clinics in the future.
In closing. I would like to leave with you a quotation
of Dr. Randall’s from the Mayo Clinic, who says, “As
in all obstetric conditions, a careful study of all
factors involved in a given case should lead to proper
selection of treatment. There is and will continue
February, 1950
63
to be difference of opinion in regard to the delivery
of diabetic women.”
DR. JOHN R. McCAIN (closing) : The review of
our experience with diabetes mellitus in pregnancy was
begun in January 1949 because of the change in our
program of treatment of these patients that Dr. Hollo-
way just mentioned. Frankly, we were amazed at our
poor results with the pregnancies of these women.
We had felt that our supervision of these cases
had been adequate, but when we actually analyzed
our results we found that our management had been
poor and that our results were even worse. It is
our impression that most physicians will have the
same unpleasant surprise if they tabulate theft
results, unless they have given very careful attention
to the diabetes and to the pregnancy.
Specific treatment of the pregnancies of these
patients involves three possibilities: (1) the admin-
istration of estrogens, or of estrogens and progest-
erone, during pregnancy to prevent an imbalance
of hormones that might develop; (2) the premature
interruption of the pregnancy about three weeks
before term; and (3) the use of cesarean section
as the means of this early termination of pregnancy.
The results obtained from any, or from all, of
these methods of treatment will be modified by
other conditions in the patient. Our study seems
to indicate that the hazards to the pregnancy of
the diabetic patient are increased if the women is
over 35 years of age, or if the duration of the
diabetes is 10 years or longer.
CLINICAL IMPRESSIONS OF SOME OF
THE NEWER ANALGESIC AGENTS
John M. Brown, M.D.
and
Perry P. Volpitto, M.D.
A ugusta
Progress in the therapy of pain within
recent years has resulted largely from in-
vestigations into two previously unexplored
and, consequently, unappreciated sources
of information related to analgesia. First,
new clinical research technics1 have yielded
additional information on the pathways,
origins, and types of pain that are observed
from day to day. Second, a systematic study
of the “naturally-occurring” chemical com-
pounds from their chemical and pharma-
cological points of view has resulted in the
synthesis of several agents which may prove
to be more desirable 2 than the original plant
alkaloids themselves.3 Until this informa-
tion is correlated through extensive and
From the Department of Anesthesiology, University of
Georgia School of Medicine, Augusta.
Read before the Medical Association of Georgia in annual
session, Savannah, May 12, 1949.
well-controlled clinical study in man, the
final evaluation of a particular agent in the
therapy of a particular type of pain cannot
he accurately stated. A study of this type,
utilizing several of the newer analgesic
agents, was begun approximately one year
ago at the University Hospital under the
direction of the Department of Anesthesi-
ology.
Three series of chemical compounds have
yielded synthetic derivatives which warrant
clinical trial in man after preliminary ani-
mal experimentation: the Morphine series,
the Isonipecaine series, and the Methadone
series.
First, by chemically rearranging the
groups on the piperidine structure of the
morphine molecule, dilaudid (Dihydromor-
phinone), dicodid (Dihydrocodeinone) ,
and metopon (Methyldihydromorphinone)
result.
Dilaudid
Dilaudid has four times the analgesic
potency of morphine, the average adult dos-
age ranging from 2-4 mg. It can be admin-
istered orally, parenterally, or by supposi-
tory. Since it is four times as somnifacient
as morphine, comparable analgesic dosages
are accompanied by almost the same degree
of hypnosis. The margin of safety appears
to be no greater than that of morphine, and
no clinical difference can be established in
the respiratory-depressant effects of these
two agents in therapeutic dosages. The
cough reflex is obtunded. Undesirable side
actions seem to occur less frequently with
dilaudid, yet addiction and tolerance devel-
op with about the same frequency as with
morphine. This is because the duration of
analgesia with dilaudid is somewhat short-
er, thus necessitating more frequent admin-
istrations.4 The gastro-intestinal (constipat-
ing) actions of dilaudid are not so pro-
nounced as with comparable analgesic dos-
ages of morphine.
64
The Journal of the Medical Association of Georgt*
Dicodid
Dicodid (Hycodan) is an excellent anti-
tussive agent only recently introduced into
this country. It is a more potent analgesic
agent than codeine, and the tendency to-
wards addiction and tolerance is greater
than with codeine. Comparable side actions
are found in these two drugs. Clinically, its
principal use is for obtundation of the cough
reflex (2-5 mg. hypodermically or in a pala-
table elixir).
Metopon
Metopon, an expensive and difficult drug
to synthesize, has been limited in its usage
to the relief of pain in incurable cancer by
the Committee on Drug Addiction of the
National Research Council. It exhibits an
exaggerated analgesic effectiveness, and a
diminution of sedative, euphoric, emetic,
and intestinal actions, when compared with
morphine.5 It may be given orally. Addic-
tion and tolerance seem to develop more
slowly than with morphine. The adminis-
tration of 3-9 mg. doses of metopon in pa-
tients with chronic, severe types of pain will
produce adequate pain relief for months
instead of the usual weeks or days possible
with other agents.0
Eisleb and Schumann' added a second
series of analgesic agents to our armamen-
tarium with their synthesis of isonipecaine
in 1939. Chemical rearrangement of cer-
tain groups in the parent compound gives,
in addition to isonipecaine itself, two other
promising agents, Bemidone and NU 718.
1 sonipecaine
Isonipecaine (Demerol, Dolantin, Mepe-
ridine) exhibits three distinct pharmacolo-
gic actions: analgesia, hypnosis, and spas-
molysis. 100 mg. has the analgesic potency
of 10 mg. of morphine,8 with a somewhat
shorter length of action (3 hours). Clini-
cally, it does not depress either the cough
reflex or respiration to the extent that mor-
phine does even when administered in com-
parable analgesic quantities. The sedative-
hypnotic properties are comparable to mor-
phine, and when combined with scopolamine
in obstetrics one can obtain analgesia,
amnesia, and adequate sedation in a sig-
nificant number of maternal patients. The
incidence of fetal apnea is low.5
Isonipecaine is the analgesic agent of
choice in urinary and ano-rectal conditions
where smooth muscle spasm is an etiological
factor in the pain. A spasmolytic and slight
antihistamine action1" benefit some asth-
matic patients.
Bemidone
The m-hydroxyphenyl analog of isonipe-
caine shows promise as an analgesic agent.
Its possibilities have not been explored thor-
oughly from a clinical standpoint at this
time.
NU 718
A slight shift in the C-0 linkage of isoni-
pecaine results in a compound which is
apparently 30 times as potent as demerol
from preliminary animal experimentation.
Clinical evaluation is not complete at this
time.
The third, and most recent, series of anal-
gesic compounds to attract attention are the
methadones and their analogs. Metadone
itself (6-Dimethylamino-4, 4-Diphenyl-3-
Heptanone), dl, isomethadone (dl, 6-Di-
methylamino-4, 4 Diphenyl-5-Methyl-3-
Hexanone), 1, isomethadone (1, 6-Di-
methylamino-4, Diphenyl-5-Methyl-3-Hexa-
none), and CB-11 (Heptazone) (dl, 4, 4-
Diphenyl-6 Morpholinoheptanone-3), have
been employed in clinical studies at this in-
stitution.
Methadone
Methadone, by weight, seems to possess
an analgesic potency somewhere near that
of morphine, although earlier clinical trial
showed more enthusiasm.11 This agent lacks
the sedative-hypnotic qualities of morphine
with small administrations, but possesses
February, 1950
05
this quality whenever larger dosage is nec-
essary for pain relief. The respiration is
not depressed clinically until 20-30 mg. are
employed. A central vagal action1" slows
the heart and stimulates peristalsis of the
gastro-intestinal tract in animal experi-
ments. The administration of 30 mg. or
more stimulates the vomiting center directly
in a significant number of cases. Hyper-
glycemia and hypothermia have been ob-
served in patients receiving metadone for
analgesia. Oral administration is not as
effective as parenteral administration, yet,
after a slight local anesthetic action, the
drug may produce secondary irritation upon
subcutaneous injection. Tolerance will de-
velop and addiction has been reported; how-
ever, the incidence of addiction is probably
less than with morphine. Methadone has
been successfully employed in the treatment
of withdrawal symptoms in morphine addic-
tion.13 A dosage of 5-10 mg. usually sup-
presses mild to moderate pain; 10-20 mg.
are necessary for adequate relief in severe
pain.
Some of the disappointing results attrib-
uted to methadone, especially when smaller
doses are administered for pain relief, can
be explained by the fact that some patients
need analgesia plus psychic sedation. This
is a poor agent to choose for such patients;
however, the addition of a hypnotic agent ( a
short acting barbiturate) will result in satis-
faction. Only a slight euphoria is experi-
enced with methadone.
dl. Isomethadone
This racemic mixture of the optical iso-
mers of a hydrolysis product of methadone
has been given clinical trial as an analgesic
agent. Clinically, it has proven to have an
analgesic potency slightly greater than co-
deine, with minimal respiratory depression.
The cough reflex is depressed only slightly
with an administration of 30 mg. Side ac-
tions become much more frequent, espe-
cially in elderly individuals, whenever the
dosage exceeds 20 mg., and sedation is
noted in a greater percentage of cases when-
ever one exceeds 15 mg. The drug may he
administered orally or parenterally in a
dosage of 10-30 mg. This agent is controlled
by restrictions of the Harrison Narcotic
Law, although tolerance and addiction po-
tentialities have not yet been established.
Clinically, it may be employed for the con-
trol of mild pain in adults who are ambu-
latory.
I, Isomethadone
Experimentally, the levo optically-active
isomer of isomethadone has proven to be
50 times as potent as the d-form with rela-
tion to analgesia. The respiratory depres-
sion of this agent is comparable to mor-
phine, clinically. The levo-rotary form has
a wider margin of safety than the dextro-
rotary form in animal experiments. Over-
dosage produces a protracted prostration
and slow death rather than convulsive phe-
nomena observed in toxicity studies of some
of the other methadones. The cough reflex
is depressed to some degree whenever anal-
gesic dosage is employed. The sedative-
hypnotic effect is less than that observed
with a comparable dosage of morphine, and
the number of side effects is significantly
reduced in comparison with morphine. This
agent may be administered orally or paren-
terally in a dosage of 7.5-15 mg. Tolerance
and addiction potentialities have not been
definitely established. Clinically, 1, iso-
methadone may be employed for pain relief
in patients postoperatively who do not need
a great amount of psychic sedation. In these
patients, the incidence of constipation is
definitely decreased over those in whom
morphine is employed.
CB-11 ( Heptazone )
Heptazone approaches codeine clinically
in analgesic potency, with minimal respira-
tory depression in the adult. Side actions
66
The Journal of the Medical Association of Georgia
are present with amounts above 15 mg.,
comparable to dl, isomethadone. The cough
reflex is not noticeably depressed with this
dosage. Administration by oral or paren-
teral routes is possible. The dosage is 10-20
mg. for the relief of mild to moderate pain.
Tolerance and addiction potentialities have
not been established.
Summary
We have listed our impressions of several
of the newer analgesic agents. Clinically,
dilaudid offers little advantage over mor-
phine; dicodid is a potent antitussive agent;
metopon is an excellent analgesic agent with
little sedative effect. Isonipecaine offers
analgesia, hypnosis, and spasmolysis. The
methadones produce less euphoria and
sedative-hypnotic qualities than other syn-
thetics. Of these, 1, isomethadone is the
most potent analgesic agent that' we have
employed from the methadone series.
BIBLIOGRAPHY
1. Pfeiffer, Carl C. ; Sonnenschein, R. ; Glassman, L. ;
Jenney, E. H., and Bogalub, S, : Experimental Methods for
Studying Analgesia, Ann. New York Acad. Sc. 51:21 (Nov.
1) 1948.
2. Batterman, R. C., and Oshlag, A. M.: The Effective-
ness and Toxicity of Methadon. a New Analgesic Agent,
Anesthesiology 10:220 (March) 1949.
3. Tainter, M. L. : Pain, Ann. New York Acad. Sc. 51:10
(Nov. 1) 1948.
4. Goodman, L. , and Gilman, A.: The Pharmacological
Basis of Therapeutics, New York, The Macmillan Company,
1947, p. 207.
5. Eddy, Nathan B. : Metopon Hydrochloride, J. A. M. A.
137:365 (May 22) 1947.
6. Editorials, Metopon Hydrochloride, J. A. M. A.
134:291 (May 17) 1947.
7. Eisleb, O., and Schaumann, O. : Dolantin, ein Neu-
rartiges Spasmolytikum und Analgetigum (Chemisches und
Pharmakologisches), Deutche med. Wchnschr. 65:967 (June
16) 1939.
8. Batterman, R. C. : The Clinical Effectiveness and
Safety of a New Synthetic Analgesic Drug, Demerol, Arch.
Int. Med. 71:345-356 (March) 1943.
9. Brown, J. M. ; Volpitto, P. P., and Torpin, R. : Intra-
venous Demerol-Scopolamine Amensia During Labor, Anes-
thesiology 10:15-24 (Jan.) 1949.
10. Yonkman, F. C. : Pharmacology of Demerol and its
Analogues, Ann. New York Acad. Sc. 51:61-62 (Nov. 1)
1948.
11. Isbell, H. ; Eiseman, A. J.; Wikler, A., and Frank,
K. : The Effects of Single Doses of Methadon on Human
Subjects, J. Pharmacol. & Exper. Therap. 92:83 (Jan.)
1948.
12. Scott, C. C., and Chen, K. K.: The Action of 4,
4-diphenyl-6-Dimethylamino-Heptanone-3 Hcl, A Potent Anal-
gesic Agent, J. Pharmacol. & Exper. Therap. 87:66 (May)
1946.
13. Vogel, V. H. : Isbell, Harris, and Chapman, K. W. :
Present Status of Narcotic Addiction, J. A. M. A. 138:1019-
1026 (Dec. 4) 1948.
VETERANS' NEWS
The Veterans Administration hospital in Danville,
Illinois, converted porches of ward buildings into gym-
nasiums for patients. Porch space has proved adequate
for rowing machines, stationary bicycles, punching
bags and basketball goals and backboards.
* * *
We cannot expect physical signs to help us very
much where early meningitis is suspected. W. S.
Craig, M.D., Brit. M. J., August. 1948.
THE EYE IN THE ADVANCING YEARS
Morgan B. Raiford, M.D.
Atlanta
The eyes begin their aging processes
throughout the entire orbit at the latter por-
tion of the fourth decade of life. In fact, the
ophthalmic system changes up to the eight-
eenth year. These changes are physiological
to maturity and are not considered those of
senescence. As the patients approach the
late thirties they notice then the first limita-
tion of their visual ranges and flexibilities.
The discussion here will include the major
changes that usually occur in the eye, be-
ginning at the fourth decade of life, with
notations of how some of the important dis-
orders are recognized and how they influ-
ence or disrupt our system of vision.
I. CHANGES IN VISUAL ACUITY
a. Influence of the Endocrine Secretion — -
Some of the most obscure symptoms of
the menopausal and male climacteric syn-
drome are their related imbalances in the
patient’s vision. These patients are at the
age where their first glasses are usually
fitted and in many cases it is their first ex-
perience that they have had with an aid to
previously existing normal vision. These
imbalances, mainly of the sympathetic and
parasympathetic nervous mechanics, mani-
fest themselves ophthalmologically in an
instability of accommodation and converg-
ence. This is in addition to the expected
changes of this age level. In these cases,
after completing the refraction of the pa-
tient, one must duly regard the necessity
of controlling the menopausal syndrome
with proper estrogenic therapy. This sta-
bilization of the patient’s nervous system
will enable the process of convergence and
accommodation, which is most noticeable
in near vision, to be restored to their proper
Presented at Emory University School of Medicine Post-
graduate Course, Atlanta, October 13, 1949.
February, 1950
67
physiological balance. Findings here are as
important from the patients history as they
are from the examination itself. The female
patient usually elicits a clearer history of
such imbalances than does the male climac-
teric. However, their responses to their re-
spective therapies are just as gratifying.
b. Metabolic Disorders — Early symptoms
of diabetes are changes in the patient’s re-
fraction variability. Vision and glasses that
are proper at one period will a few days
later be noticed to be blurred. This will be
detected medically by the patient’s history
as well as by the laboratory findings. It is
not, however, a true disorder of advancing
years but many times these diabetic symp-
toms are seen in the later years of life.
Arteriosclerotic changes of the fundi pro-
ducing circulatory embarrassment in the
region of the macula will be noted in the
early cases as changes in size and shape of
images and a distortion of their previous
normal relationships. Here the effects of
poor blood supply may impair the visual
acuity permanently.
c. Metabolism of Lens — The lens grows
throughout life with an increase of as much
as one millimeter in diameter and in thick-
ness. The cuboidal cells are flattened on the
anterior lens capsule by the pressure of the
enlarging lens, which is associated with a
hydrolysis of the lens protein. Slow calcifi-
cation is attributed to the combination of the
positive charged calcium in the lens with the
negative phosphate ions to precipitate an
insoluble calcium phosphate. The lens grad-
ually become more opaque with the end re-
sult being that of cataract formation. The
existing cataxact, whatever its density,
should be individualized. Theie are no
known methods of treatment that can cause
the absoiption of the true lenticular opaci-
ties.
The term that we hear frequently used
by eldeily people is that their vision has
improved and that they now have “second
sight.” This improvement of visual acuity
is brought about by changes within the lens
due to its disturbed metabolism which by its
enlargement has caused an increase in its
optical power so that the patient can read
without glasses. This improvement in vision
gives the patient a sense of false security
that in some cases may lead to an increase
in intra-ocular tension so as to ci’eate glau-
coma. These signs and symptoms should be
duly regarded and a thorough examination
should be carried out with proper treatment
as indicated for that particular case.
d. Sudden Loss of Vision — -The patient
may awake in the morning and ixotice that
the vision has been gieatly reduced as com-
pared to that of the day before. Usually
this is of vascular origin which has been
brought about by a thrombosis of the central
retinal artery or one of its branches. Varia-
tion from the total loss of vision occurs in
branches of the retinal artei'ies of the fun-
dus which results in their respective seg-
mental or quadrant loss of the field of vis-
ion. Sclerosis with atheromatous plaques
of the blood vessels invite such thrombi to
occui\ as part of an over-all systemic pic-
ture.
The treatment of this condition is xxiost
favoiable in its earliest stages. The sooner
the patient has therapy, the greater his
chance of recovery. Dicurxiarol to reduce
the coaguability of the blood with that level
letained to lower the congestion of the pos-
terior segment of the eye aids considerably
in this condition. Delaying action here piac-
tically eliminates the chance for any im-
provement.
II. LIDS
a. Ptosis — Physiologic ptosis of the lids
with its relative enophthalmos is due to the
absorption of fat within the oibital area.
There may also be some loss of tone of the
levator muscles. Any sudden drooping of
The Journal of the Medical Association of Georgia
68
the lids should be examined for lesions in
the oculomotor nerves. If unilateral, les-
ions along the nerve pathways should be
considered.
b. Xanthomata — Xanthomata frequently
occur on the lids of the aged. This is a
disturbance of the cholesterol metabolism.
They may be removed surgically if they ap-
pear to he causing any apparent impairment
or cosmetic blemish. They do not have the
faculty of becoming malignant.
c. Ectropion and Entropion — Ectropion
occurs mostly along the inner half of the
lower lids and is brought about by relaxa-
tion of the orbicularis muscle and the
fibrous tissue of the lid and with deformi-
ties of the tarsal plate. There is a loss of
proximity of the upper and lower lacrimal
punctum that greatly impairs the egress of
tears. Entropion with its turning in of the
margin of the lower lid enables the eye
lashes to rub against the cornea which leads
to the formation of ulcerations and scarifi-
cation of its epithelium. This latter condi-
tion can be enhanced by spastic contraction
of the orbicularis muscles and contractions
of the lower tarsal plate. Treatment for
these conditions is cauterization by the
Ziegler technique, or surgical repair at the
anterior angle of the lid. At the proper
level suture techniques may be used but with
less satisfactory results. If trichiasis exists
these distorted cilia are best permanently
removed by the use of fine electrocauteriza-
tion.
d. Tumors of the Lids — Epithelial and
basal cell carcinoma are frequently seen in
the area of the eye lids. These growths are
insidious and are considered, by the pa-
tients, as of little importance. Even with
their spread, their seriousness is discounted.
Any abnormal growth on the eye lid should
be biopsied and if found to be malignant
should be excised with the proper plastic
repair and radiation therapy. It is very im-
portant that these lesions should be detected
as early as possible as the magnitude of the
surgery will be reduced as well as the period
of radiation therapy, thus resulting in a
better functional and cosmetic appearance.
e. Blepharochalasis— There is a fat de-
posit of the upper lid with senile atrophy
of the fibrous tissues and usually a weak-
ness of the levator muscle. A heaviness of
the eyes resulting in an inability to raise
the upper lids properly occurs and this is
greater in its outer half. Chronic infections
and myasthenia gravis should he excluded.
Excision of the excess tissues is the best
treatment. However, cauterization may be
utilized if the volume of tissue is small.
/. Lacrimal Apparatus — The lacrimal
punctum are usually everted or inverted in
the advancing years. They may be elevated
as to their relation to the lid margin with
accompanying stenosis. Along with this
there is a retarded function of the lacrimal
gland which contributes to a dryness of the
conjunctiva. A chronic blepharitis results
which has an accompanying tearing of the
eye. This is an annoying symptom and it
may be corrected by dilatation of the lacri-
mal punctum with reduction of its elevation
along the lid margin. Lock’s solution (0.7
per cent gelatin in 0.35 per cent saline) may
be substituted for the normal tears by being
used as an irrigation every three to four
hours during the day. The blepharitis may
he combated in addition by the use of:
Sodium chloride 0.5 Gm.
Sodium bicarbonate 0.3 Gm.
Dist. water 240 cc.
Use in a warm solution. This is an excel-
lent solvent for the crusts and exudates that
form in this condition.
III. CONJUNCTIVA
Pinguecula are the yellow deposits that
usually occur as the result of fatty infiltra-
tion and is greater at the inner half of the
bulbar conjunctiva. Sclerosis with deposi-
tion of calcium salts may accompany this
which in itself creates a low grade irritation
in the conjunctiva. These may be excised
February, 1950
69
if their cosmetic blemish is indicated. The
angular conjunctivitis seen often in the
spring and fall of the year is usually the
Morax-Axenfeld diplobacillus. This is usu-
ally seen after the conjunctivitis has extend-
ed throughout, with symptoms of itching,
irritation, and morning deposits of mucoid
material at the inner canthi. A 0.5 per cent
solution of zinc sulfate in a buffered solu-
tion is specific here. For mild conjunctivi-
tis which may be brought about by irrita-
tion and exposure. Tr. Opii 10 cc., aqua
dist. 10 cc., gtt. i q2h 0. U. is used to combat
this annoyance.
IV. CORNEA
Cornea sensitivity decreases after the fifth
decade of life, with a loss of lustre and a
flattening of the corneal surface which cre-
ates an astigmatism. The arcus senilis (ge-
rontoxon) along its periphery has an infil-
tration of fat globules into the substantia
propria. This does not impair the vision or
extend toward the center of the cornea. Pig-
ments from the iris may adhere to the endo-
thelium of the cornea and may be observed
with a corneal microscope. This is usually
on the lower half of the corneal endothelium
and does not affect the vision.
V. IRIS
There is a disappearance of the pigment
epithelium of the pupillary margin with an
ill defined border of whitish color due to
hyalinization. This fibrous replacement
gives rise to senile myosis and rigidity of the
pupil. The dilator fibers also undergo
hyalinization which makes it difficult for the
pupil to be dilated. There is some prolifera-
tion of pigments of epithelium of the iris
which may migrate into patches and create
areas that can be confused with melanoma.
There may be sufficient pigments in the iris
angle so as to establish a secondary glau-
coma.
VI. LENS
“‘Second sight” beguiles its possessor into
believing that there is an improvement of
his visual acuity when it is actually a prodr-
omal finding of cataract formation. The
changes of the lens brought about by a dis-
turbance of metabolism with hardening of
the nucleus of the lens will create distortion
of vision and with the increase of these den-
sities will cause the vision to become im-
paired all together. The maturity of the
lens varies as to its rapidity of metabolic
disturbance. To wait for a cataract to fully
develop is limiting the patient’s ability by
allowing poor vision and impairment of
one’s activities. The criteria for cataract
removal are social, economical, and occu-
pational impairments. With modern tech-
niques and improvements of this operation,
delay for the formation of a dense lens has
little or no foundation. Vitamin therapy,
electrotherapy, stimulating drugs, and local
medicants to increase the blood supply have
no practical therapeutic value. Medical
treatment will not cause absorption of true
lenticular opacities.
VII. THE FUNDUS
a. Vitreous — Within the vitreous body
deposits of iris pigment may create floating
opacities and fibrilla or threads which are
part of senile changes. The patient notices
these as shadows in front of his field of
vision and they are a source of annoyance to
the patient. They move fairly rapidly on
excursions of the eyes as the vitreous loses
its gel characteristics and becomes more
fluid. Hard particles may float about and
are observed as “cotton balls.” These par-
ticles are calcium soaps of fatty acids and
usually do not create noticeable reduction
of vision. Explanation of these impairments
should be made to the patients as it is neces-
sary with our present knowledge that they
should learn to live with them.
b. Retina and Choroid — The retina be-
comes less transparent due to fibrous
changes of the limiting membranes with
atrophy in its periphery which causes a de-
crease of its nerve fiber and ganglion cells.
70
The Journal of the Medical Association of Georgia
A cystoid degeneration in the rods of the
cones is present which as a rule is first
greater on the temporal side. In the macular
region one first notices a conglomeration of
whitish particles of minute spots which are
of excrescences on the Bruch s membrane.
These do not change one’s visual acuity to
any marked degree hut cause impairment of
the blood supply of the retina. Here is the
direct agent that is responsible for the great-
est impairment of its optical properties. The
small blood vessels of the chorio-capillaris
in the choroid layer show considerable pro-
liferation of the intimal-arteriosclerotic
changes with subsequent disorganization
and atrophy. This loss of blood supply is
the greatest agent in visual loss of the aged.
The retinal blood vessels themselves present
a picture of arteriosclerosis giving rise to
“silver wire arteries,” their visible walls,
localized constriction, plaques in the lumen,
and with resultant hemorrhages and exu-
dates that are part of the aging process.
VIII. OPTIC NERVE
Sclerotic changes in the blood vessels of
the pia-arachnoid sheath produce irregular
atrophic areas of the optic nerve. These
changes manifest themselves in a variation
of qualities and quantities of vision that can
he detected by perimetry under controlled
illumination. The appearance of the optic
nerve in the retina will vary from its normal
pinkish tinge to a pallor which can be evi-
dence of other pathological lesions other
than that of sclerotic changes. Glaucoma,
the optic atrophies, syphilis, those of inter-
cranial lesions, and exogenous toxins, will
create similar clinical findings.
IX. INCREASED INTRA-OCULAR PRESSURE
The normal intra-ocular tension is from
15 to 25 millimeters. The normal tension
range will vary during the day fluctuating
10 to 12 millimeters. Increased intra-ocular
tension should be immediately investigated
and given a thorough evaluation. Glaucoma
is responsible for about 11 per cent of all
of the blindness in this country. It may be
primary glaucoma of which the origin is
still vague, or it may he secondary glau-
coma which is caused by a known agent or
some related disease. The presence of in-
flammation, intra-orbital tumors, and hem-
orrhages, must he ruled out. The taking of a
tension by palpation should be a part of
every routine physical examination. A de-
lay in proper therapy is to destroy the vision
and its importance can not be over esti-
mated. Medical therapy with the accurate
control of tension is an ideal seldom
achieved by the physician. Surgical meas-
ures are our most reliable answers to this
formidable disease. The patient should be
followed frequently with regularly taken
visual fields and tensions. They should be
made aware of the seriousness of the con-
dition. Early detection and therapy are our
best control of this debilitating disorder.
BIBLIOGRAPHY
1. Bellows, J. G. : Senile Exfoliation of Lens Capsule,
Quart. Bull., Northwestern Univ. M. School, no. 3, 18:232,
1944.
2. Berens, Conrad: The Aging Eye, no. 16, New York
Med. 2:13-16 (Aug. 20) 1946.
3. Berens, Conrad: Aging Process in Eye and Adnexa,
Arch. Ophth. no. 2, 29:171 (Feb.) 1943.
4. Frandsen: Riboflavin and Ariboflavinosis with Special
Reference to Eye Changes, Acta Ophth. 19:331, 1941.
5. Grant, Hendrie W. : Eye Problems in the Aged, Lancet
64:199 (June) 1944.
6. Parsons, Sir John: Eye Diseases in Elderly Patients,
Practitioner 150:329 (June) 1943.
7. Raiford, M. B. : Endocrine Imbalances in Ophthal-
mology, 4th District Med. Soc. Virginia (April) 1944.
8. Rones. Benjamin: Senile Changes and Degeneration of
the Human Eye, no. 3, Am. J. Ophth. 21:239 (March)
1938.
9. Rutherford, C. W. : Gerontology and the Eye, With
Some Remarks of Old Age, Indiana M. J. no. 5, 39:209
(May) 1946.
10. Smith, C. Souter: Problems of the Eyes in the
Aged, J. Missouri M. A. 40:30, 1943.
11. Stern, Milton: Ophthalmic Geriatrics, Kentucky M.
J. 43:202, 1945.
12. Tyrrell, T. M. : Affections of the Eyes in Old Age,
M. Press & Circular, p. 322 (Oct. 18) 1939.
13. Van der Heydt, Robert: Visual Prognosis for the
Aging Lens, Am. J. Ophth. no. 3, 25:576, 1942.
HEALTH ASPECTS OF TELEVISION
That television is here to stay cannot be denied, for
the development of such a powerful medium not only
for entertainment but for education cannot be retarded.
What are the health aspects of television, The Educa-
tional Committee of the Illinois State Medical Society,
in a Health Talk , says frankly it doesn’t know, even
though it sponsors a weekly telecast on health educa-
tion.
Since “eye strain” seems a complaint commonly
made by adults and children following a prolonged
session with the television screen, attention must be
directed to the factors involved in the complaint. These
would include the clarity of the screen image, the
avoidance of flickering, and certainly the angle from
February, 1950
which the televiewer is watching the screen. These
factors are also a consideration for any other medium,
whether it be the watching a multi-colored jig saw-
puzzle or a motion picture.
l)r. Benjamin Renes in Sight-Saving Review stated
that watching television may cause people to receive
needed eye care more promptly, for if a fatigue is
noticed it will cause the individual to seek medical
attention earlier and, in a number of cases, allow
serious eye diseases to be discovered at a more favor-
able time than would otherwise be the case.
Dr. Derrick Vail in the Illinois Medical Journal
reveals that when movies were first invented people
were fearful of their effect on the eyes. As the technical
aspects were developed, flickering was controlled, and
ophthamologists generally concurred that proper view-
ing was not harmful to the eyes. Today, Dr. Vail points
out, television had led to the same situation. The
ophthalmologist and the family physician are daily
questioned about whether or not harm to the eyes
can come from viewing it. As the novelty wears off
and improvements come, these fears too are gradually
disappearing. It is safe to sav that no organic ocular
disease can be attributed to the television habit. The
Journal of the American Medical Association recently
gave the following helpful hints: 11) television in
itself does not produce eyestrain ; however, since it
requires the utilization of all the important components
of the visual act, such as convergence, accommodation
and fusion, patients often complain of fatigue after
relatively short periods: this is particularly true if
there are any defects of anv of the mentioned mecha-
nisms; 12) in general, a large screen is considered
to be better than a small one, because it allows
clearer vision at a greater distance and gives a larger
visual angle: 13) a distance of ten feet or more would,
in general, be better than a short distance, provided
the size of screen and room would permit; 14) the
nearer perpendicular, the better; too much of an
angle produces distortion and makes fusion difficult:
15) there is not a definite time limit; however, some
discretion should be used, and it should not he per-
sisted in beyond the point of fatigue; 16) daylight
screens, in general, are considered to be better because
they are compatible with more light in the room,
thus reducing the contrast between screen and sur-
rounding objects.
Television as a teaching instrument offers great
potentialities — it combines sound, action and realism.
The medical profession is using it not only for pro-
viding health education to public televiewers, but for
teaching surgical technics to its own profession. These
surgical telecasts have more recently been produced
in color. As the baby television grows, its health
aspects will be closely studied by the medical profes-
sion.
UNDERSTANDING THE NEW BABY
The advent of the first child poses many problems
to the parents. Awkwardness and the fear of doing
the wrong thing in handling the child are replaced
almost overnight by the natural instinct of parenthood,
the Educational Committee of the Illinois State Medi-
cal Society points out in a Health Talk.
Babies as a rule are verv well put together and
will stand considerable mauling. Handling the infant
like a piece of china is not necessary. Holding the
child firmly, supporting his back and head and moving
him slowly are essential. To move the child quickly
gives it a feeling of loss of support and tends to
frighten it. In turning the baby over, it is wise to
take the arm nearest you and the leg farthest awav.
In this manner the baby can be rolled toward you
and so into your arms.
Many mothers wonder about the shape of the head.
Vi hile there are many causes for variations in shapes
of the head, the mother can see to it that the baby’s
position in the crib is turned often enough to help
71
mold the head properly. An infant’s head increases
in circumference about one inch a month during the
first two or three months. Since all the small bones
have not united, pressure and position are great
factors.
If the baby is in a crib next to the wall it will
naturally attempt to turn toward the noises in the
room. The wise mother will either turn the crib
around or turn the baby around periodically, giving the
baby an incentive to change its pressure points.
Shortly after birth, the eyes often water and dis-
charge. This is most commonly due to a chemical
irritation from the medicine that is put into every
baby’s eyes as soon as it is bom, in compliance with
a state law. Sometimes one eye will water. This is
frequently caused by the plugging of the small duct
that drains the tears and secretions from the eye to
the nose. The opening of this little duct is in the
edge of the lower lid in the corner of the eye. In
most instances this can be corrected by pressing
gently with the small finger in the comer of the
eye toward the nose. The light pressure helps clear
the duct, but if the tearing persists, the physician
should be consulted.
Some babies are born with teeth, but this is very
rare. What some mothers think are teeth are little
pear-like spots that may appear in the gum. These
are merely small hard collections of cells that will
cause no harm and will disappear naturally in time.
There are mothers who complain that their babies
take all their formula very quickly at times only to
nurse for several minutes at other times without
getting his food. After the baby has taken some of
the food a vacuum may be created in the bottle which
will prevent the milk from flowing freely. It is there-
fore wise to take the nipple out of the baby’s mouth
at frequent intervals to see that the nipple holes are
not plugged. A good procedure is to keep a large
needle in a cork, sterilize over a flame and pierce the
hole if necessary so that the milk will flow freely.
Normally the baby should get his full feeding in ten
or fifteen minutes, and even in a shorter time.
All new babies should be given affection in large
doses. They need it as much as they do food. A
normal baby cries because it is uncomfortable or
hungry and a mother should never hesitate to pick up
her crying baby and coddle it. With much common
sense and judicious affection, a new baby will take
its rightful place in the home.
PARENTS SHOULD BE ALERT TO SYMPTOMS
OF DIABETES IN CHILDREN
Parents often do not recognize excessive thirst, loss
of weight, and easy fatigue as symptoms of early diabetes
in children, points out a Michigan pediatrician.
Writing in Hygeia, health magazine of the American
Medical Association, Dr. Lewis J. Burch of Mount
Pleasant and his daughter, Isabella C. Miller, say that
the duration of minor symptoms of the disease is rarely
more than four or five months in children.
Because parents do not realize the significance of
these minor symptoms, the disease frequently is disre-
garded until vomiting, severe abdominal pains, and
other critical signs appear.
Although diabetes runs in families, there have been
many cases in which it has appeared in families where
there was no known history of the condition, the article
says. These cases may have come from parents who are
carriers but who do not have the disease themselves.
To detect diabetes, the doctor makes a urinalysis and
a blood sugar test. But since other diseases can cause
symptoms similar to those of diabetes, only the glucose
tolerance of fasting blood sugar test can be relied upon
as conclusive.
The Medical Association of Georgia will
hold its 1950 annual session in Macon,
April 18-21.
72
The Journal of the Medical Association of Georgia
INTEGRATED HOSPITAL SERVICE
Tully T. Blalock. M.D., Chairman ,
Georgia Hospital and Health Council
Atlanta
It is becoming more evident every day
that hospitals, clinics and health centers
can no longer isolate themselves and func-
tion economically and efficiently as indi-
vidual units. The highly technical aspects
of modern medical care and hospital ad-
ministration make it almost impossible for
small units operating alone to render satis-
factory yet economical medical care and to
properly discharge their obligation to the
maintenance of the public health. It is im-
perative that some cooperative program he
put into effect whereby each individual hos-
pital can contribute its knowledge and ex-
perience for the common good, and profit
by the special talents and achievements of
the other.
Culminating nearly two years of planning
and ground work, final steps are being com-
pleted for the organization of such a coop-
erative plan. A Georgia hospital and health
service is being formulated which will offer
expert consultative assistance to any com-
munity requesting aid in solving its hospital
or medical care problems. This service will
he in a position to assist hospitals and clinics
in setting up anything from a clinical labora-
tory to a bookkeeping system. It will give
advice on the establishment of a diet kitchen
or the building of a medical library. In
many cases, post-graduate scholarships will
be granted for short technical courses in
order to fill needs for these services in small
community hospitals. Itinerate technicians
will be sent to fill the need until local per-
sonnel can be trained. All phases of hos-
pital administration will be covered, so that
any hospital so desiring can obtain assist-
ance in whatever particular problem it may
confront. Educational programs will be set
up to afford local staff members an oppor-
tunity to take advantage of post-graduate
work.
Behind this service is the concerted effort
of a large group of Georgia physicians, hos-
pital administrators and public health offi-
cials. This group was recently welded into
a dynamic organization under the name,
“The Georgia Hospital and Health Coun-
cil”. At the organizational meeting in At-
lanta, January 17, 1950, the projects out-
lined above were discussed in detail. An
executive committee was elected including.
Dr. Tully T. Blalock, Atlanta, Chairman;
Dr. Charles Jones, Atlanta, Secretary of the
Council; Dr. Alex G. Little, Valdosta; Dr.
Lester Harbin, Rome; Dr. Edgar H. Greene,
Atlanta; Dr. John Elliott, Savannah; and
Mr. Gene Kidd, Albany. Among the speak-
ers discussing the proposed projects were:
Dr. J. E. Paullin, Atlanta, Dr. Hugh Wood,
Atlanta, Dean of Emory University Medical
School, Dr. Lombard Kelly, Augusta, Dean
of University of Georgia Medical School
and Mr. John Ransom, Atlanta, Director.
Hospital Services, State Department of
Health.
It is emphasized that participation in
the service would be of a cooperative volun-
tary nature. Tbe program is to be patterned
after one already in operation in New Eng-
land under the auspices of the Bingham
Foundation. It is not the intention to inter-
fere in any way with local management and
control, but rather to study the needs and
offer a service which will help to integrate
and improve medical care throughout the
State.
WARN OF ILL EFFECTS FROM OVERDOSES
OF ASPIRIN
A warning that aspirin acts as a poison when taken
in too large doses is given by three Philadelphia doctors.
Excessive amounts of the drug have a toxic effect on
the brain, kidneys, and other organs, Drs. Bernard L.
Lipman, Sidney 0. Krasnoff, and Robert A. Schless point
out in the current (October) issue of American Journal
of Diseases of Children , published by the American
Medical Association.
They report five cases of poisoning from overdoses of
aspirin. Three patients were children, and there were
two deaths in the series.
February, 1950
73
PRESIDENT’S PAGE
LEGISLATION
I had hoped to he able to announce that
the new nonprofit Hospital Service Bill and
the Medical Prepayment Bill had been
passed by the Legislature, hut at the present
time both bills are still in the hands of com-
mittees. Your Public Policy and Legisla-
tion Committee is keeping in close touch
with these bills and expects them to be re-
ported out of committee and passed at an
early date.
An interview with Oscar Ewing, appear-
ing in the Atlanta journal, quotes him as
saying that: “President Truman’s Health
Insurance Plan is basically different from
the British system. The payroll tax of three
(3) per cent, shared equally by the em-
ployer and employee, would go into a fund
to finance the medical service plan. That
he contended would not be a new drain on
the economy because the people are paying
for these services today. This is another way
of financing. It is not socialism. It is not
Nationalized Medicine."
One of the industries in LaGrange offers
to their employees’ a policy which furnishes
full hospital and surgical service and also
medical service when admitted to a hospital.
The cost of this policy averages less than
the one and one half (l!4) per cent which
Mr. Ewing would have deducted from the
worker’s payroll. One hundred (100) per
cent appears to be a high tax for the Fed-
eral Government to impose on a man for the
privilege of protecting himself against the
cost of illness.
Mr. Ewing is probably correct when he
says, “This is not Nationalized Medicine.”
It is not any type of medicine. It is not any
type of insurance. It is pure political chica-
nery.
Enoch Callawy, M.D.
Editor s Note: This is February 14. The Gen-
eral Assembly of Georgia ended its session yes-
terday. Dr. Callaway just called on the phone
and requested that the members be informed,
through his message, that both the Blue Shield
and Blue Cross bills were enacted into law at
this session of the Legislature.
Other medical bills enacted were: an amend-
ment to the Medical Practice Act, sponsored and
written by the Board of Medical Examiners of
Georgia and later modified by the Committee on
Public Policy and Legislation of the Medical
Association of Georgia, which will permit the
issuance of temporary licenses to certain alien
physicians while in the employ of State institu-
tions; and amendments to already existing laws
dealing with Public Health: to clarify rules and
regulations ; to better handle the milk situation;
and to permit the State Board of Health to use
certain unexpended funds to help hospitals other
than Battey in the control and treatment of
tuberculosis.
Unfortunately, the Naturopath Bill was enacted
into law despite all the efforts of the medical
profession of this State to defeat this measure.
74
The Journal of the Medical Association of Georgia
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
February, 1950
AM A PRESIDENT RECEIVES LETTER
Many types of letters are addressed to the
president of the American Medical Association,
hut Dr. Ernest E. Irons received one recently
that is a No. 1 morale builder.
Reading it. said Dr. Irons with a smile, one
becomes suddenly aware of a fresh breeze blow-
ing through tired brain cells.
The letter did not come from a doctor. It was
written by Mr. Joseph Christensen, of the Pro-
gressive Cafeterias in Chicago, and reads as
follows:
“I cannot put M.D. after my name but I can, at
least for a while, still put IJ.S.A. As a consequence,
please accept the enclosed cheek for $25 as a
slight token of regard for my doctor and all his
colleagues. These are my ‘dues’ as a citizen, and
I hope they will help in your fight against socialized
medicine.
“As people without guts are soon a nation without
guts, and if it should become necessary to remove
any part of mine, I want to pick my man and pay
his charge without a precinct captain getting his
nose in my anatomy.”
THE ALLEGED SHORTAGE OF PHYSICIANS
During the past few years officials of the Fed-
eral Security Agency frequently have alluded to
a shortage of physicians which will exist, they
claim, in 1960 if heroic measures are not taken
to increase enrolments in medical schools. The
Federal Security Agency recently published a
bulletin entitled “Health Service Areas: Esti-
mates of Euture Physician Requirements,” by
Mountin, Pennell and Berger.* 1 This 89 page
study is intended to reveal the number of physi-
cians needed in 1960 to meet certain “minimum
measures of adequacy.” The base year from
which the compilations are projected is 1940.
The authors have estimated that there will be
227.000 physicians living in the Linked States in
1960 and that this will provide 143 physicians
per 100,000 population. In 1940 there were 133
physicians per 100,000 population. Thus, the
first conclusion of the authors is that the number
of physicians per 100,000 population will rise
from 133 to 143 between 1940 and 1960. The
medical population has increased more rapidly
than the general population since 1940, and the
authors offer assurance that this trend will con-
tinue until 1960.
The data offered in the Federal Security Agen-
1. Mountin, J. W. : Pennell, E. H., and Berger, A, G.:
Health Service Areas: Estimates of Future Physician
Requirements, Federal Security Agency, U. S. Public
Health Service, Bulletin 305, 1949.
cy report can be questioned on several counts.
For example, in one table figures are presented
that show the number of physicians per 100,000
population has declined from 149 in 1909 to 125
in 1929; thereafter the number rose to 133 in
1940 and 137 in 1949. This compilation does
not take into consideration, however, the fact
that the earlier decrease in the physician-popula-
tion ratio was the result of the closing of weak
medical schools and “diploma mills.” The sig-
nificance of the term “physician” with respect to
training and ability differs so markedly today
from the significance of the term in 1909 that
any crude statistical formula invoked to compare
or contrast the situation in the two periods must
be rejected. It is interesting to observe that,
although the authors have included this table in
their bulletin, they do not utilize it in deriving
their “minimum measures of adequacy.” There
are reasons to believe that there will be several
thousand more physicians in the United States in
1960 than the 227,000 estimated in this study.
Nevertheless, it is reassuring to know that even
the authors of this study predict that the number
of physicians per 100,000 population will in-
crease. The United States already has the largest
number of physicians per 100,000 of any nation
except Palestine, where there is a large number
of refugee doctors.
Mountin. Pennell and Berger do not accept
143 physicians per 100,000 population as ade-
quate for 1960. In estimating the “adequate”
number for 1960, the authors begin with the
active nonfederal physicians in 1940 in each of
126 politically boundaried health service re-
gions; they then array these regions in descend-
ing order of number of physicians per 100,000
population and then select the twelfth, sixteenth
and thirty-seventh regions as standards A, B and
C. ( The final estimates for 1960, however, in-
clude all physicians alive in 1960 rather than
just the active nonfederal physicians). Under
method A the twelfth region, the center of which
is Buffalo, is set as the standard because one
fourth of the population of the United States in
1940 lived in the first twelve regions. Since the
Buffalo region contained 146 active nonfederal
physicians per 100,000 population in 1940, the
authors reason that the 114 regions which had
fewer than this ratio should be brought up to
the level of 146 by 1960 while the regions 1 to
12 are left with their 1940 ratios. The center of
the sixteenth region is Newark, N. J. This region
is chosen as the standard under method B be-
cause one third of the people in 1940 lived in
the first sixteen regions. The authors propose
under method B to increase by 1960 the supply
of physicians sufficiently to raise the 110 regions
below the Newark level up to the Newark level of
136 and to maintain the 1940 ratios in regions
1 to 16. Likewise they select region number 37,
the center of which is Madison, Wis., as their
February, 1950
75
standard under method C because one half of the
people of the United States in 1940 lived in these
first 37 regions. On this basis they would recom-
mend increasing the medical population to pro-
vide the Madison level of 118 active nonfederal
physicians per 100,000 population in all the 89
regions below this level while maintaining the
1940 ratios in regions 1 to 37. Translated into
national ratios for all physicians, not just active
nonfederal, method A assumes that the physician-
population ratio in 1960 should be 172, method
B, 165 and method C, 154, instead of the 143
which the authors predict. The 1960 deficits
according to the three “minimum measures of
adequacy” will be 45,053, 33,666 and 17,413.
Instead of the 227,119 physicians predicted for
1960. under these three estimates there should
be 272,172, 260,785 and 244,532.
The methods employed in this study are so
unrealistic that the study adds nothing to the
knowledge of the physician requirements of the
American people now or in 1960. The authors
have not made any apparent attempt to rate these
126 health service regions according to mortality
and morbidity rates, in spite of the fact that the
1940 crude death rate (unadjusted for age dis-
tribution) was roughly 11.8 deaths per 1,000
population for the top 12 regions in the authors’
array according to number of physicians per
100,000 popultaion and only 10.2 in the lowest
twelve of the 126 regions. Furthermore, the
Buffalo region, the first standard used, contains
two medical schools. The inference from method
A is, therefore, that every one of the 114 health
service regions below the Buffalo level should
contain the equivalent of two medical schools.
In addition, the Buffalo ratio of 146 set as the
standard under method A would be reduced to
135 if the interns, residents and the teachers in
that region were eliminated and would be further
reduced if the physicians employed by industry
also were eliminated. Although the Newark re-
gion does not have a medical school, the number
of interns, residents and industrial physicians is
too large to permit use of the Newark region as
a standard. The Madison region does have a
medical school.
The authors do not claim that the additional
physicians needed in 1960 as computed by meth-
ods A, B and C would, if available, actually prac-
tice medicine in those regions below the three
selected regions in the array of 126 regions.
Apparently they are attempting to determine only
the over-all national deficit. The authors make
it clear that these calculated deficits existed in
1940 and are not deficits which will arise between
1940 and 1960. If their three calculated deficits
for 1940 were adjusted upward to allow for in-
active and federal physicians, the shortages under
their three methods for 1940 would actually ex-
ceed their shortages for 1960. Thus it is obvious
that these shortages for 1940 or 1960 are de-
clared shortages or assumed shortages. The
methods employed by the authors established
the shortages; an attempt is not made in this
particular study to prove or disprove that there
was a shortage in 1940. Had the number of physi-
cians in each of the 126 regions been twice as
great in 1940, their deficits would likewise have
been twice as great. Their study provides an
excellent example of an assumed conclusion.
If a method of measuring national shortages
of physicians is valid, it should be equally ap-
plicable to most, if not all, professions and occu-
pations. It could be shown by the authors’
methods that in 1940 there was an inadequate
number of dentists, of teachers, of lawyers and
of persons in every gainfully employed occupa-
tion. In fact, one might deduce the principal
fault with the United States was that there were
only 132,000,000 persons in 1940 when actually
the authors’ “minimum measures of adequacy”
would have required forty or fifty million addi-
tional!
It is difficult to forecast the national demand
for physicians because it is practically impossible
to estimate in advance the rapidity of technologic
progress in the practice of medicine. Neverthe-
less, it is possible that there will be a surplus of
physicians in 1960. During the 1940’s, a great
increase in the number of auxiliary personnel, as
well as improvements in therapeutic remedies,
greatly enhanced the amount of medical service
which any 1,000 physicians could render. The
Bureau of Medical Economic Research of the
American Medical Association has estimated that
the increase in productivity per physician during
the 1940’s might have been as much as one third.
If this rapid and widely recognized trend con-
tinues, it certainly seems more reasonable to
expect a surplus than a deficit of physicians in
1960. Obviously a crisis in the health of the
people does not now exist. In any event, physi-
cian-population ratios are not true measures of
the demand or supply of physicians. The most
important objective is raising the standards of
performance in the medical profession. The num-
ber of physicians divided by the number of peo-
ple and multiplied by 100,000 to obtain the ratio
of physicians per 100,000 population certainly
cannot be expected to provide a satisfactory guide
to Congress or to the American people on the
number of physicians needed. A satisfactory
study would pinpoint the situation in every sec-
tion of the United States.
Mountin, Pennell and Berger appear to have
arbitrarily chosen 1960 as the year when the
number of physicians in the low ratio areas of
1940 should meet their three arbitrarily chosen
“minimum measures of adequacy.” Why not
take 1970 or 1980 as the objective? In fact, even
the data furnished by the authors suggest that by
1980 the steady increase in the number of physi-
cians per 100,000 population will meet stand-
ards B and C and possibly standard A set by the
authors. The arbitrary selection of 1960 as a goal
76
The Journal of the Medical Association of Georgia
supports the impression that the authors have
“assumed their conclusions.” — AMA Bureau of
Medical Economic Research Miscellaneous Pub-
lication M-31.
REPORT NEW TEST FOR CANCER
OF UTERUS
A new test for cancer of the uterus has been
developed by two doctors of the University of
Chicago.
An estimated 17,000 women in the United
States die annually of cancers which are uterine
in origin.
The test is a laboratory procedure for deter-
mining the activity of an enzyme (compound that
expedites chemical reactions), Drs. Lester D.
Odell and James C. Burt report in the January
28 Journal of the American Medical Association.
The test is not to replace procedures now in
use but is to be used as an aid to other methods
of diagnosis, they emphasize.
“For the past several years the Papanicolaou
smear has been used in some clinics as a screen
for uterine cancer,” the doctors say. “Unfor-
tunately, false negative tests occur. Furthermore,
it is acknowledged that specialized training in
cytology is a prerequisite for reliable results.
“Even if the Papanicolaou method were satis-
factory, there are not enough trained cytologists,
and there is little prospect of training them for
years. Every physician would welcome a simple
chemical test which could be used with confi-
dence.
“Cancer tissues may exhibit quantitative differ-
ences in enzymic pattern from their benign
counterparts. The problem in obtaining a diag-
nostic test has been one of finding the enzyme
( or enzymes) which is most quantitatively altered
and a reaction which is simple enough for aver-
age technical facilities.
“In a limited but carefully controlled series
of cases, estimation of the activity of the enzyme
beta-glucuronidase was successfully used as an
adjunct for diagnosis of cancer of the uterus.”
The method of determining activity of the
enzyme, as described by the doctors, involves a
chemical processing of vaginal fluid or tissue
following which positive or negative results are
determined by color reactions.
In 665 tests, 20 per cent showed false positive
results, the doctors say.
REPORT SUCCESSFUL USE OF ACTH IN
TREATMENT OF GOUTY ARTHRITIS
Prompt and dramatic relief of gouty arthritis
in three patients following administration of one
or two injections of ACTH (pituitary adreno-
corticotropic hormone) is reported by two Pitts-
burgh doctors.
All three patients were middle-aged men, Drs.
H. M. Margolis and Paul S. Caplan of the School
of Medicine of the University of Pittsburgh say
in the January 28 Journal of the American
Medical Association.
“Striking beneficial results” were noticeable
in two patients in an hour to an hour and a half
after a single injection of ACTH was given,
according to the article.
“A man aged 59 sought treatment because of
recurring attacks of severe gouty arthritis of 16
years duration,” the doctors say, describing one
patient.
“The attacks, which had involved at various
times the joints of the big toes, the knees, wrists,
elbows and ankles, would last several weeks to
a month.
“About August 1, 1949 the patient had his
severest attack involving the left hand and wrist;
it progressed within several weeks to involve-
ment of both hands, wrists, elbows and shoul-
ders, the neck, spine and feet. The pain was vio-
lent and the patient was completely disabled.
He could not raise his arms to feed himself and
he could not clench his fists.
“On September 18 at 11:40 a. m. ACTH was
administered intramuscularly. By 12:55 p. m.
the patient had practically recovered from the
acute gouty attack. He was able to move his
hands, elbows and shoulders without any dis-
comfort, he was able to feed himself, and he had
no pain in the neck, back or feet. The tenderness
of the joints had disappeared.
“Except for minor nondisabling joint symp-
toms related to the chronic rheumatoid arthritic
changes, the patient has remained comfortable
and active.”
A.M.A. COUNCIL WARNS OF NEED FOR
INFORMATION ABOUT PESTICIDES
Unless certain information about new agricul-
tural poisons is supplied before they are released
for general distribution, accidents may occur
which will offset the potential benefits of these
new materials, the American Medical Associa-
tion’s Council on Foods and Nutrition warned
today.
The statement of the council, which appears in
the January 28 Journal of the A.M.A., follows in
full:
The introduction of numerous new synthetic
organic pesticides offers promise for increasing
the nation’s food supply and improving health
through the control of insects and other pests.
Past experience, however, indicates that poisons
cannot be used safely on food crops without the
development of certain fundamental knowledge
concerning the poison.
What these materials will do to pests and food
crops and to the workers who handle them must
be known, and there must be developed, also, a
knowledge of what these materials will do to
warm-blooded animals and man when small
amounts of residue are incorporated in their
foods. Furthermore, practical methods of analy-
sis should be available to permit identification
February, 1950
77
and measurement of residue that may persist on
or in consumer products. Such essential infor-
mation is undeveloped for many of the agricul-
tural poisons now in use.
It is the opinion of the Council on Foods and
Nutrition that the information on the following
factors should be supplied before pesticides that
may contaminate food or forage crops are re-
leased for general use :
(1) Chronic as well as acute toxicity tests.
These should be carried out in such a manner
as to demonstrate satisfactorily the toxicologic
effects of pesticides on warm-blooded animals
and man.
(2) Accurate methods of isolation and quan-
titative determination of pesticide residues in
biologic material. These methods must be suffi-
ciently rapid as to be of practical use in the
examination of perishable foods.
Thorough pharmacologic investigations and
practical quantitative methods are two of the
most vital and pressing current needs in this field.
The fundamental requirement for the orderly de-
velopment of needed information must not be
ignored. Unless this information is supplied safe
methods for handling and use cannot be devel-
oped. Furthermore, unless this information is
supplied before new agricultural poisons are re-
leased for general distribution, accidents may
occur which will offset the potential benefits of
these new materials and cause delay in their
adoption.
THE AMAZING YEAR 1949
Nineteen forty-nine also could very well be de-
clared the Great Achievement Year in Medicine.
The name could be applied largely because of
the tremendous strides made in research and in
therapeutics, especially in three specific fields:
(1) Atomic Medicine, (2 ) Cancer Investigation,
and ( 3 ) Development of the Antibiotics.
In retrospect one cannot imagine the total
funds now applied to research problems. Every
medical school in the country has investigators
at work, either in chemistry, in biology or in
other phases of study. The Government has also
allotted large funds for child welfare, rheuma-
tism, heart disease and atomic research. The
American people, besides paying taxes and more
taxes, have given liberal support whenever called
upon to help out in cancer, poliomyelitis, tuber-
culosis and whatnot. The health of the people as
a whole was never better, and our statistics would
indicate the United States to be the healthiest
country in the world! People are living longer
than ever before, and the matter of caring for
our older citizens now looms as the one big
problem before the nation. People who die now
at 80 would, in the next 25 years, die at 100
or older. Geriatrics must become a new and
wider field for the practitioner. We should not
be misled, however. Not all of this progress has
been due to any single group hut to many, and
preventive medicine must claim a big share of the
credit for our state of well being. Pure water,
better milk, elimination of Bang’s disease and
intestinal parasites, control of syphilis, gonorrhea
and rabies — all have played a remarkable part
in the search for better health. It is actually
amazing when one realizes what has been accom-
plished in reducing infant mortality. Some one
has said that medical science has advanced more
in the past 50 years than it had in 1,000 previous
years. This is certainly true and astoundingly
so.
With the preceding thoughts in mind, let us
turn now to some of the specific advances. This
column has been more devoted to “Cancer” than
any other division of medicine; therefore, let us
bring ourselves up to date on some of the latest
revelations about that disease.
Cancer research leads the field of activity at
present, and I dare say that most every founda-
tion in the U. S. has some project concerned with
cancer, its cause and control. The money ex-
pended for investigation is almost staggering. In
1947-48 the American Cancer Society alone re-
ceived $13,221,000.00 in contributions. Money
has also poured in from many other sources to
clinics and leading institutions to keep the work
going. Out of all these efforts, new information
and new thoughts are slowly developing. Power-
ful microscopes are being devised for cellular
study. Radio isotopes are coming forward in
stride, and, besides the valuable therapeutic
agents that are being produced, chemicals such as
phosphorous can be made radioactive, and can
be traced through the body and into cells. In the
field of hormone therapy it is now known that
certain hormones can either control or produce
malignancy. Radioactive iodine offers a stand-
ard procedure in treating Graves’ disease and
malignancies of the thyroid. Theories as to the
cause of cancer have been prominent and a few
facts are acceptable as unrefuted, such as the
influence of chronic inflammation and possibly
inherited stigmas. Tumors can be produced at
will by inoculating mice and inbreeding them.
Cancer can also be produced, and almost every
type at that, by using the various carcinogenic
agents, such as methylcholanthrene.
There is some indication that a virus might be
associated with malignancy, and milk seems to
be indicted as a vehicle of distribution, especially
in cancerous mice. However, it probably remains
true that we actually know very little about the
etiology of cancer, and, according to the latest
report by Gye and his associates in London, many
of our current ideas about the nature of cancer
“can be quietly relegated to the waste basket.”
Dr. Gye and his workers seem to have proved that
cancer is generated by an agent residing within
the malignant cells, which can be separated;
frozen and dried to dust, reinactivated and will
78
The Journal of the Medical Association of Georgia
then produce a cancer again. The agent, which
they believe to be an infective one, causes all
kinds of malignancy, and can be termed a “vi-
rus." This work, if correct, might well shake
the cancer world. Heretofore, most scientists
have felt that malignancy depended upon inherent
cellular growth which could be stimulated by a
great number of substances, and this thought
seems still to be one that cannot yet be discarded.
It is of interest to recall that one of the world’s
greatest scientists, working in his small labora-
tory in Germany in 1907, made a very profound
experiment and found that malignant tissue could
be transplanted after it had been retained at a
freezing temperature! At first it was believed that
tumors, produced by tissues that had been frozen,
demonstrated the capacity of malignant cells to
survive conditions which were incompatible with
life. Gye and Cramer thought otherwise. They
confirmed their contrary opinions by freezing
normal embryonic tissues and found that such
tissue does not live after its exposure to extreme
cold! Gye also proved that exposure of malignant
tissue to a temperature of — 79 degrees for more
than a year did not destroy the ability of the
cancerous virus to form tumors when trans-
planted. They went further in these experiments
at the Imperial Cancer Research Institute in
London. They froze cancer tissue and then re-
duced it to dried dust and were still enabled to
produce malignant tumors. Mann and Dunn
have also performed similar experiments and
have produced mammary cancers in mice. They
have also devised a thought that a virus of can-
cer, such as the Bittner milk factor, when trans-
mitted, remains dormant and widely distributed
into the tissues, and only becomes active and
effective by continued exposure to such a hor-
mone as estrogen, when it will then produce
tumors in the breast. These experiments led us
to concede that there is a continuing cause of
cancer in the form of a resistent type of virus
which can be freed from the living or dead cells,
and if this hypothesis be true then we should be
within sight “of the road to be traveled towards
a cure for cancer."
It would take columns of paper to cover thor-
oughly all other discoveries in the immediate
years just passed which have come so strongly
to be emphasized in 1949. We might just men-
tion a few to keep informed.
The antibiotics lead with penicillin, strepto-
mycin, neomycin and auroemycin, and it now
appears that chloromycetin might well prove to
be the wonder drug of the ages. Don’t let us shove
the sulfa drugs aside, because they continue to
throw a mighty wallop against certain maladies,
and their cheapness make them continually in
demand. The antibiotics and sulfa chemicals
have turned the practice of medicine to a magic
field, away from suffering and despair. Pneu-
monia, meningitis, syphilis, gonorrhea, strepto-
coccal infections, endocarditis and a host of other
diseases have fallen by the conquerors’ side. And
now comes the climax with the recent report by
Payne and Levy and their associates in the
J.A.M.A., December 31, 1949, of the effective-
ness of chloromycetin in treating pertussis! This
malady, as everyone knows, has been continually
one of our leading killers of our young people for
untold years. We must also refer to ACTH. This
hormone seems to be amazing. It might well turn
out to be unlimited in its use. It not only shrinks
tumors, relieves pain, but has also been shown
to have a splendid effect as blocking agent in
hypersensitivity concerned with allergy. It ap-
pears to control asthmatic attacks, and in a small
series of patients all asthmatic symptoms disap-
peared in 48 hours to 8 days.
Thus the wheel of research and investigation
rolls on. Much has been accomplished; much
needs still to be done. Numerous ideas and
theories must be re-evaluated, some accepted,
others discarded.
It might well be added that in the perform-
ance of research, all cannot be superdupers in
this important field of endeavor; however, there
is good reason to expect every member of the
medical profession to be on the lookout for any
new observations in the clinical or pathologic
fields that might give clues to some important
leads. To illustrate, the recent report, and ap-
parently the confirmation, that Jewish women sel-
dom have cervical or uterine cancers, is an ob-
servation that could well be of great significance.
In the histologic or pathologic group we might
spend some time further studying the effect that
the antibiotics might have on cancer. This much
seems to be true, that secondary and primary
cancers, especially those in the intestinal cavities,
appear somewhat retarded after the administra-
tion of considerable quantities of penicillin and
streptomycin. The involved malignant ulcers
certainly appear to be less necrotic with de-
creased inflammatory reaction in the deeper tis-
sues adjacent thereto. The invasive structures
seem to more quickly react to fibrous tissue in an
effort to withhold the metastatic processes. More
work will be reported on these observations as
time passes, and it may well open a greater use
for the antibiotics as secondary helpful aids in
controlling cancer.
Jack C. Norris, M.D.
REPORT EARLY TREATMENT PREVENTS
PAINFUL FOOT DEFORMITIES LATER
Painful foot deformities in adult life may
be prevented by manipulative treatments at the
first sign of any unusual condition in babyhood,
two Wisconsin doctors report in the October 15
Journal of the American Medical Association.
According to Drs. Donald W. McCormick of
Fond du Lac and Walter P. Blount of Mil-
waukee, a condition known medically as meta-
tarsus adductovarus and commonly as skewfoot
February, 1950
79
is now more prevalent in this country than
cluhfoot. In skewfoot the fore part of the foot
tends to curve inward.
Untreated, it may persist as an annoying
deformity with displacement of the big toe,
bunion, flatfoot and chronic foot strain, the
Wisconsin physicians report.
“Adequate early and persistent manipulative
treatment with casts will completely correct the
moderate deformity,” they say. “As skewfoot is
recognized and treated by the orthopedic sur-
geon in the nursery, much disability in adult
life will be eliminated.”
SKIN DISEASE ATTACKS
FLORIDA SWIMMERS
People who bathe in the ocean off the lower
East coast of Florida are being attacked by a
strange skin disease, according to Dr. Wiley
M. Sams of Miami.
A rash or welts and associated itching occur
a short time after leaving the water, Dr. Sams
reports in a current issue of Archives of Derma-
tology and Syphilology published by the Ameri-
can Medical Association.
The disease appears at infrequent intervals
and its occurrence is unpredictable, he says.
Cause of the eruption has not been determined.
“In children, especially in younger children
in whom the eruption is extensive, fever is
common, often with a temperature to 101 or
102 F., and sometimes higher,” he writes. “In
spite of the severity of the symptoms, however,
the disorder ordinarily will run its course
in four or five days.”
TREAT SCARLET FEVER WITH
HUMAN BLOOD FRACTION
Gamma globulin, a fraction of human blood,
compares favorably with antitoxin as a treat-
ment for scarlet fever, a study made by Dr.
Francis F. Silver of Western Reserve University
School of Medicine, Cleveland, shows.
Dr. Silver treated 106 patients with gamma
globulin and 108 with scarlet fever antitoxin,
he reports in the September issue of the Ameri-
can Journal of Diseases of Children, published
by the American Medical Association.
The blood fraction and the antitoxin “affected
the temperature and accelerated the fading of
the rash in like manner and degree,” Dr. Silver
says.
“There were fewer complications (15.7 per
cent) in patients treated with human immune
globulin than in those treated with scarlet
fever antitoxin (25.6 per cent).”
REPORTS POISONING FROM USE OF
INSECTICIDE
An insecticide using an ingredient which Germany
had developed during the war as a substitute for
nicotine is blamed for the poisoning of a user in an
article in the September 17 Journal of the American
Medical Association.
The American manufacturer of an insecticide (trade
name, vapotone-XX) on its label states that tetraethyl-
pyrophposphate fTEPP) comprises 20 per cent of
the compound. In reporting the illness of a 17-year-old
hoy who used the substance to spray melons, Dr. Jacob
Faust of Baton Rouge, La., said:
“In view of the small dose necessary to produce
symptoms and the possibility that poisoning may occur
through cutaneous absorption of the compound, it is
recommended that practitioners he on the lookout for
such cases and that commercial compounds of this
type be labeled to impart more detailed information
for the protection of their users.”
Dr. Faust said that boy developed weakness, ab-
dominal cramping, diarrhea, and vomiting after spray-
ing melons with the compound and eating a melon
without first washing his hands. He recovered without
any aftermath.
THEORY SUGGESTS PREVENTION OF CANCER
BY ARTIFICIAL FEEDING OF BABIES
The “vertical epidemic” theory of cancer merits con-
sideration because it raises the question of preventing
breast cancer in women by the artificial feeding of
infants born to mothers with a family history of cancer,
says an editorial in the September 17 Journal of the
American Medical Association.
“The development of mammary carcinoma in mice
can be prevented by isolating newly born animals from
their potentially cancerous mothers and transferring
them for nursing to mice whose milk is free from the
tumor agent,” it explains.
“The newly born mice become infected by the milk
of their mothers; they remain in perfect health, how-
ever, through early adult life, mammary carcinoma
developing at one to one and a half years of age. In
the meantime, they may transfer the tumor agent to
their own offspring and thus assure the continuation of
the disease.”
The theory assumes that breast cancer in humans
may be caused by agents similar to the one responsible
for breast cancer in mice, the editorial points out,
adding:
“If this is true, women with a history of cancer
should not nurse their babies: artificial feeding should
be substituted. This simple measure may interrupt the
flow of the virus and eradicate a strain of human
breast cancer within one generation.”
The editorial points out, howrever, that the hypothesis
is not perfect, since it provides no explanation of why
cancer can be produced in mice by other methods.
MEDICAL OPINION IS NEEDED BEFORE
CONTACT LENSES ARE WORN
Would-be contact lens wearers would do well to secure
medical opinion before attempting to wear the lenses,
points out an article in the current (October) issue of
Hygeia, health magazine of the American Medical Asso-
ciation.
At least some of the disadvantages of contact lenses
may be reduced or eliminated by the new “waterless”
type, says Marguerite Shields, Chicago, of the A. M. A.
bureau of press relations.
This new contact lens, according to the producers, is
“solutionless, medically correct, and safe.” Describing
the lenses, an A. M. A. exhibit list says:
“The patient’s tears from the necessary fluid lens,
thereby eliminating the difficulties caused by artificial
buffer solutions. The new lens can be worn over long
continuous periods with comfort.”
Study by ophthalmologists will be required, however,
before the new lenses become generally available, if
ever, the article advises.
“At present they are an encouraging development, but
would-be contact lens wearers would do well to remem-
ber the recommendation of the American Committee on
Optics and Visual Physiology that medical opinion
The Journal of the Medical Association of Georgia
80
should be secured in every case before contact lenses are
prescribed.”
COLD-SUSCEPTIBLE PERSONS RATE HIGH
IN ALLERGIES
Weather changes and wet feet often get the blame
for frequent colds, but two University of Illinois doctors
are convinced that a hidden allergy may be at fault.
People for whom life is just one sniffle or sore throat
after another during the common cold seasons have
more allergies than hardy persons who resist the virus,
Drs. Noah Fox and George Livingston of Chicago found.
Reporting in a current issue of Archives of Otolaryn-
gology, published by the American Medical Association,
the doctors describe a study of more than 3,000 cold
victims of all ages and walks of life.
Only 358 of this cold-susceptible group had no per-
sonal or family history of allergy, while 2,127 were or
had been allergic.
“Frequently allergy goes unnoticed because it is of the
borderline variety,” the doctors write. “The nose and
pharynx (throat) of the cold-susceptible patient must
be examined to ascertain whether there are changes in
the structures.
“The mucous membranes of the allergic person seem
always to harbor organisms, ready, when the proper
stimulus occurs, to overgrow.
“Although it is popularly believed that exposure to
cold, humidity, fatigue, and debility are associated with
lowered resistance to the common cold, confirmatory
laboratory data are still lacking. However, these same
factors are known to influence severely the allergic state
of a patient.
“The great frequency of other allergies in the cold-
susceptible person or in members of his family suggests
a specific allergy to the virus or its proteins.”
HEALTHGRAMS
Convincing arguments can be advanced to support
the thesis that tuberculosis is the most important
among the diseases which are both preventable and
curable. Carl Muschenheim, M.D., Amer. Rec. Tuberc.,
July, 1949
* * *
Health education is the application of measures to
induce experiences which favorably influence knowl-
edge, attitudes and actions for the prevention of disease
and the perfection of health of the individual members
of society. Ira V. Hiscock, Pub. Health News, Feb.,
1949.
* * *
If tuberculosis control is to reach its proper goal—
the disappearance of tuberculosis from the United States
— every reservoir of infection must be found and
eliminated. One of the great sources of infection still
remaining in this country may be found among inmates
of mental institutions. Over and over again we have
been told of the high rates of disease which prevail
there. In 1946 there were 635,769 mental patients
in the United States, and 4,247 of them died of tubercu-
losis. This is a rate of 668.0 per 100,000 in contrast
to 36.4 for the general population. Deaths from
tuberculosis in mental institutions comprised 8.3 per
cent of the total deaths from tuberculosis in the United
States during that year. Robert J. Anderson, M.D.,
Pub. Health Rep., Jan. 7, 1949.
MACON HOTELS
Macon hotels are: Dempsey, Lanier, Central,
Southland, Colonial, and Milner. Tourist courts
are: Magnolia, and Peach State. The dates of
our annual session are April 18-21. Get your
reservations now.
COMMUNICATION
Savannah, Ga., Jan. 20, 1950.
Dr. Edgar D. Shanks, Secretary
Medical Association of Georgia
Atlanta.
Dear Edgar:
Just a line to give you a little job. About this
time every year a notice is placed in The Journal
relative to the awards which the Association has
to offer to its membership. Would you insert such
a notice covering these points?:
The Medical Association of Georgia has several
awards which its offers to its membership in com-
petition in certain specific lines, namely:
I he Crawford W. Long Memorial prize which is
offered for the best essay on original work done by
the author. The essay describing this research work
must be delivered before the convention of the
Medical Association of Georgia at its annual session
and must be the work of a member of the Associa-
tion in good standing.
The Hookworm Prize is presented to a member
of the Medical Association of Georgia who has
done some original, some beneficial or some out-
standing work on this disease.
The Hardman Loving Cup is presented to a
member of the Medical Association of Georgia
who has done some progressive or outstanding work,
scientific or otherwise, whereby the Association has been
benefitted.
These prizes are controlled and awarded by the
Awards Committee of the Medical Association of
Georgia. They are presented annually when there
is a winner. It is the desire of this committee that
there be active competition for these prizes. They
are pleased to have suggestions relative to possible
worthy winners of the two latter prizes. Their
names and data can be sent directly to the chair-
man of this committee.
And Edgar, dear: You might get your secretary
to send a short note to each of the essayists of
essays to the committee in competition for the Crawford
W. Long Memorial Prize. About six copies should be
sent. This would be done by March 15.
I would have attended to this sooner, but on
Christmas Eve I had a bad fall resulting in the
fracture of two ribs, bursting the cartilages and
doing me up generally. Was confined to home
for three weeks and, although out now, I am not
worth a darn.
WILLIAM R. DANCY, M.D., Chairman,
102-4 Jones St., West
Savannah, Ga.
NEW PLANS FOR EMORY CLINICS
The clinics this year will follow a completely
revised plan directed to the needs of the general
practitioner. Concentration of the program to a
three-day session will also be of value.
Three lectureships have been provided for and
one will be given each day at noon. These are:
the Elkin Lectureship provided by Dr. Daniel C. Elkin,
Whitehead Professor of Surgery; the Warren Lecture-
ship. provided by Dr. William Warren, and one provided
by an anonymous donor.
The morning programs will be devoted to medi-
cine and surgery and the major specialties of obstetrics
and pediatrics. In the afternoon, the round-table or panel
programs will be given, with a question and answ'er pe-
riod to encourage participation by everyone.
The Medical Association of Georgia will hold its
1950 annual session in Macon, April 18-21.
February, 1950
GEORGIA DEPARTMENT OF PUBLIC HEALTH
ORGANIC PHOSPHORUS INSECTICIDES
The group of insecticides known as organic
phosphates has come into widespread use in the
past few years, particularly in agricultural areas
including Georgia. All who use these prepara-
tions are warned of their dangers by the original
manufacturers, responsible governmental agen-
cies, and the like. All warnings advise the victim
of poisoning to immediately seek medical atten-
tion. The following warning just released in
the Market Bulletin by the Georgia State Depart-
ment of Agriculture in cooperation with the
State Health Department is a typical brief sum-
marization of preventive measures.
Danger! Take Notice
1. Two new organic phosphates, diethyl-nitro-
phenol thiophosphate, and tetra-ethyl pyrophos-
phate, commonly called Parathion and Tepp,
are excellent controls for many kinds of insects
but, like many poisons, are also highly toxic to
humans.
2. They are poisonous if swallowed, inhaled,
or absorbed through the skin.
3. Learn to use Parathion and Tepp safely.
4. Avoid breathing in the wettable powder
while opening bags and introducing it into the
spray tank and avoid inhaling the spray mist
during the spray operation.
5 Wear an approved respirator when spray-
ing or dusting. Keep on hand an adequate sup-
ply of cartridges and filters for the respirator.
6. Wash hands and face after handling these
chemicals and before eating or smoking.
7. Wear protective clothing. A light plastic
raincoat and hat give good protection.
8. Never handle these chemicals with the bare
hands — always wear natural rubber gloves.
9. Atropine is the emergency antidote, but is
obtainable only on a doctor’s prescription. Do
not use morphine. While using these chemicals,
if you get a headache, blurred vision, weakness,
cramps, nausea, diarrhea, or discomfort in the
chest, quit spraying or dusting at once, take two
atropine tablets, and go to a doctor.
Because widespread use is so new, some physi-
cians may not be sufficiently familiar with the
nature and pharmacology of the drugs, and symp-
toms and diagnosis of poisoning. Intelligent
recognition and treatment of cases require such
knowledge.
The specific poisons are: (1) Parathion (also
commercially known as Thiophos); (2) Tetra-
ethyl-pyro-phosphate (TEPP), and (3) Hexa-
ethvl-tetra-phosphate (HETPl. They are manu-
factured as concentrates; they are mixed, dis-
tributed, and used in the field as primary or sec-
ondary dilutions in dusts or liquid sprays. They
are all extremely toxic. Lehman gives the mean
lethal doses per kilogram body weight as 0.0035
grams (Parathion), 0.002 grams (TEPP) and
0.007 grams (HETP) respectively. Cases of poi-
soning have occurred in people engaged in the
manufacture of the materials, in those com-
pounding dilutions, in agricultural workers ap-
plying them, and even in people who have un-
wittingly come in contact with them.
Absorption. It appears that they all are readily
absorbed through the intact skin as well as
through the respiratory and digestive tracts.
Symptoms have appeared within a very brief
time after exposure, indicating rapid absorption.
Dermatitis may develop at the site of contact,
but this is not a constant finding and absence of
skin irritation does not rule out immediate po-
tential danger. Parathion in the eye produces an
intense miosis, resulting in temporary blindness.
One drop of TEPP concentrate in the eye of a
dog has been sufficient to kill.
Pharmacology. The principal pharmacologic
effect of these substances is the inactivation or
destruction of the enzyme cholinesterase. This
enzyme, normally present in the blood and other
tissues, destroys acetylcholine. Destruction of
the enzyme activity hence results in excess accu-
mulation of acetylcholine which, in turn, produces
stimulation of the parasympathetic nervous sys-
tem. The muscarine-like effect is the underlying
cause of the clinical symptoms. Evidence con-
cerning chronic toxicity and cumulative action is
incomplete. The question, “Does chronic expo-
sure produce an irreversible reduction of choli-
nesterase activity or other cumulative effects?”
is unanswered.
Signs and Symptoms. These are primarily the
signs and symptoms of parasympathetic stimu-
lation. They may vary from mild, transient
symptoms to those of severe toxemia and death.
In definite cases there is marked pupillary con-
traction and spasm of the eye muscles of accom-
modation which may persist for two or three
days with resulting blurred vision and inability
to focus. Headache, nausea, vomiting, dizziness,
abdominal cramps, and diarrhea or constitpation
are other typical early symptoms. There may be
a feeling of tightness in the chest, difficulty in
breathing, bronchial spasm and pulmonary
edema. Mental excitement, fibrillary twitching of
the voluntary muscles, convulsions, and coma
have all been observed. Primary excitation is
frequently followed by depression of the central
nervous system. Death is usually the result of
combined pulmonary edema and congestion and
edema of the brain.
Diagnosis. Accurate diagnosis depends upon
obtaining a history of exposure. A high index of
suspicion should be maintained, especially in
agricultural areas where the materials are most
The Journal of the Medical Association of Georgia
82
commonly used. However, cases have also oc-
curred in the cities, especially among workers
engaged in manufacture or formulation of in-
secticides. Any patient who complains of head-
ache, dizziness, nausea, or blurred vision and
who has come in contact with organic phosphate,
should be suspected of suffering from acute poi-
soning. A lowered blood cholinesterase is con-
firmatory evidence. The Industrial Hygiene Lab-
oratory is experimenting with the technique for
performing this test and will be glad to receive
samples submitted by a physician from any sus-
pected case for experimental purposes; 10 cc. of
citrated blood are necessary for the test.
T r eat men t.
(1) First aid instructions to the user :
Atropine is the emergency antidote for para-
thion poisoning. Atropine is obtainable only on
a doctor‘s prescription. The doctors in your
neighborhood should be informed regarding the
symptoms of parathion poisoning and the treat-
ment therefor, as shown below. Consult your
doctor and arrange with him for a prescription
of atropine grains 1/120 (0.5 mg.) to be kept
on hand for emergency use. Never take atropine
or any similar drug until AFTER warning symp-
toms appear. The symptoms of parathion poi-
soning include headache, blurred vision, weak-
ness, nausea, cramps, diarrhea and discomfort
in the chest. If you feel any of these symptoms
while spraying with parathion, quit spraying, take
two atropine tablets at once, and go to a doctor.
Do not spray again with parathion or other or-
ganic phosphate insecticides until your doctor has
examined a blood sample for parathion effect.
When you go back to the job, be sure you observe
all of the precautions outlined above.
(2) Additional information for physicians:
Parathion inactivates the cholinesterase en-
zymes of the blood and tissues and. therefore, the
signs and symptoms resulting from excessive ab-
sorption are primarily those of marked para-
sympathetic stimulation. Hyperhidrosis, miosis,
lachrymation and salivation may be noted in ad-
dition to signs and symptoms noted above. If
the patient has already taken atropine, as indi-
cated above, the physician should administer ad-
ditional doses of grains 1/60 to 1/30 (1 or 2
mg.) of atropine every hour up to ten or 20 mg.
in a day if necessary to control the respiratory
symptoms and keep the patient FULLY atro-
pinized. The intravenous route is the most rapid.
It will be noted that the dosage of atropine here
is in excess of amounts conventionally employed,
but within safe limits. For mild poisoning this
treatment alone is sufficient.
Do not give morphine. If pulmonary secre-
tions have accumulated before atropine has be-
come effective, the patient must be turned upside
down to cough out mucus. The parasympathetic
effect on the heart and lungs is blocked by atro-
pine. Weakness and muscular twitching are not
controlled by this antidote. Even with very seri-
ous poisoning, atropine can completely protect
the airway, but muscular weakness may become
so extreme that artificial respiration is required.
Insert a tracheal tube. Suck mucus from bronchi
with a catheter. Empty distended stomach with
Levine tube. Complete recovery may be expected
even after a very severe acute poisoning and
many hours of artificial respiration. Adminis-
tration of oxygen is indicated at the earliest signs
of pulmonary edema provided that adequate at-
tention to the airway has been given. The acute
emergency lasts 24 to 48 hours; patient must be
watched continuously during this interval. Fol-
lowing exposure heavy enough to produce symp-
toms, further organic phosphate insecticide ex-
posure should be avoided. The patient remains
susceptible to relatively small exposures of para-
thion until regeneration of blood and tissue
cholinesterase is nearly complete. Other organic
phosphate insecticides also inactivate cholines-
terase. Persons exposed to these become sus-
ceptible to parathion and vice versa.
Reporting. Physicians are urged to report
cases of poisoning from insecticides to their
Health Department.
Lester M. Petrie, M. D.
Director, Division of Industrial Hygiene.
REFERENCES
1. Abrams, H. K. : California Department of Public
Health.
2. Hamblin, D. O. : Medical Director, American Cyana-
mid Company.
3. Rohwer, S. A.: Chairman, Interdepartmental Com-
mittee on Pest Control, U. S. Department of Agriculture,
Bureau of Entomology and Plant Quarantine, Washing-
ton 25. D. C.
4. Lehman, Arnold J. : U. S. Food & Drug Administra-
tion. Washington, D. C.
NEWS ITEMS
The American College of Surgeons Sectional Meeting
was held in Belleair. Fla., January 9-10. Georgia surgeons
participating in the program were Dr. Thomas W. Good-
win, Augusta; Dr. Peter 15. Wright, Augusta; Dr. Walter
R. Holmes, Atlanta; Dr. J. Elliott Scarborough, Atlanta;
Dr. David Henry Poer, Atlanta. Also attending were Dr.
C. F. Holton, Savannah; Dr. J. Alvin Leaphart, Jesup;
Dr. J. C. Patterson, Cuthbert; Dr. W. A. Risteen,
Dr. Robert Major, and Dr. W. J. Williams, all of
Augusta; Dr. Herschel Smith, Americus, and Dr.
D. N. Thompson, Elberton.
* * *
Dr. C. Raymond Arp, Atlanta, presented a paper
at the annual meeting of The American College
of Allergists held in St. Louis, Mo., January 18,
entitled “Some Problems in Food Allergy.”
* * *
The Bartow County Medical Society held its regular
meeting at the office of Dr. Harvey Howell, Howell-
Quillian Clinic, Cartersville, December 7. The following
officers for 1950 were elected; Dr. C. L. Ellis, Kingston,
president; Dr. H. B. Bradford, Cartersville, vice-presi-
dent, and Dr. A. L. Horton, Cartersville, was re-elected
secret ary-treasu rer.
* * *
Dr. W. C. Baxley, Blakely physician and surgeon,
announces the removal of his offices to Magnolia Street,
Blakely. The building has nine rooms with two baths,
besides a large room for records and supplies. The
building has a treatment, x-ray and diathermy room,
February, 1950
83
business office, separate waiting rooms for white and
colored, and a room each for white and colored obstetric
cases.
* * *
The Macon-Bibb County Board of Health, Macon,
approves plan for retirement. The retirement plan, as
explained by Dr. R. Frank Cary, health officer, was
passed during the last session of the General Assembly.
He said members will pay five per cent a year from
their salary, to be deducted monthly. He said the
State contributes a like amount, plus 1.83 per cent.
The retirement age now is 70 years. Dr. W. D. Hazle-
hurst, Macon, was selected by the Bibb County Medical
Society to take the seat on the board which was
recently vacated by Dr. R. W. Edenfield, Macon.
* * *
The Bulloch-Candler-Evans Medical Society held its
meeting at the Edwards Restaurant, Claxton, December
11. Dr. Myer M. Schneider, Savannah obstetrician,
was guest speaker. He discussed “The Use of Stil-
bestrol in the Treatment of Abortions.” Dr. Waldo
E. Floyd, Statesboro, president.
* * *
Dr. Fred N. Clements, Adel physician and surgeon,
has been appointed surgeon for the Southern Railway
System by Dr. Milton B. Clayton, Chief Surgeon for
the Southern Railway System. Dr. Clements is the
son of Dr. H. W’. Clements, Adel, who has been com-
pany surgeon for the Southern Railway System for
the past 23 years and has found it necessary to restrict
his practice to office work only.
* * *
The Crawford W. Long Memorial Hospital, Atlanta,
has three doctors interning under a newly-established
program designed to provide “more and better” gen-
eral practitioners. Members of the Atlanta Chapter
of the American Academy of General Practice, which
is sponsoring the nation-wide program, believe it will
mean in time more doctors for small towns and rural
areas. An alarming shortage of well-trained general
practitioners or “family doctors” — particularly in sparse-
ly population areas in Georgia — prompted the program.
The internships sponsored by the Crawford Long section
of the Academy are the first of their kind in Georgia.
Dr. John R. Walker, Atlanta, is chief of the Crawford
Long Hospital Section, American Academy of General
Practice. Doctors interning under the program now
include, Dr. William L. Bridges, sumner. Dr. Richard P.
Campbell, Rockmart and Dr. Perry A. McGinnis, Knox-
ville, Tenn.
* * *
Dr. Hal M. Davidson, Atlanta, opened the discus-
sion on a paper entitled “The Relation of Allergy to
Character Problems in Children” by Dr. T. Wood
Clarke, Utica, N. Y., presented at the annual meeting
of The American College of Allergists held in St.
Louis, Mo. on January 16.
* * *
Dr. Hal M. Davison, Atlanta, president-elect of
the Fulton County Medical Society, was guest speaker
at the monthly meeting of the Woman’s Auxiliary to
the Fulton County Medical Society held at the
Academy of Medicine, Atlanta, January 6. Dr. Davison
discussed “A Doctor’s Philosophy.”
* * *
Dr. Laurence B. Dunn, Savannah physician, was
recently elected president of the staff of St. Joseph’s
Hospital, Savannah. His father, the late Dr. Matthew
F. Dunn, was the first president of the St. Joseph’s
staff. A plaque near the entrance door memorializes
the late Dr. Dunn, who served for some years as
head of the hospital staff, which was organized in
1902. Dr. Dunn succeeds Dr. John E. Porter, who
retired after serving a year in this capacity. Dr.
Porter will continue as a member of the staff.
* * *
Dr. Harold A. Ferris, Atlanta, announces the opening
of his office at suite 526 Candler Building, Atlanta.
Practice limited to internal medicine.
* * *
The Georgia Baptist Hospital Medical Staff held its
annaul banquet in the hospital cafeteria, Atlanta,
January 17. Dr. G. Lombard Kelly, Augusta, dean
of the University of Georgia Medical School, was
guest speaker. His subject was “A Plan to Integrate
Medical Education and Medical Care in Georgia .
Edwin B. Peel, administrator.
* * *
The Georgia Heart Association Fifth District Chapter,
Atlanta, was recently organized and the following
officers were elected: Dr. Joseph C. Massee, Atlanta,
president; Dr. J. Gordon Barrow, Atlanta, vice-presi-
dent, and Dr. C. Purcell Roberts, Atlanta, secretary-
treasurer.
* * *
The Glynn County Medical Society held its meeting
at the City Hospital, Brunswick, January 17. Routine
business was transacted and three new applications for
membership received. Dr. T. V. Willis, Brunswick,
conducted a symposium on “Gynecologic Problems.
Dr. T. H. Johnston, secretary.
* * *
The Fulton County Medical Society held its semi-
monthly dinner meeting at the Academy of Medicine,
Atlanta, January 19. Scientific meeting — Dr. Shelley
C. Davis, moderator. “The Personality and Plastic
Surgery” (The Possibilities of Plastic Surgery), Dr.
John R. Lewis Jr.; “Emotional Reaction of Children to
Abnormalities”, Dr. William H. Kiser; Plastic Surg-
ery and Psychiatry”, Dr. John Campbell, and "Rehabili-
tation of the Patient by Plastic Surgery , Dr. Frank
K. Kanthak. General discussion. Dr. A. Worth Hobby,
secretary-treasurer.
* * *
Dr. Charles H. Daniel, College Park, was recently
elected president of the Section of Obstetrics and
Gynecology of the Crawford W. Long Memorial Hos-
pital, Atlanta. Dr. A. Worth Hobby, Atlanta, was
elected chairman of the Medical Section of the above
named hospital for 1950.
* * *
Dr. Samuel A. Heaton, Augusta, announces the
opening of his office in the Bleckley Building, Clayton,
for the practice of medicine and surgery. Dr. Heaton
graduated from the University of Georgia School of
Medicine, Augusta, and spent thirty-two months in
the Medical Corps of the U. S. Navy.
* * *
Dr. J. Hiram Kite, Atlanta, announces the association
with him of Dr. Woodrow* W. Lovell at 490 Peachtree
Street, N. E., Atlanta, in the practice of orthopedics.
* * *
Dr. W. H. Lewis, Rome physician for more than
43 years, was recently named director of the Floyd
Hospital, Rome, by the administrative board. Dr.
Lewis is a native of Cincinnati, and a graduate of
the University of Cincinnati College of Medicine.
* * *
Dr. W. D. Lundquist, who has been with the Geor-
gia Department of Public Health, is the new regional
medical director with headquarters at 1 Milledge Road,
Augusta, in charge of health work of 28 counties. Dr.
Lundquist previously served at Statesboro and Waynes-
boro.
* * *
Dr. Charles S. McCall, formerly of Bennettsville,
S. C., announces the opening of his office in Albany
for the practice of internal medicine and heart diseases.
* * *
Dr. Clarence W. Mills, Atlanta, announces the
removal of his office to 809 Medical Arts Building,
384 Peaechtree Street, N. E., Atlanta, for the practice
of internal medicine and diseases of the chest.
* * *
Dr. Frank B. Mitcell. Jr., Metter, formerly physician
and surgeon at the Kennedy Memorial Hospital, an-
84
The Journal of the Medical Association of Georgia
nounces t lie removal of his office to Brunswick for the
practice of medicine and surgery.
* * *
Dr. Hubert U. King, formerly of Nicholls, has been
named health commissioner for Jenkins, Burke and
Screvens counties, it was recently announced. His
headquarters will be announced later.
* * *
Dr. W. J. Peeples, formerly health officer of Troup
County for two years, recently assumed duties of assist-
ant commissioner of health for Muscogee County, Dr.
J. A. Thrash, Columbus commissioner, announced. Dr.
Peeples has lived in Key West, Fla. for the past year.
Dr. Margaret Olsen Peeples, his wife, will do part-time
work with the Muscogee County Department of Public
Health.
* * *
Dr. J. R. Sams, Covington physician and surgeon,
has been appointed surgeon for the Georgia Railroad,
according to Dr. John P. Garner, Atlanta, chief sur-
geon for the railroad, who made the appointment.
* * *
Dr. Paul T. Scoggins, Commerce physician and civic
leader, was elected mayor of the city of Commerce
for a full term of two years in the biennial city
election of December 7.
* * *
Dr. A. R. Sims, Richland physician, attended the
meeting of the Georgia Heart Association held at the
Upson Hotel, Thomaston, December 13. For several
years Dr. Sims has attended special courses in the
study of diseases of the heart.
* * *
The Tift County Medical Society held its annual
Christmas meeting at the Elks Home. Tifton, December
16. Dr. Car] S. Pittman, retiring president, was host
to the members of the society. New officers for 1950
are Dr. Richard K. Winston, Tifton, president; Dr.
R. E. Jones, vice-president; Dr. Tom Edmondson,
secretary-treasurer; Dr. E. M. Flowers was named dele-
gate to the Annual Session of the Medical Association of
Georgia to be held in Macon, and Dr. C. A. Fleming,
alternate delegate.
* * *
Dr. John H. Venable, Dalton, health commissioner
of Whitfield and Murray counties, has resigned to
become health commissioner of Spalding, Lamar and
Pike Counties. His resignation is effective February
28 and he will assume his new duties on March 1.
* * *
The Upson County Medical Society held its Decem-
ber meeting at the Upson Hotel, Thomaston. The
following officers for 1950 were elected: Dr. R. L.
Carter, president; Dr. D. L. Head, vice-president;
Dr. Herbert D. Tyler, secretary-treasurer; Dr. J. E.
Garner, delegate to the annual session of the Medical
Association of Georgia, and Dr. Herbert D. Tyler,
alternate delegate. The society has sixteen members
— all the practicing physicians in Upson County — and
one honorary member. Dr. H. A. Barron.
* * *
The Ware Countv Medical Society held its January
meeting at Hotel Ware, Waycross. Dr. W. L. Pomeroy
and Dr. Leo Smith were hosts for the supper meeting.
Dr. William A. Hendry. Blackshear, is president of
the Ware County Medical Society, and Dr. Leo Smith,
Waycross, secretary-treasurer.
* * *
The Ware County Board of Health, Waycross, re-
cently named Dr. B. C. Youmans, Waycross veterina-
rian, rabies control officer for 1950, Dr. W. C. Hafford,
chairman of the Ware County Board of Health and
Commissioner of Health, announced.
* * *
Correction — Dr. Howell A. Wasden, Jr., was listed
in the Thomas County membership roster published
in the December issue of The Journal incorrectly as
living at Boston. His correct address is Pavo.
Members of the Georgia Medical Society (Chatham
County) reported after the membership roster was
published in the December issue of The Journal are
Drs. John S. Howkins, 111 East Jones St., Savannah,
and P. H. Smith, 3 East Gordon St., Savannah.
* * *
The New York Polyclinic Medical School and Hos-
pital, 345 West 50th Street, New York City 19, will
hold a five-day Seminar in Otolaryngology-Ophthal-
mology, April 17-21, 1950. A review of recent advances
in the diagnosis and treatment of the more common
disorders in the fields of Otolaryngology and Ophthal-
mology, comprising lectures, motion pictures and dem-
onstrations in the clinics, operating rooms and dissect-
ing room. Members of the staff and visiting speakers
will participate. For further information write Dr.
David N. Barrows, Medical Executive Officer, 345
West 50th Street, New York City 19.
* * *
The Habersham County Medical Society held its
December meeting at the home of Dr. George T.
Nicholson, Cornelia. Scientific program; “Treatment
of Fractures”, Dr. James A. Green, Athens. Dr. E.
M. Christenson, Alto Medical Center; Dr. George Tol-
hurst, Cleveland, and Dr. James A. Green, Athens,
were guests. Officers for 1950 are: Dr. D. H. Garrison,
Clarkesville, president; Dr. C. T. Hardman, Tallulah
Falls, vice-president; Dr. George T. Nicholson, Cornelia,
secretary-treasurer; Dr. J. Lee Walker, Clarkesville,
delegate; Dr. George T. Nicholson, Cornelia, alternate
delegate; Drs. Joe J. Arrendale and B. J. Roberts,
both of Cornelia, censors.
* * *
iDr. William C. Coles, Atlanta, announces the opening
of his office for the practice of radiology at 272 Court-
land Street, N. E., Atlanta.
* * *
The Cobb Memorial Hospital, Royston, was dedicated
January 22, and honor guest was Tyrus Raymond
Cobb, baseball's famed Georgia Peach. The 23-bed
hospital was dedicated by Mr. Cobb and its name
honors his parents, Prof, and Mrs. Herschel Cobb,
of Royston. Their famous son gave more than 100,000
toward construction of the modern medical center, of
which total cost is $216,000. Dr. Stewart D. Brown,
Royston. boyhood companion and lifelong friend of
the Georgia Peach is the superintendent of the hos-
pital. Mrs Stewart D. Brown is secretary-treasurer.
Mr. Ty Cobb is honorary chairman of the Board of
Trustees. Others on the program included Dr. Frank
K. Boland, Atlanta; Dr. Edgar D. Shanks, Atlanta, and
John Ransom, Atlanta, director of hospital services
division of the Georgia Department of Public Health.
More than 3,000 persons attended the dedication of
the Cobb Memorial Hospital, which will serve the
people of Franklin, Hart and Madison Counties.
* * *
Dr. Howard J. Morrison, Savannah physician, pre-
sented a paper entitled “Breast Feeding” at the clinical
session of the American Medical Association held in
Washington, D. C., December 8.
NEW BOOKS
Questions Medical State Board and Answers: By R.
Max Goepp, M. D., formerly Professor of Clinical
Medicine, Graduate School of the University of Pennsyl-
vania, and Professor of Medicine, Woman’s Medical
Col'ege of Pennsylvania; and Harrison F. Flippin,
M. D.. Associate Professor of Medicine at the Graduate
School of the LIniversity of Pennsylvania. New, 8th
edition, 663 pages. Philadelphia and London: W. B.
Saunders Company, 1950. Price $7.00.
Members of boards of medical examiners, while per-
haps a bit more sane than a quarter of a century ago,
still are human and are likely to dig up some unusual
pet questions to be answered by those taking the
examination. This old reliable book has most of the
answers.
February, 1950
Bo
PROGRAM
ANNUAL MEETING OF THE GEORGIA SOCIETY
OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
Friday and Saturday, March 3 and 4, 1950 at
GENERAL OGLETHORPE HOTEL
Wilmington Island, Savannah, Ga.
Friday, March 3
8:30 (All day) Registration.
9 — Motion picture: High Speech motion picture of
the Human Larynx.
9:20 — Case Report: ‘‘Cysts of the Larynx,” Dr. Paul
Keller, Lawson VA Hospital, Chamblee, Ga.
9:30-10:30 — Dr. Horton: Treatment of the Dizzy
Patient.
10:40-11:40 — Dr. Converse: Treatment of Acute
Maxillo-facial Tramua.
11:50-12:50 — Dr. Lynch: Carcinoma of the Larynx
and Methods of Approach including Lynch Suspension.
Lunch.
2:00-3:00 — Dr. Wiener: Medical Ophthalmology.
3:10-4:10 — Dr. Berliner: Slit Lamp Microscopy.
4:20-5:20 — Dr. Hughes: Lid Reconstruction.
6 :00 — Reception.
7 :00 — Shore Dinner.
9:30 — General Oglethorpe’s Famed Turtle Races.
Saturday, March 4
9:00 — Motion picture.
9:15 — Case Report: “Oxy-cephaly,” Dr. Morgan
Raiford, Clay Memorial Eye Clinic, Atlanta, Ga.
9:30-10:30 — Dr. Berliner: Slit Lamp Microscopy.
10:40-11:40- Dr. Hughes: Personal Procedures in
Ophthalmology.
11 :50-12:50— -Dr. Wiener: Surgical Ophthalmology.
Lunch.
1 :45-2:00 -Case Report: ‘‘Osteo-myelitis of the Skull
with Sequestration of the Otic Capsules.” Dr. Ralph
Arnold, Duke Hospital, Durham, North Carolina.
2:00-3:00 — Dr. Converse: Rhinoplasty.
3:10-4:10 — Dr. Horton: Headaches — Common vari-
eties and their treatment. •
4:20-5:20 — Dr. Lynch: Radical External Sinus Oper-
ations.
Spare time entertainment — Yachting parties, fishing
parties, golfing contests.
Lecturers — Milton L. Berliner, M.D.. New York City;
Bayard T. Horton, M.D.. Rochester, Minnesota; Mercer
G. Lynch, M.D., New Orleans, La.; John M. Converse,
M.D., New York City; Meyer Wiener, M.D., Coronado,
Calif.; Wendell L. Hughes, M.D., Hempstead, N. Y.
Officers — Lester A. Brown, M.D., Atlanta, president;
William L. Barton, M.D., Macon, vice-president; Braswell
E. Collins, M.D., Waycross, secretary and treasurer.
Committee on Local Arrangements — Stacy C. Howell,
M.D., Atlanta; James T. King, M.D., Atlanta; George
H. Lang, M.D., Savannah; John K. Train, Jr., M.D.,
Savannah; James R. Paulk, M.D., Moultrie.
NEW BOOKS
Electrocardiography — Fundamentals and Clinical Ap-
plication: By Louis Wolff. M. D„ Visiting Physician,
Consultant in Cardiology and Chief of the Electro-
cardiographic Laboratory, Beth Israel Hospital; Asso-
ciate in Medicine, Harvard Medical School. 187 pages
with 110 figures. Philadelphia and London: W. B.
Saunders Company, 1950. Price $4.50.
(This small book will be helpful to all clinicians
and electrocardiographers as well. It will answer many
of the present-day questions regarding the value and
interpretation of the electrocardiogram.
* * *
Clinical Pathology — Application and Interpretation:
By Benjamin B. Wells, M.D., Ph.D., Professor of Medi-
cine, University of Arkansas School of Medicine, Little
Rock, Arkansas. 397 pages with 32 figures. Phila-
delphia and London: W. B. Saunders Company, 1950.
Price 6.00.
This book of 397 pages should serve as a useful
reference in making proper evaluations of what can
be done, or what has been done, in the clinical labora-
tory.
* * *
Human Growth. The Story of How Life Begins and
Goes On. Based on the Educational Film of the
Same Title. By Lester F. Beck, Ph.D., Associate
Professor of Psychology, University of Oregon. With
the Assistance of Margie Robinson, M.A. Cloth. Price
$2. Pp. 124, with illustrations. Harcourt, Brace and
Company, 383 Madison Avenue, New York 17, N. Y.,
1949.
This 1 ittle book is well written, its reading matter
is dignified and to the point, and the book can be
used by all age groups.
* * *
From the Hills: An Autobiography of a Pedia-
trician. By John Zahorsky, M.D. Cloth. Price $4. Pp.
338. The C, V. Mosby Company, St. Louis, 1949.
This autobiography by a pioneer American pedia-
trician is excellent in every way. May he live long
and be happy.
* * *
Primer of Allergy. A Guidebook for Those Who
Must Find Their Way Through the Mazes of This
Strange and Tantalizing State. By Warren T. Vaughan,
M.S., M.D., Richmond, Virginia. With illustrations
by John P. Tillery. Third edition revised by J. Harvey
Black, M.D., Dallas, Texas. Cloth. Price $3.50. Pp.
175, with illustrations. The C. V. Mosby Company,
St. Louis, 1950.
This book, while small, covers a wide range discus-
sion of allergy. It should be in the library of every
physician, and in public libraries as well.
COUNTIES REPORTING FOR 1950
App'ing County Medical Society
President — James A. Bedingfield, Baxley
Vice-President — J. T. Holt, Baxley
Secretary-Treasurer — J. B. Brown, Jr., Baxley
* * *
Banks County Medical Society
Member — J. S. Jolley, Homer
* * *
Brooks County Medical Society
President — Harry A. Wasden, Quitman
Vice-President — A. B. Jones, Jr., Quitman
Secretary-Treasurer — Walter G. Thwaite, Quitman
Delegate — L. A. Smith, Quitman
Alternate Delegate — Walter G. Thwaite, Quitman
* * *
Burke County Medical Society
President — W. R. Lowe, Midville
Vice-President — W. W. Hillis, Sardis
Secretary-Treasurer — D. L. Butterfield, Waynesboro
Delegate — J. M. Byne, Jr., Waynesboro
Alternate Delegate — D. L. Butterfield, Waynesboro
* * *
Carroll-Douglas-Haralson Medical Society
President — Steve Worthy, Carrollton
Vice-President — O. W. Roberts, Carrollton
Secretary-Treasurer — E. V. Patrick, Carrollton
Delegate — Roy L. Denney, Carrollton
Alternate Delegate — D. S. Reese. Carrollton
Censors: J. H. Pritchett, Jr., J. Ernest Powell, Jr.,
and Thomas E. Reeve, Jr.
* * *
Georgia Medical Society
(Chatham County)
President — H. M. Kandel, Savannah
President-Elect L. B. Dunn, Savannah
JVice-President — L. M. Freedman, Savannah
Secretary-Treasurer — Sam Younblood, Jr., Savannah
Delegates — John L. Elliott, Ruskin King and Ralph
O. Bowden
Alternate Delegates — Oscar H. Lott, Harold M. Smith,
and Joseph Pacifici
86
The Journal of the Medical Association of Georgia
Clayton-Fayette Medical Society
President J. L. Robak, Jonesboro
Vice-President — J. R. Wallis, Lovejoy
Secretary-Treasurer — T. J. Busey, Fayetteville
Delegate — Y. R. Coleman, Jonesboro
* * *
Dougherty County Medical Society
President — J. Z. McDaniel, Albany
Vice-President — E. S. Armstrong, Albany
Secretary-Treasurer Paul T. Russell, Albany
Delegate — Paul T. Russell, Albany
Alternate Delegate — W. F. McKemie, Albany
Censors: J. M. Barnett, J. C. Keaton and J. A.
Redfearn
* * *
Emanuel County Medical Society
President — S. S. Youmans, Swainsboro
Vice-President R. G. Brown, Swainsboro
Secretary-Treasurer- H. W. Smith, Swainsboro
Delegate — D. D. Smith, Swainsboro
Alternate Delegate — C. E. Powell, Swainsboro
Censors — S. S. Youmans, R. G. Brown, and C. E.
Powell.
* * *
Glynn County Medical Society
President — T. V. Willis, Brunswick
Vice-President — H. L. Moore, Brunswick
Secretary-Treasurer — T. H. Johnston, Brunswick
Delegate — Thomas W. Collier, Brunswick
Alternate Delegate — S. P. McDaniel, Brunswick
Censors — Herbert Kirchman, Ira G. Towson and
Louis A. Valente
* * *
Habersham County Medical Society
President — D. H. Garrison, Clarkesville
Vice-President — C. T. Hardman, Tallulah Falls
Secretary-Treasurer — George T. Nicholson. Cornelia
Delegate — J. L. Walker, Clarkesville
Alternate Delegate -George T. Nicholson, Cornelia
Censors — Joe J. Arrendale, and B. J. Roberts
* * *
Hall County Medical Society
President — John M. Hid sev, Jr., New Holland
Vice-President — Ben P. Gilbert, Gainesville
Secretary-Treasurer — C. W. Whitworth. Gainesville
Delegate — Billy S. Hardman. Gainesville
Alternate Delegate — H. E. Valentine, Jr., Gainesville
Censors — Derrell C. Sirmons, W. Raleigh Garner and
C. W. Whitworth
* * *
Henry County Medical Society
President — R. V. Brandon, McDonough
Vice-President — G. R. Foster. Jr., McDonough
Secretary-Treasurer — H. C. Ellis, McDonough
* * *
Macon County Medical Society
Secretary-Treasurer — Thomas M. Adams, Montezuma
* * *
Meriwether -Harris Medical Society
President — H. C. Jackson, Manchester
Vice-President — Stuart Raper, Warm Springs
Secretary-Treasurer — R. B. Gilbert, Greenville
Delegate C. E. Irwin, Warm Springs
Alternate Delegate — Stuart Raper, Warm Springs
* * *
Mitchell County Medical Society
President — C. L. Howard, Pelham
Vice-President C. A. Stevenson, Camilla
Secretary-Treasurer — D. P. Belcher, Pelham
Delegate — J. C. Brim, Pelham
Alternate Delegate — M. W. Williams, Camilla
* * *
Morgan County Medical Society
President — J. H. Nicholson, Madison
Secretary-Treasurer — W. C. McGeary, Madison
Delegate W. C. McGeary. Madison
Alternate Delegate — J. H. Nicholson, Madison
* » *
Polk County Medical Society
President — J. E. Griffith, Rockmart
Vice-President — W. H. Blanchard, Cedartown
Secretary-Treasurer W. H. Lucas, Cedartown
Delegate — W. H. Lucas, Cedartown
Alternate Delegate — J. E. Griffith, Rockmart
Censors: J. E. Griffith, W. H. Lucas and W. H.
Blanchard
* * *
Randolph-Terrell Medical Society
President — Ernest F. Daniel, Dawson
Vice-President — Robert B. Martin, III, Cuthbert
Secretary-Treasurer — W. G. Elliott, Cuthbert
Delegate Robert B. Martin, III, Cuthbert
Alternate Delegate — R. B. Quattlebaum, Fort Gaines
Censors: J. C. Tidmore, A. R. Sims, and F. S.
Rogers
* * *
Rockdale County Medical Society
Secretary-Treasurer Harvey E. Griggs, Conyers
* * *
Tattnall County Medical Society
President — J. M. Hughes, Glennville
Vice-President — L. V. Strickland, Cobbtown
Secretary-Treasurer -A. G. Pinkston, Jr., Glennville
Delegate — A. G. Pinkston, Jr., Glennville
Censors — A. G. Pinkston, Jr., J. C. Collins, and R.
L. Jelks
* * *
Telfair County Medical Society
President — F. R. Mann, Jr., McRae
Vice-President — F. A. Smith, Jr., McRae
Secretary-Treasurer F. R. Mann, Sr., McRae
Delegate — S. T. Parkerson, McRae
Alternate Delegate — C. J. Maloy, Milan
Censors — F. R. Mann. Sr., W. H. Born, and C. J.
Maloy
* * *
Tift County Medical Society
President -Richard K. Winston. Tifton
Vice-President — Robert E. Jones, Tifton
Secretary-Treasurer — Tom L. Edmondson, Tifton
Delegate — Eugene M. Flowers, Tifton
Alternate Delegate — Carlton A. Fleming, Tifton
* * *
Walton County Medical Society
President — M. W. Anderson, Social Circle
Vice-President —Lynn M. Huie. Monroe
Secretary-Treasurer- Harry B. Nunnally, Monroe
Delegate — Charles S. Floyd, Loganville
Alternate Delegate — Samuel J. DeFreese, Monroe
♦ ♦ ♦
Ware County Medical Society
President- W. A. Hendrv. Blackshear
Vice-President -W. C. Calhoun, Waycross
Secretary-Treasurer — Leo Smi'h, Waycross
Delegate — W. L. Pomeroy, Waycross
Alternate Delegate — Leo Smith. Waycross
Censors — H. A. Seaman, W. A. Hendry, and W. M.
Flanagin
* * *
W ilcox County Medical Society
President — V. L. Harris, Rochelle
Vice-President — Wm. P. Durham, Abbeville
Secretary-Treasurer — J. D. Owens, Rochelle
Delegate — V. L. Harris, Rochelle
Alternate Delegate — J. M. Estes, Abbeville
Censors: J. D. Owens and J. A. Bussell
* * *
Worth County Medical Society
Secretary-Treasurer — Gordon S. Sumner, Sylvester
Delegate — J. L. Tracy, Sylvester
Alternate Delegate — Henry G. Davis, Jr., Sylvester
February, 1950
87
OBITUARY
Dr. George S. Kerr, aged 42, Dalton physician, died
of a heart attack at the Hamilton Memorial Hospital,
November 24, 1949. A native of Dalton, the son of
Mr. and Mrs. J. H. Kerr, a pioneer family. He gradu-
ated from the University of Texas Medical Branch,
Galveston, Texas. He interned one year at Southern
Pacific Hospital, Houston, Texas, and was examining
physician for Southern Pacific Railroad for two years.
He practiced medicine two years at Alice, Texas,
before moving to Dalton six years ago. He was a
member of the Whitfield Medical Society, the Medical
Association of Georgia and a fellow of the American
Medical Association. He was a member of the First
Methodist Church, Dalton. Survivors include his wife;
a daughter, Kay Carolyn Kerr; a son, George Stafford
Kerr, all of Dalton, his parents, Mr. and Mrs. J. H.
Kerr, Houston. Texas. Funeral services were held at
the First Methodist Church with the Rev. Paul A.
Turner, pastor, officiating, assisted by Dr. S. Wilkes
Dendy, pastor of the First Presbyterian Church. Burial
was in the Richardson Cemetery, Dalton.
* * *
Dr. William A. Turner, aged 75, outstanding Newnan
surgeon for the past 50 years, died at his home follow-
ing a long illness, January 21, 1950. He was the son
of the late William Allen and Josephine Reese Turner,
prominent citizens of Newnan. He graduated from the
University of the South Medical Department, Sewanee,
Tenn., in 1899. Later he studied in England, Germany,
and Austria, specializing in surgery. He was admired
and respected by countless friends, and held a high
position among members of his profession. He was
a member of the Coweta County Medical Society, the
Medical Association of Georgia, and a fellow of the
American Medical Association. Also a member of
the Newnan Rotary Club and the Masonic order.
He is survived by his wife, the former Miss Annie
Kirk Dowdell ; two daughters, Miss Annie Dowdell
Turner and Mrs. J. G. White, both of Washington,
D. C.; one sister and one brother. Funeral services
were held at the graveside, with the Rev. J. E.
Hannah and the Rev. J. T. Robins officiating. Burial
was in Oak Hill Cemetery, Newnan.
TUBERCULOSIS NEWS
The tuberculosis mortality rate for 1947 was the
lowest ever recorded in the United States. An even
further reduction in the tuberculosis death rate in 1948
is indicated by the estimated rate of 30.3, based on a
10 per cent sample of death certificates. Sara A. Lewis,
Pub. Health, Rep., April 1, 1949.
* * *
More attention should be directed to the problem
of pulmonary tuberculosis in the old, which is often
an active process with a high proportion of sputum-
positive cases. The onset is insidious, and the symptoms
are commonly ascribed to old age. F. J. Hebbert, M.D.,
The Lancet, Aug. 14, 1948.
* * *
There are two aspects to the educational problem
(in tuberculosis). First, the getting of knowledge,
which is not, after all, a very difficult thing to do . . .
We perhaps are sometimes embarrassed by the knowl-
edge we have. The knowledge which we have of
tuberculosis is really enormous . . . The second aspect
is the difficult problem: making this knowledge effec-
tive . . . There are three to educate, the public, the
profession, and the patient. William Osier, M.D., Nat.
Tuberc. A. Tr., 1905.
* * *
The real purpose of every type of attack we make
on tuberculosis is the eventual eradication of the disease
from this country. It is the urgent need to eliminate
perpetual danger to public health that makes rehabilita-
tion of the tuberculous so important. It is the fact
that tuberculosis is perpetuated by transmission from
one person to another that justifies any measures which
will not only make a tuberculous person well but also
keep him well. Norvin C. Kiefer, M.D., Nat. Tuberc.
A. Tr., 1948.
* * *
Ideally, the patient orientation program (in a tubercu-
losis hospital) should be directed by a physician with
the rare combination of the skills and knowledge of
the doctor, nurse, psychologist, social worker, rehabilita-
tion specialist, and special services specialist. Responsi-
bility for the program cannot be made an “additional
duty” for someone functioning primarily in another
area, nor can it be delegated to the novice who is not
yet professionally experienced for something “more
important”. William B. Tollen, Ph.D., VA Pamphlet
10-27, Oct., 1948.
* * *
There is much to recommend the practice of inte-
grating tuberculosis hospital facilities with those of
a general hospital. This is especially true when a
general hospital possesses central services and resources
which can provide for the additional patient load.
Indeed, even where separate construction is practicable,
it is desirable to consider locating the tuberculosis unit
adjacent to the general hospital, thus permitting the
use of common facilities. Robert J. Anderson, M.D.,
Pub. Health Rep., Nov. 5, 1948.
* * *
The proportion of deaths from tuberculosis among
people over 45 years of age is steadily increasing.
Robert J. Anderson, M.D., Pub. Health Rep., April 1,
1949.
* * *
A roentgenographically normal chest in a person
over 40 does not eliminate the possibility of pulmonary
tuberculosis developing in the future. Incipient pul-
monary tuberculosis in persons over 40 may be much
more common than is generally supposed. Aaron D.
Chaves, M.D., Am. Rev. Tuberc., May, 1949.
* * *
In the entire United States about 270,000 mental
patients are coming back into the community each year.
The spread of the disease from those who may have
contracted tuberculosis while in mental hospitals there-
fore becomes a community problem which we cannot
afford to ignore. Robert J. Anderson, M.D., Pub.
Health Rep., Jan. 7, 1949.
* * *
There can be no isolationism in the field of health.
The fight against infectious disease is not a national
or racial problem; it is a task for a whole of human-
ity . . . The all-inclusive objective of any sound
tuberculosis programme is the prevention and eventual
eradication of tuberculosis from the peoples of the
world. — Bull. World Health Organization, 1948.
* * *
In giving the public and the medical profession
full information on what has been done with strepto-
mycin in the treatment of tuberculosis, it is vitally
important that neither the toxic effects nor the benefits
be magnified on the one hand or minimized on the
other. James J. Waring, M.D., J.A.M.A., January, 1948.
* * *
We have learned that you cannot put a patient’s
mind in a cast. The tuberculosis experience is an
interesting example of this. The great problem of the
tuberculosis sanatorium is people leaving against medi-
cal advice. We have been foolish enough to expect
patients to rest idly in bed and not to worry, but worries
about families, jobs or money, go round and round in
their heads until they decide to give up treatment and
go home. Howard A. Rusk, M.D., Nat. Foundation for
Infantile Paralysis.
* * *
The responsibility of the doctor in enabling the
patient to gain psychological acceptance of the diagnosis
cannot be too strongly emphasized. There is much that
88
The Journal of the Medical Association of Georcia
auxiliary medical personnel can do, but all that they
do cannot equal what the doctor himself can accomplish
in helping the patient to develop a constructive attitude
toward his illness. The patient ‘‘can take if’ from
the doctor to a degree that no one else can match.
The understanding and assurance the patient receives
from the doctor have far more effect in creating a
frame of mind conducive to successful hospitalization
than any help the patient receives from others. William
B. Tollen, Ph.D.. VA Pamphlet 10-27, Oct., 1948.
* * *
City-wide x-ray surveys can be conducted with rela-
tive economy of means and money. Previous experience
in cities already surveyed and preliminary studies of
other communities indicate that if present facilities are
fully utilized and if newly discovered cases are given
realistic disposition, the increased case load of tubercu-
losis will not present a grave problem to the com-
munity. Francis J. Weber, M.D., Ohio Pub. Health,
Feb., 1948.
* * *
Ignored tuberculosis progresses. An organized regi-
men, active treatment, awareness of the possibilities
and cooperation are necessary to cure or check the
disease. Sarcoidosis may be entirely ignored, and with
few exceptions the patient does just as well, or better,
than with medical intervention. There is an environ-
mental and family factor in tuberculosis. Great stress
is laid on finding the infection source — the contact.
Henry E. Michelson. M.D., J.A.M.A., April 17, 1948.
* * *
The body cannot undo the damage wrought by years
of tuberculous infection in a few days or even in a
few weeks. Many months are required even to “arrest”
the disease. H. Corwin Hinshaw, M.D., Nat. Tuberc.
A. Tr„ 1948.
* * *
Pulmonary tuberculosis is the most serious public-
health problem in the Philippines. It exists throughout
the islands in epidemic form, and it is estimated that
10 per cent, or more, of the population suffer from it.
The leading cause of death, it is responsible for from
15 to 20 per cent of all deaths, and it is one of the
leading contributors to the high infant mortality rate.
The war not only increased all the predisposing factors,
but destroyed most of the islands' means of coping
with the disease. Leroy K. Young, M.D., Pub. Health
Rep., Feb. 4, 1949.
* * *
The creation of adequate medical service must of
necessity be the ultimate product of the co-working
of many forces: enlightened local leadership, an in-
formed and cooperative citizenry, a corps of well-
trained doctors, and the financial resources necessary
to enable these doctors to earn a living and to establish
and maintain efficient hospital services. Medicine in
the Changing Order, Rep. N. Y. Academy of Med.
Comm., The Commonwealth Fund, 1947.
* * *
The new drug, streptomycin, has proved more effec-
tive than any other yet discovered in controlling pro-
gressive tuberculosis in the lungs and other organs of
the body. There are certain limitations and disadvan-
tages in its use, and it is not expected that strepto-
mycin will replace conventional methods of treatment,
such as bed rest and the mechanical measures, like
pneumothorax, which selectively put diseased tissue
at rest. It has appeared so promising, however, that
its potentialities must be thoroughly explored. More
money is being spent on streptomycin research in the
United States today than on any other phase of
tuberculosis research. — Edmond R. Long, M.D., Chair-
man Comm, of Tuberc. Research, N.T.A.
* * *
The clinical and x-ray pictures of virus pneumonia
may at times be duplicated by early acute tuberculosis,
and patients diagnosed as having virus infections
should not be dismissed until the chest films are en-
tirely clear. David T. Smith, M.D., Am. Rev. Tuberc.,
April, 1948.
* * *
The efficacy of streptomycin against tuberculous
infections has proved that tuberculosis is yet another
disease vulnerable to chemotherapeutic attack. With-
out undue optimism, greater triumphs may be antici-
pated. Karl H. Pfuetze, M.D., and Marjorie M. Pvle,
M.D., J.A.M.A.. March 5, 1949.
FOR SALE — Complete Modern Eye, Ear,
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condition. Centrally located in a popula-
tion of 200,000. Reason, failing health.
Write J.F.B., 2571 Mt. Auburn Avenue,
Augusta, Ga.
LONG established hospital for immediate
sale in South Georgia — Surgeon in
charge retiring. Well equipped and fully
accredited by College of Surgeons. Nurses
home and doctors’ apartments joining hos-
pital. Contact Journal Medical Association
of Georgia, 478 Peachtree St., N. E., At-
lanta, Ga.
FOR SALE — Government surplus Picker
X-Ray Machines 30 M. A. New, Mobile
Type $975.00. Also hospital and medical
equipment at big savings: Autoclaves,
tables, lights and instruments. A. H. Smul-
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Atlanta.
ESTES SURGICAL SUPPLY COMPANY
Phone WAlnut 1700-1701
56 Auburn Avenue
ATLANTA, GA.
IMPROVED PORTABLE
ELECTROCARDIOGRAPH
Sound and Pulse Wave Attachments
Edgar D. Shanks, M.D.
Doctors’ Building
Atlanta Phone: Main 7740
THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia, March, 1950 No. 3
HISTORY OF THE MEDICAL ASSOCIATION
OF GEORGIA, 1881-1949
Thirty Second Annual Session
Thomasville, 1881
The transactions of this meeting contain the
names of 223 physicians as members of the Asso-
ciation. Dr. J. C. Hardy, of Savannah, was
President.
James B. Baird, of Atlanta, read a bill designed
to regulate the practice of medicine in Georgia,
which, after considerable discussion, was en-
dorsed by the meeting. The bill provided that a
committee of seven members should be appointed
to direct its passage through both houses of the
General Assembly.
J. P. Lo gan, of Atlanta, chairman of the com-
mittee on the claims of Crawford W. Long as the
discoverer of anesthesia, presented through the
Secretary the following letter from Dr. Robert
Rattey, a member of the committee, as the final
report of the committee, and asked to be dis-
charged:
Rome, Ga„ 12th April, 1881
Dear Dr. Logan:
Your letter of the 10th is received. I had an inter-
view with Dr. Marion Sims, in June last, in reference
to the movement to secure from Congress a recognition
of the claims of Dr. Crawford W. Long, as the original
discoverer of surgical anesthesia, and the making of
some substantial provision of his family.
Dr. Sims stated to me that his hopes of success
were founded upon the personal devotion of Mr. Henri
L. Stuart, who had the matter deeply at heart, and
possessed leisure, means and enthusiasm to press
the claim. With the death of Mr. Stuart, died his
hope of success. Dr. Sims expressed the opinion that
the claim in the future would be hotly contested, as
it had always been in the past, and nothing short of
so able and devoted an advocate as Mr. Stuart would
stand any chance of success.
Truly yours,
ROBERT BATTEY.
(Note: Stuart, a retired New York lawyer, was a
great admirer of Long, and presented Long’s portrait
to the State of Georgia. He died while on a visit to
Athens, and at his request was buried beside Crawford
Long).
R. J. Nunn read a paper describing the Paque-
lin cautery and its use in the treatment of “rachi-
algia. ’ A. Sibley Campbell discussed a case of
gunshot wound of the abdomen with fecal fistula,
spontaneous closure and recovery without opera-
tion. He believed quinine and opium, when used,
were important factors in the success of the
treatment. Thomas R. Wright reported three
cases of compound comminuted fracture of the
leg treated with success without resorting to
antisepsis.
William F. Holt, of Macon, was elected Presi-
dent for the ensuing year; Eugene Foster, Au-
gusta, and T. M. McIntosh, First and Second
Vice Presidents; A. Sibley Campbell, Augusta,
Secretary; and R. J. Nunn, Savannah, Censor.
The next meeting was to be held in Atlanta.
Thirty Third Annual Session
Atlanta, 1882
The names of 115 members are given as at-
tending this meeting. Dr. Holt presided. Among
the papers read were: “The Relative Merits of
Humanized and Bovine Vaccine Virus,” by Eu-
gene Foster, Augusta; “Hemorrhagic Malarial
Fever,” by R. M. Brown; “Is Typhoid Fever
Contagious”? by W. H. Philpot; and “Fistula-
in-ano,” by L. M. Jones. DeSaussure Ford,
chairman of the committee on surgery, stated that
he had requested contributions from the mem-
bers of his district, and had received none. He
asked that the committee be continued, promis-
ing better results next year.
It was decided to hold the next meeting in
Athens, and the following officers were elected:
K. P. Moore, Forsyth, President: A. G. White-
head. Waynesboro, and F. R. Calhoun. Euharlee,
First and Second Vice Presidents; E. C. Good-
rich, Augusta, Treasurer. A. Sibley Campbell
was continued as Secretary. For the first time
in its history, the session lasted three days.
Thirty Fourth Annual Session
Athens, 1883
The report of this meeting is brief. Dr. Moore
presided. W. B. Wells read a paper on “Cerebro-
spinal Meningitis;” H. J. Williams discussed
“The Carbolic Acid and Iodine Treatment of
Typhoid Fever.” Officers chosen were: A. W.
Calhoun, Atlanta, President; R. J. Nunn, Savan-
nah, and M. J. Deadwyler, Elberton, First and
Second Vice Presidents; J. A. Gray, Atlanta,
Secretary; and E. C. Goodrich, Augusta, Treas-
urer. Macon was the next place of meeting.
Thirty Fifth Annual Session
Macon, 1884
The Association met in Macon for its three-
day session. Ninety-five members were regis-
tered as present, and the Board of Censors re-
ported favorably upon the applications for mem-
bership of 26 new members. The title of the
presidential address of Dr. Calhoun was “School
Hygiene in Relation to Its Influence upon the
Vision of Children, or School Sanitation.”
Among the papers read and discussed were:
90
The Journal of the Medical Association of Georgia
“A Case of Empyema Successfully Treated by
Free Incisions, Constant Drainage and Antisep-
tic Injections,” by Howard J. Williams, Macon:
“Extreme Age No Contraindication for Cataract
Extractions,” by J. M. Hull. Augusta; “Syphilis
as a Sociological Problem,” by Eugene Foster.
Augusta; “Successful Removal of Uterine Tumor
per Vaginum,” by J. W. Flanders, Wrightsville;
“Plaster Paris Apparatus in the Treatment of
Fractures,” by W. O’ Daniel. Bullard’s; “Anti-
septics in Ovariotomy and Battey’s Operation,”
by Robert Battey; and “Typhoid and Typho-
Malarial Fevers and the Treatment with Acids
and Gelsemium,” by A. A. Smith, Hawkinsville.
I he following officers were chosen for the en-
suing year: Eugene Foster. Augusta, President;
J. B. Roberts, Sandersville, and W. D. Bissell.
Atlanta, First and Second Vice Presidents; John
Gerdine, Athens, and Milo Hatch. Tennille, Cen-
sors. Savannah was to be the next place of
meeting.
Thirty Sixth Annual Session
Savannah, 1885
The transactions of the meeting were pub-
lished only in the Atlanta Medical & Surgical
Journal (Old Series, Vol. XXV; New Series
Vol. II, No. 3, May 1885, pp. 146-1-59). There-
after, the former annual Transactions were con-
tinued.
A paper on “Hemorrhagic Malarial Fever,”
by A. G. Whitehead, W aynesboro, stimulated
unusual discussion. The author took the ground
that quinine did but very little, if any, good in
such cases. He relied mainly upon calomel and
chinoidine, and always pushed calomel to ptyal-
ism, after which he used chlorate of potash and
muriated tincture of iron. He regarded ptyal-
ism as important, and gave calomel in two-grain
doses every hour until specific effect was ob-
tained. H. McHatton, of Macon, stated that
calomel might be curative in such cases, hut
was not prophylactic in all of them. The last
patient he had seen had taken thirty grains of
calomel in the previous thirty-six hours. In
many cases he had found no red blood cor-
puscles, and considered the condition one of
hemoglobinuria rather than hematuria. Sig-
nificantly he said that Michifara and Celli had
described a “microbe” attacking the red blood
corpuscles in malarial diseases.
Officers elected for 1885-86 were: R. J. Nunn,
Savannah, President; L. B. Alexander, Forsyth,
and T. F. Walker, Cochran. First and Second
Vice Presidents. James A. Gray, Atlanta, and
E. C. Goodrich. Augusta, were to remain as
Secretary and Treasurer, respectively, until
1887.
Thirty Seventh Annual Sessio/i
Augusta, 1886
The Association convened for three days, April
21st, 22nd and 23rd. with President R. J. Nunn
in the chair. Seventy members were in attend-
ance, and twenty-five new members were added.
The committee appointed to prevail upon the
Fegislature to provide anatomical material for
medical schools reported that the hill for this
purpose had failed to pass. Although the chair-
man erroneously declared that the hill would
never pass, the committee was continued in
office. ( Many tales were prevalent in those davs
of the surreptitious manner in which cadavers
often were obtained for anatomical study).
The use of alcohol in medicine was exciting
much pro and con arguments. The paper of
J. P. Logan, of Atlanta, on “The Relation of the
Medical Profession to the Uses and Abuses of
Alcoholic Liquors” brought out animated dis-
cussion. A motion to consider fully the ques-
tion of the therapeutic value of various prepara-
tions of alcoholic liquors was laid on the table.
A committee of thirty-three members was ap-
pointed as delegates to the next meeting of the
American Medical Association, and such a large
group was continued annually for many years.
How many committeemen attended the A.M.A.
convention was not stated.
The Treasurer reported a balance of $1.28 on
hand. It was voted to meet next in Atlanta, and
the following officers were chosen: President.
T. O. Powell. Milledgeville; First and Second
Vice Presidents, G. W. Mulligan, Washington,
and E. H. Richardson, Cedartown; Censor, for
the long term, S. B. Hawkins, Americus.
Hunter P. Cooper, Atlanta, presented a paper
on “The Treatment of Empyema;” and J. McF.
Gaston. Atlanta, discussed “Surgical Relations
of the Gallbladder to Obstruction of the Ducts.”
Dr. Gaston described cholecvstduodonostomy
which he had performed on a dog. Robert Bat-
tey, Rome, spoke of Lister’s carbolic spray which
he was using in his ovariotomies. Eugene Foster,
Augusta, discussed antiseptic midwifery, while
Thomas R. Wright, of the same city, talked about
minor operations under cocaine anesthesia. Wil-
liam Abram Love, Atlanta, gave an eloquent
memoir on the life of the distinguished Alexan-
der Means, who died in 1883.
Thirty Eighth Annual Session
Atlanta, 1887
At this meeting, with Thomas O. Powell pre-
siding. a new Constitution was read, with action
on it postponed for another year. One hundred
and twenty-five members were present, and 25
new ones elected. As was the custom, different
members made reports from their districts on
the principal branches of medicine, practice,
surgery and obstetrics. Four of these reports
were published in the transactions, Surgery in
the Third Congressional District, by P. L. Hils-
man, Albany; Surgery in the Fifth District, by
J. McF. Gaston, Atlanta; Surgery in the Eighth
District, by S. C. Benedict, Athens; and Surgery
in the Tenth District, by DeSaussure Ford,
Augusta.
M\kch, 1950
91
It was voted to publish Dr. Powell's presiden-
tial address on “Heredity and Environment” in
the newspapers. Eugene Foster gave an interest-
ing lecture on “Alcoholic Liquors in the Practice
of Medicine,” while “The Relations of the Medi-
cal Profession to the Use and Abuse of Alcoholoic
Liquors” was the title of the paper read by
Joseph P. Logan.
Officers elected were: President, A. G. White-
head, Waynesboro; First and Second Vice Presi-
dents, A. A. Smith, Hawkinsville, and John Ger-
dine, Athens; Secretary, elected for five years,
James A. Gray, Atlanta; Treasurer, elected for
five years, E. C. Goodrich, Augusta. It was voted
to hold the next meeting in Rome.
Thirty Ninth Annual Session
Rome, 1888
The opening of this session was marked by
inspiring outbursts of eloquence as Robert Bat-
tey, speaking for the committee on arrange-
ments, welcomed the Association to Rome. The
well-known orator, John Temple Graves, extended
a welcome from the City of Rome; and J. Scott
Todd, of Atlanta, responded with equally stirring
remarks.
Under the presidency of Dr. Whitehead, an
interesting three-day meeting was held, with
social parties being given by Dr. Battey, and by
Dr. J. S. B. Holmes. Floyd W. McRae made a
report of more than ordinary importance in
stating that the Anatomical Board had been or-
ganized according to the requirements of the
law passed at the last session of the Legislature,
and was working satisfactorily.
A few of the papers read were: “Is the Germ
Theory of Disease Rational?” by J. S. Todd,
Atlanta, whose answer was “Yes;” “Superin-
volution of the Uterus following Trachelor-
rhaphy,” by Virgil 0. Hardon, Atlanta; “Anti-
febrin as an Antipyretic,” by P. R. Cortleyou,
Marietta; “Antipyrin in Gynecological Practice,”
by T. S. Dekle, Thornasville; and “Treatment of
Hemorrhoids,” by Hunter P. Cooper, Atlanta.
Officers selected were: President, J. S. Todd,
Atlanta; First and Second Vice Presidents,
J. S. B. Holmes, Rome, and E. R. Anthony,
Griffin; Secretary (to fill the place of James A.
Gray, deceased ) , K. P. Moore, Macon. The
next meeting was to take place in Macon. The
total membership at this time was 248.
Fortieth Annual Session
Macon, 1889
It is noteworthy that throughout this meeting
no mention was made of the new Constitution
which had been proposed a year previously. For
the first time, however, there appeared in the
Transactions of 1889 reference to the “State
Board of Health,” and members were urged to
use their influence with representatives in the
General Assembly providing for such a body.
J. S. Todd presided, and gave a notable ad-
dress on “Medicine and Longevity.” Among the
essays presented were: “Ununited Fracture of the
Forearm. Operation by Drilling and Wiring,”
by W. P. Nicolson, Atlanta; “Abuse of Obstetric
Forceps,” by L. G. Hardman, Commerce; “Use
of Veratrum Viride in Puerperal Convulsions,”
by C. H. Richardson, Montezuma; “Some Typical
Cases of Fever Prevailing in Athens during the
last Ten Months,” by John Gerdine, Athens.
J. S. B. Holmes, Rome, was elected President for
the ensuing year; R. 0. Engram, Montezuma,
and P. R. Cortleyou, Marietta, First and Second
Vice Presidents. The meeting place for 1890 was
to be Brunswick.
Forty First Annual Session.
Brunswick, 1890
In the absence of Dr. Holmes, the meeting was
presided over by Vice President R. 0. Engram.
S. C. Benedict, Athens, read a paper on “Aseptic
versus Antiseptic Surgery,” the first time such
a subject had been brought before the Associa-
tion, and many members discussed it. Other
papers read were: “The Female LIrethra, a
Source of Trouble liable to be overlooked in
our Gynecological Investigations,” by K. P.
Moore, Macon; “The Importance of Chemical
and Bacteriological Examination of the Urine,”
by H. J. Williams, Macon; and “Stricture of
Male Urethra, and some Forms of Neuroses,” by
R. 0. Engram, Montezuma. It was remarkable
that papers “sent by mail” were allowed to be
read by the Secretary at this meeting and at
other meetings.
A. W. Griggs, West Point, was elected Presi-
dent; J. A. Dunwody, Brunswick, and E. W.
Lane, Scarboro, First and Second Vice Presi-
dents. Augusta was the place for the next meet-
ing.
Forty Second Annual Session
Augusta, 1891
The transactions of the Association for 1891
contained the Constitution as adopted in 1873,
so the new Constitution offered in 1888 was not
accepted. With Dr. Griggs presiding, A. S.
Johnson, Bowman, read a paper on “A Success-
ful Case of Laparotomy for Intussusception;”
C. C. Fowler, Rome, spoke on “Battey’s Opera-
tion’ ; and Thomas D. Coleman, Augusta, dis-
cussed in a paper, “Treatment of Phthisis Pul-
monalis.” Arthur C. Davidson, Sharon, pre-
sented “La Grippe: Its Etiology, Clinical His-
tory and Treatment,” which was the first time
this disease, then so prevalent, was brought to
the attention of the Association. Dr. Davidson
stated that the condition had prevailed almost
universally throughout Middle Georgia, and that
probably 90 per cent of all the people, white and
black, had been attacked. He claimed that Geor-
gia’s famous orator, Henry W. Grady, had died
in 1889 of the disease, although the usual cause
of Grady’s death was given as pneumonia.
Officers for 1892: President, G. W. Mulligan,
Washington; First and Second Vice Presidents,
92
The Journal of the Medical Association of Georgia
J. M. Hull. Augusta, and Mark H. O’Daniel, Mil-
ledgeville, Secretary, Dan H. Howell. Atlanta.
Columbus was chosen for the next place of meet-
ing.
Forty Third Annual Session
Columbus, 1892
The meeting was called to order by the presi-
dent, G. W. Mulligan. The chairman of the
Program Committee stated that they had sent
2,500 circulars to members of the Association
soliciting scientific contributions in order to
arrange a program for the meeting. As a result
the committee reported forty-three papers.
Among the papers which were read were:
“Cough: Some of Its Causes and Treatment,”
by C. I). (later known as Dunbar) Roy, Atlanta;
"The Relation Between Skin Diseases and the
General Health, " by M. B. Hutchins, Atlanta;
“Plaster Paris in Surgery,” by W. F. Westmore-
land, Atlanta; “Some Remarks on Tonsil Ex-
cisions, with Presentation and Description of
New Instruments,” by A. G. Hobbs, Atlanta;
“Extirpation of the Rectum for Carcinoma,” by
J. McF. Gaston, Atlanta; and “The Treatment
of Hemorrhoids by Carbolic Acid Injections,”
by J. W. Hallum, Carrollton.
This was the first time in the history of the
Association that such matters were discussed as
skin diseases, plaster of Paris, tonsillectomy, ex-
tirpation of the rectum for carcinoma, and the
treatment of hemorrhoids by carbolic acid in-
jections. Two papers were read on “Typhlitis,”
the forerunner of appendicitis, but they were not
published in the Transactions.
The transactions of the year contained obitu-
aries of several physicians who had been distin-
guished and useful members of the Medical As-
sociation of Georgia. Among these were Henry
Frazer Campbell, a native Georgian and an
alumnus of the Medical College of Georgia, who
died in 1886. The number of important medical
offices he held, and number of valuable and
original papers he wrote have scarcely been ex-
ceeded by any other member, before or after his
time. In 1885 he became the first physician of
the State to be elected President of the American
Medical Association.
Officers elected for the ensuing year were:
President, A. A. Smith. Hawkinsville; First and
Second \ ice Presidents, George J. Grimes, Co-
lumbus, and R. H. Taylor, Griffin; Treasurer,
E. C. Goodrich, Augusta. The next meeting was
to be held in Americus.
Forty Fourth Annual Session
Americus, 1893
Papers presented at this convention were:
“Puerperal Eclampsia and Its Treatment,” by
J. I. Darby, Americus; “Contagiousness of Con-
sumption,” by J. G. Hopkins, Thomasville;
“Stone in the Bladder, with Report of Cases,” by
F. W. McRae, Atlanta; “A Case of Multiple Neu-
ritis” (alcoholic), by Mark H. O’Daniel, Mil-
ledgeville; and “A Board of Medical Examiners:
The State’s Medical Duty,” by Luther B. Grandy,
Atlanta. In the last paper Dr. Grandy brought
to the attention of the Association for the first
time the timely subject of a State Board of Medi-
cal Examiners, which bad not been mentioned
before.
Dr. A. A. Smith presided. Atlanta was chosen
for the next meeting. Officers chosen were:
President, W. H. Elliott, Savannah; First and
Second Vice Presidents, G. T. Miller, Americus.
and H. McHatton, Macon; Secretary, Dan H.
Howell. Atlanta; Treasurer, E. C. Goodrich,
Augusta.
Forty Fifth Annual Session
Atlanta, 1894
The meeting was called to order by the Presi-
dent. W. H. Elliott, of Savannah. A large and
varied program was submitted. The number of
members in attendance wras not stated.
For the first time since the naming of “appen-
dicitis” by Reginald Fitz, in 1886, a paper on
the subject was read before the Association, the
speaker being Floyd W. McRae, of Atlanta. Ex-
tended discussion followed, and many essays rvith
similar titles were to be heard in the years to
come. Dr. Richard Douglas, of Nashville, Ten-
nessee, addressed the meeting on “Surgical
Shock.” W. B. Gilmer, Macon, presented a paper
on “Drainage of the Peritoneal Cavity with the
Use of the Siphon Pump.” The title of the paper
of R. P. Cox, of Rome, was “Sacrificial Surgery
of the Ovaries, Tubes and Uterus.” J. M. Hull,
of Augusta, discussed “Foreign Bodies in the
Larynx.”
Dr. H. E. Stafford, of New York City, spoke
on “The Extraction of Clear Lenses for Myopia.”
Among other essays read were: “A Plea for the
Closer Recognition of Dermatology as a Spe-
cialty,” by Bernard Wolff, Atlanta; “Phlegmasia
Alba Dolens,” by George H. Noble, Atlanta;
“Trephining in Head Injuries, with Paralysis in
the Opposite Arm, Followed by Fungus Cerebri,”
by R. M. Harbin, Calhoun.
Officers elected for 1895 wrere: President, W. F.
Westmoreland. Atlanta; First and Second Vice
Presidents, R. H. Taylor, Griffin, and William
Tate, Tate. The Secretary and the Treasurer
held over. The invitation of Savannah to enter-
tain the next meeting was accepted.
Forty Sixth Annual Meeting
Savannah, 1895
The meeting, at the DeSoto Hotel, rvas called to
order by the President, W. F. Westmoreland.
Several instructive papers were presented on sub-
jects for the first time before the Association:
“Urinalysis,” by Louis H. Jones, Atlanta;
“Graves’ Disease, with Cases,” by J. M. Hull,
Augusta; “Ligation of the External Carotid Ar-
tery as a Preliminary to, and Coincident with,
Operations Upon the Jaws,” by W. P. Nicolson,
Atlanta. Thirty-one papers were “read by title,”
which was more than were actually read. This
March, 1950
93
situation showed the increasing necessity for a
House of Delegates which could conduct the busi-
ness of the Association, and allow more time for
scientific considerations.
J. S. B. Holmes, acting for the Committee on
Legislation, announced the passage by the Legis-
lature of the bill establishing a Board of Medical
Examiners for the State of Georgia. The audit-
ing committee reported a balance of $763.51 in
the treasury, and recommended that the Secretary
and the Treasurer be paid $100 each for their
services, and the stenographer be allowed $130.
Augusta was selected for the next meeting, and
the following officers were elected: President,
Frank M. Ridley, LaGrange; First and Second
Vice Presidents, W. H. Doughty, Jr., Augusta,
and M. L. Boyd, Savannah; Secretary, R. H.
Taylor, Griffin; Treasurer, E. C. Goodrich, Au-
gusta. The matter of combining secretary and
treasurer in one office was considered, but no
action was taken.
Forty Seventh Annual Session
Augusta, 1896
The opening addresses at the meetings of this
period were characterized by a great show of
oratory which was not an uncommon talent
among the members of the Association. Neither
was there any attempt at brevity. Seven pages
in fine print were required in the transactions to
produce the eloquent speech of Dr. Eugene Foster
made as the address of welcome on this occasion.
Frank M. Ridley, another magnetic orator, was
president. As his concluding sentence Dr. Foster
said: “To you. my brethren, worthy successors
of the illustrious physicians whom I have just
named, to you, worthy members of the grandest
and noblest calling on earth, to each of you, in
the name of the medical profession of Augusta,
in the name of the citizens of this hospitable
community, I bid you welcome, thrice welcome,
beloved physicians!”
Of 31 essays scheduled on the published pro-
gram, 12 were actually read, and 11 were ’’read
by title." The scientific program was interrupted
frequently by business matters, more or less es-
sential. This situation showed the increasing
necessity for a House of Delegates.
Dr. Samuel Lloyd, of New York, read a paper
entitled, “Appendicitis,” and E. H. Richardson
New York, followed with one on “The Medical
Side of Typhlitis.” The Committee on Prize
Essay made its annual report, with the usual
statement that no essays had been offered for
the prize. George H. Noble, Atlanta, became
President for the next year; J. B. Morgan, Au-
gusta, and R. B. Barron, Macon, First and Sec-
ond Vice Presidents; and E. C. Goodrich was
continued as Treasurer. Macon was to entertain
the succeeding meeting.
Forty Eighth Annual Session
Macon, 1897
With Dr. Noble presiding, 27 papers were
read, although the titles of 62 appeared on the
official program. Stonewall Jackson’s surgeon,
Dr. Hunter McGuire, of Richmond, Virginia,
gave a paper entitled “Remarks on Appendicitis,
with a report of twenty-six cases operated upon
during the past twelve months,” which elicited
much complimentary discussion.
Other papers presented were: “Entero-colitis
in Infancy,” by M. A. Clark. Macon; “The Treat-
ment of Cutaneous Cancers,” by J. B. Morgan,
Augusta; “Puerperal Eclampsia,” by S. Rumble,
Goggansville; “Endemic Influenza, or La
Grippe,” by W. O’Daniel, Bullards; “Cause and
Prevention of Consumption,” by J. S. Todd, At-
lanta, “Expert Testimony,” by John C. Olmsted,
Atlanta; “Morphine and Its Effects,” by A. K.
Bell, Madison; and “A Study of the Refraction
of One Thousand Eyes,” by C. H. Peete, Macon.
The election of officers resulted as follows:
President, J. B. Morgan, Augusta; First and
Second Vice Presidents, L. G. Hardman, Har-
mony Grove (later Commerce) ; and J. L. Hiers,
Savannah. It was voted to hold the next meeting
at Cumberland Island, a popular resort at that
time. The Transactions of the year contained the
names of 300 members of the Association.
Forty Ninth Annual Session
Cumberland Island, 1898
In the absence of the President, First Vice
President L. G. Hardman called the meeting to
order. The new Constitution and By-Laws were
finally adopted. Among the papers heard were:
“The Importance of Careful Chemical Analysis
in Gastric Disorders,” by W. C. Lyle, Augusta;
“Mushrooms, a Food and a Poison,” by W. H.
Elliott, Savannah; “Peritonsillar Abscess, by
Dunbar Roy, Atlanta; “Report of Twenty-nine
Successful Cases of Tracheotomy for Foreign
Bodies in the Air Passages,” by W. F. Westmore-
land, Atlanta; and “Hysteria,” by A. A. David-
son, Augusta.
Although the Spanish-American War was
being fought in 1898, no mention of it occurs in
the Transactions. Several members were with the
Medical Corps, among them Major Edward C.
Davis.
The x-ray was given to the world by Roentgen
in November, 1895; it was first seen in Georgia
at the University of Georgia in January, 1896;
and papers on the epochal discovery were first
presented before the Medical Association of Geor-
gia at this meeting, in 1898. The papers read
were: “A Rare Form of Bone Atrophy Following
an Ununited Fracture, as seen by the x-ray,” by
Eugene Corson, Savannah; and “A Supernu-
merary Cervical Rib — A Deception by Skia-
graphy,” by Howard J. Williams, Macon. In
his discussion Dr. Williams declared that the
x-ray he was reporting had been shown at the
meeting of the Association the previous year, in
1897, but the Transactions for the year contained
no such report.
Howard J. Williams, Macon, was elected
President; and J. G. Hopkins, Thomasville, and
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The Journal of the Medical Association of Georgia
I. H. Goss. Athens, First and Second Vice Presi-
dents. The Association accepted the invitation
of Macon to meet in that city the following year.
Fiftieth Annual Session
Macon. 1899.
This assemblage marked the semi-centennial of
the organization of the Association, which had
occurred in Macon fifty years previously. Dr.
Howard Williams presided, the eloquent Judge
Emory Speer, of Macon, delivering the address
of welcome. As his presidential speech Dr. Wil-
liams read an inspiring original poem directed
‘'To the Surviving Members of the First Meeting
of the Medical Association of Georgia.” several
of whom were present.
Typhoid fever was a common and serious dis-
ease at this time, and there were animated dis-
cussions as to its treatment. Papers read were:
“The Eliminative and Antiseptic Treatment of
Typhoid Fever,” by T. Virgil Hubbard, Atlanta;
“Infant Feeding in Health and Disease,” by Gil-
man Robinson, Atlanta: “Seven Cases of Diph-
theritic Croup. Two Aborted, and Five Cured by
Antitoxin and Intubation,” by R. M. Harbin,
Rome; “The Endoscopic Treatment of Chronic
Urethritis,” by W. L. Champion. Atlanta; “Mitral
Stenosis, by M. F. Carson, Griffin; “Surgical
Treatment of Empyema,” by W. S. Elkin, At-
lanta; “Case of Gunshot Wound of the Abdo-
men,” by Hunter P. Cooper, Atlanta; and “As-
phyxia Neonatorum,” by C. H. Richardson,
Montezuma.
Floyd W. McRae, Atlanta, was elected Presi-
dent; and St. J. B. Graham, Savannah, and H. B.
McMaster. Waynesboro, First and Second Vice
Presidents. Atlanta was chosen for the next place
of meeting.
Fifty First Annual Session
Atlanta, 1900
The Association was called to order by the
President, Floyd W. McRae. In delivering the
address of welcome Hon. Fulton Colville called
attention to the fact that if it had not been for a
Governor's veto the right to practice in Georgia
would have been granted osteopaths the previous
year.
Among the papers read were: “Hvdrophobia
and the Necessity for a Pasteur Institute in Geor-
gia,” by Henry R. Slack, LaGrange; “Hemor-
rhage Occurring Before the Menopause,” by
E. C. Davis, Atlanta; “The Use of Spectacles,” by
A. W. Stirling, Atlanta; “Diseases of the Stom-
ach,” by Edgar J. Spratlin, Forsyth: “The Duty
of the Medical Profession and the State to Chris-
tian Science Healers,” by P. R. Cortleyou. Ma-
rietta; “The Necessity for the Use of the Micro-
scope in the Diagnosis of Malaria,” by E. E.
Murphey, Augusta; and “Some of the Uses of
Veratrum viride,” by J. E. Mangum, Reynolds.
Officers elected were: President, Samuel C.
Benedict, Athens; First and Second Vice Presi-
dents, R. M. Harbin, Rome, and L. V. Lockhart,
Maysville; Secretary, L. H. Jones, Atlanta. The
following annual meeting was voted to Augusta.
Fifty Second Annual Session
Augusta. 1901.
The session was called to order by the Presi-
dent, S. C. Benedict. Several matters, mentioned
in the report of the Committee on Public Legis-
lation. provoked considerable discussion. Among
these were a bill designed to create a State Board
of Health, and the efforts of the osteopaths to gain
recognition. The report of the committee on the
establishment of a Pasteur Institute also was
given much attention.
Some of the papers presented were: “Excision
in Tuberculosis of Joints — Hips and Wrists,” by
H. J. Williams, Macon; “Hysterectomy with In-
teresting Complications,” by J. G. Earnest, At-
lanta; “Caesarean Section,” by E. C. Davis,
Atlanta; “Lung Injuries,” by D. A. N. Thomas.
Jersey; “Epidemic Sore Throat,” by L. J. Sharp.
Harmony Grove; “Bottle Fed Babies,” by W. Z.
Holliday, Augusta; and “Yellow Atrophy of the
Liver,” by T. E. Oertel, Augusta. Dr. George R.
Fowler, of Brooklyn, New York, gave a disserta-
tion on “Internal Derangements of the Knee-
joint, with Report of Three Cases of the Removal
of the Internal Meniscus, or Semi-lunar Carti-
lage.”
Officers chosen were: President, James B.
Baird, Atlanta; First and Second Vice Presidents,
Thomas R. Wright, Augusta, and J. D. Chason,
Bainbridge; Secretary and Treasurer, Louis H.
Jones, Atlanta. This was the second time in the
history of the Association that secretary and
treasurer were combined in one office. It was
decided to meet next in Savannah.
Fifty Third Annual Session
Savannah, 1902
The meeting convened in the historic DeSoto
Hotel, where many sessions of the Association
have been held. President was J. B. Baird, of
Atlanta. The action of the committee on charter
incorporating the Association was ratified and
approved.
Several papers were read on typhoid fever.
Others read were: “Trachoma,” by J. M. Craw-
ford, Atlanta; “Ligation of the Femoral Artery
for Traumatic Aneurysm,” by J. B. Morgan,
Augusta; “Some Reasons why we should have a
State Board of Health,” by E. C. Thrash, Oak-
land; “The Treatment of Uterine Fibroids,” by
Virgil 0. Hardon, Atlanta; and “Gunshot
Wounds of the Intestine,” by W. J. Little, Macon.
Dr. F. W. McRae stated that he had received
a letter from Dr. George H. Simmons, of the
American Medical Association, bringing up the
matter of State Associations becoming affiliated
with the A.M.A. This was an important proposal
which would be acted upon later.
Charles Hicks, Dublin, was elected President
for the ensuing twelve months; J. A. Guinn,
Conyers, and W. W. Binion, Benevolence, First
March, 1950
95
and Second Vice Presidents. Columbus was
chosen for the next meeting.
Fifty Fourth Annual Session
Columbus, 1903
Charles Hicks, Dublin, presided. Among the
papers read were: “Some Observations in 1400
Cataract Operations,” by A. W. Calhoun, Atlanta;
“Albuminuric Retinitis,” by T. H. Mitchell, Co-
lumbus; “Summer Complaints of Children,” by
S. A. Visanska, Atlanta; “Puerperal Insanity,”
by J. W. Palmer, Ailey; “A Study of a Case of
Spinal Curvature; Preliminary Report of a New
Operation,” by Michael Hoke, Atlanta; and “Gas-
troptosis,” by J. N. LeConte, Atlanta. Fifteen
papers were read by title.
The title of a paper read by Floyd W. McRae
was “The Sin of So-called Conservative Medical
Treatment in Diseases Requiring Prompt Surgi-
cal Intervention.” Papers of this kind were be-
coming more frequent as modern surgery was
getting better established as rational successful
treatment in cases which before had been sacri-
ficed for want of sufficient knowledge and ex-
perience to save them. How the advocates of
conservatism in such cases would have delighted
to have the sulfa drugs and antibiotics of forty-
five years later to cope with many diseases with-
out resorting to surgery!
The next President was to be H. McHatton,
Macon; First and Second Vice Presidents, J. H.
McDuffie, Columbus, E. C. Thrash, Oakland.
Previously many delegates had been appointed
to represent the Association at the meeting of
the A.M.A., but this year only one delegate was
selected, Dr. Floyd W. McRae, Atlanta. Macon
was chosen for the next convention.
Fifty Fifth Annual Session
Macon, 1904
The Association convened with President H.
McHatton in the chair. The report of the Execu-
tive Committee recommending the plan of reor-
ganization as suggested by the American Medical
Association was read, and action deferred for
one year. A committee of one member from
each state senatorial district was appointed to
co-operate with the Committee on Medical Legis-
lation in procuring the establishment of a State
Health Department.
The program offered one of the largest number
of papers in the history of the Association, being
63. So many other matters consumed the time
of the sessions that only 32 papers were read.
Among these were: “Ectopic Gestation with Re-
port of Complete Operation and Recovery of the
Patient.” by E. C. Davis, Atlanta; “The Treat-
ment of Cancer,” by M. B. Hutchins, Atlanta;
“Anesthesia and Anesthetics,” by Ralph Thom-
son, Savannah; “Uncinariasis in Georgia,” by
Claude A. Smith, Atlanta; “Incurable Headache
— Report of Two Cases,” by V. D. Lockhart,
Maysville; “The Necessity of a State Board of
Examiners for Trained Nurses in Georgia,” by
E. B. Elder, Macon.
Other papers heard were: “Intestinal Obstruc-
tion,” by C. T. Nolan, Marietta; “Smallpox, with
Especial Reference to the Extraordinarily Mild
Epidemic of this Disease now prevailing in Geor-
gia,” by H. F. Harris, Atlanta; “Report of a
Case of Twins of Unequal Size and Age,” by
W. W. Evans, Higgston; and “The Prevention
of Tuberculosis,” by T. E. Oertel, Augusta.
The following new officers were installed: Pres-
ident, W. P. Nicolson, Atlanta; First and Second
Vice Presidents, M. A. Clark, Macon, and W. Z.
Holliday, Augusta. Delegate to the A.M.A., J. B.
Morgan, Augusta; the next meeting place to be
Atlanta. An unprecedented event occurred in the
suspension of a member for five years for ver-
batim plagiarism.
Fifty Sixth Annual Session
Atlanta. 1905
This meeting, destined to become historic, was
called to order by the President, William Perrin
Nicolson. The Committee on Tuberculosis made
an extensive report telling of the progress which
it was making in fighting what was then referred
to as the “Great White Plague.”
There was active discussion and at times vio-
lent disagreement over the adoption of the new
Constitution and By-Laws, as proposed by the
A.M.A., but they were finally adopted by the
close vote of 134 to 111. The arguments became
so heated that a former president of the Asso-
ciation, Charles Hicks, of Dublin, resigned from
the Association from the floor. His resignation
was not accepted, however, and he withdrew it.
The total membership at this time was 823,
104 new names being added at this meeting.
Sixty-six essays were on the program, 36 being
read. The Treasurer reported a balance of
$582.88 on hand.
J. Cheston King, Atlanta, presented “Report of
a Case of Myasthenia Gravis.” The title of the
article of W. B. Armstrong was “Mucus Colitis;”
“Diagnostic and Therapeutic Importance of the
Recent Advances in the Examination of Feces,”
by H. F. Harris, Atlanta; “The Prevention and
Treatment of Puerperal Infection,” by L. C.
Fischer, Atlanta; “Some Remarks on Results of
Radical Operation for Hernia,” by W. S. Elkin,
Atlanta; and “Complications of Chronic Sup-
puration of the Middle Ear, with Special Ref-
erence to Thrombosis of the Lateral Sinus,” by
C. H. Cunningham, Macon.
Officers chosen were: President, W. Z. Holli-
day, Augusta; First and Second Vice Presidents,
R. P. Izler, Waycross, and C. T. Nolan, Marietta;
Secretary-Treasurer, L. H. Jones, Atlanta. And
for the first time, in accordance with the pro-
vision of the new Constitution, a Councilor was
elected from each Congressional District. These
were: First District, J. S. Howkins, Savannah;
Second District, W. L. Davis, Albany; Third,
R. E. L. Barnum, Richland; Fourth, W. L. Fitts,
Carrollton; Fifth, E. C. Davis, Atlanta; Sixth,
M. A. Clark, Macon; Seventh, A. T. Calhoun,
90
The Journal of the Medical Association of Georcia
Cartersville; Eighth. S. C. Benedict, Athens;
Ninth, W. B. Hardman, Commerce; Tenth. W. W.
Pilcher, Warrenton; Eleventh, J. D. Herrman,
Eastman. The salary of the Secretary-Treasurer
was fixed at $600.00 per annum. J. B. Morgan
and H. F. Harris were selected as delegates to
the A.M.A. Augusta was selected for the next
meeting.
Fifty Seventh Annual Session
Augusta, 1906
The Association convened with Dr. W. Z.
Holliday presiding. The report of the Committee
on Education attracted considerable attention.
The regular medical inspection of schools was
recommended, as was limitation of the number
of pupils which should be assigned to one teacher.
Sanitary and moral prophvlaxis were empha-
sized. and a resolution was adopted urging proper
instruction to boys and girls separately as to
social hygiene and social purity.
For the first time the Council and House of
Delegates held meetings, and made reports to
the sessions, thus permitting more time for scien-
tific discussions. The House of Delegates met
the day before the opening of the sessions, which
has been the custom ever since. The salary of the
Secretary-Treasurer was raised to $1,000. Bal-
ance in the treasury was $3,280.29.
Of 78 papers on the program 48 were read.
Among these were: “Needed Legislation on Pure
Food Laws in Georgia,” by O. H. Buford. Car-
tersville; Dementia Praecox,” by J. W. Mobley,
Milledgeville; “A Simple Method of Staining
Spirochetae Pallida,” by Charles R. Andrews,
Atlanta; “The Diagnosis and Treatment of Gall-
stones,” by George R. White, Savannah: “Report
of a Case of Addison’s Disease,” by W. C. Lyle,
Augusta; and “A New and Original Simplifica-
tion of the Present Method of Infant Feeding,”
by Charles E. Boynton, Atlanta.
J. N. Downey, New Holland, read a “Report of
Five Cases of Fracture of the Femur, with Re-
marks on Treatment and Exhibition of Extension
and Counter Extension Apparatus.” It is prob-
able that this was the first demonstration before
a medical society of an apparatus of this kind; it
certainly antedated the “Hawley” table. The
article on “Radium” by Frederick G. Hodgson
was the first paper read on radium before the
Association.
Officers were elected as follow's: President,
H. H. Martin, Savannah; First and Second Vice
Presidents, T. E. Oertel, Augusta, and J. W.
Palmer, Ailey; and three delegates to the A.M.A. :
T. D. Coleman, Augusta, George R. White, Sa-
vannah, and H. F. Harris, Atlanta. Savannah
was chosen for the next annual meeting.
Fifty Eighth Annual Session
Savannah, 1907
The meetings were held at the DeSoto Hotel
and Tybee Island, with Dr. Martin presiding.
The report of the Committee on Tuberculosis was
very complete and offered valuable plans for the
control of the disease in Georgia.
Papers read were: “Enterocolitis in Children,”
by T. J. McArthur, Cordele; “Training of Epi-
leptic and Feeble-minded Children,” by Wesley
Taylor, Atlanta; “Tetanus,” by J. A. Crowther,
Savannah; “Tropical Aptha or Sprue in Geor-
gia,” by H. F. Harris, Atlanta; “A Preliminary
Report on the Relation of Albuminous Putre-
faction in the Intestines to Arthritis Deformans
I Rheumatoid Arthritis, Osteo-arthritis) : Its In-
fluence upon Treatment,” by C. R. Andrews and
Michael Hoke, Atlanta; and “Blood Pressure in
Health and Disease,” by Ralston Lattimore. Sa-
vannah. This was the first paper read on blood
pressure before the Association. There were
several papers read on typhoid fever and tuber-
culosis.
The new officers were: President, M. A. Clark,
Macon; First and Second Vice Presidents, Ralph
M. Thomson, Savannah, and Eugene E. Murphey,
Augusta. Councilors and Delegates to the A.M.A.
were elected, and Fitzgerald chosen for the next
meeting.
Fifty Ninth Annual Session
Fitzgerald, 1908
The meeting was called to order by the Presi-
dent, M. A. Clark. The House of Delegates con-
vened five times, and transacted much business.
An innovation was the introduction of a scien-
tific exhibit. H. F. Harris, the first Secretary of
the State Board of Health, presented a resolution
urging the Association to endorse a resolution
of the board asking for an annual appropriation
of $3,500 or more to permit the Board to control
all matters pertaining to stream pollution. The
resolution wras adopted, as was another asking
the Legislature for more funds for the control of
tuberculosis and other diseases.
The following papers were read: “The Neces-
sity for the Proper Treatment for School Chil-
dren’s Eyes,” by Dunbar Roy, Atlanta; “The Re-
sults of Vaccine Therapy in Acute and Chronic
Infections,” by J. E. Paullin, Atlanta; “A Favor-
able Report of the Use of Gonococcic Vaccine,”
by E. G. Ballenger, Atlanta; “Report of Five
Cases of Facial Neuralgia Treated with Injec-
tions of Osmic Acid,” by C. C. Harrold, Macon;
“The Indications for the Mastoid Operation,”
by Phinizy Calhoun, Atlanta; “Cicatricial Stric-
ture of the Esophagus,” by George R. White,
Savannah; and “Hip Joint Operation, Removal
of the Head of the Femur,” by J. T. Gammage,
Pine View.
Other papers submitted were: “Significance of
Arterial Hypertension — Its Treatment,” by Ral-
ston Lattimore, Savannah; “Fractures of the
Skull,” by W. A. Norton, Savannah; “Drainage
in Suppurative Conditions about the Abdomen,”
by W. S. Goldsmith; “Headache and Neuralgia
due to Diseases of the Nose and Accessory Sin-
uses,” by H. M. Lokey, Atlanta; and “Gastroje-
March, 1950
97
j unostomy — Report of Cases,” by E. G. Jones,
Atlanta. These essays received liberal discus-
sion.
Officers chosen were: President, T. D. Cole-
man, Augusta; W. B. Armstrong, Atlanta, and
Ralston Lattimore, Savannah, First and Second
Vice Presidents. Dr. L. H. Jones having re-
signed the office of Secretary-Treasurer, which
he had filled so long and well, Claude A. Smith,
Atlanta, was elected to fill his place. The invita-
tion of Macon to entertain the next meeting was
accepted.
Sixtieth Annual Session
Macon, 1909
President Coleman delivered an unusually in-
teresting address, which was followed by a valu-
able paper on “Medical Organization” by Dr.
M. A. Clark. Report of Council showed that 90
County Societies and 10 District Societies were
organized, leaving only one district without a
society. The total membership was reported as
1200.
Papers read were: “The History of the Modern
Treatment of Penetrating Wounds of the Ab-
domen,” by Thomas R. Wright, Augusta; “How
to Abort Acute Gonorrhea, by W. L. Champion,
Atlanta; “Inguinal Hernia Operated on under
Local Anesthesia,” by A. G. Little, Valdosta;
“Pellagra, with Report of Two Cases,” by Law-
rence Lee and Ernest S. Cross, Savannah; “The
Success of Local Anesthesia in the Performance
of Operation for Radical Cure of Inguinal Her-
nia,” by W. W. Battey, Augusta; “Prevention of
Ophthalmia Neonatorum,” by H. H. Martin,
Savannah; “The Common House Fly is the Cause
of Typhoid Fever,” by J. W. Palmer, Ailey; and
“The Senile Prostate,” by F. W. McRae, Atlanta.
So far as the record goes this was the first time
papers were read on pellagra, local anesthesia
and hypertrophied prostate. The article on the
house fly attracted many discussors.
Other articles heard were: “Neurasthenia,” by
W. Herbert Adams, Savannah; “Antirabic Serum
with Report of Cases,” by J. N. Brawner, At-
lanta; “The Value and Limitation of Blood Ex-
aminations in the Diagnosis of Diseases Accom-
panied by Enlargement of the Spleen,” by V. H.
Bassett, Savannah; and “Preliminary Report on
the Use of Antirabic Serum,” by J. E. Paullin,
Atlanta. Thus antirabic serum and enlarged
spleen were mentioned for the first time before
the Medical Association of Georgia.
Result of the election of officers was as follows :
President, T. J. McArthur, Cordele; First and
Second Vice Presidents, M. F. Carson, Griffin,
and J. R. Shannon, Forsyth; Secretary-Treas-
urer, Claude A. Smith, Atlanta. The next meeting
was to be in Athens.
Sixty First Annual Session
Athens, 1910
With President McArthur presiding, many re-
ports were read, resolutions adopted, and a pro-
posed new Medical Practice Act presented.
Among the papers read were: “Treatment for
Chronic Discharging Ears,” by Phinizy Calhoun,
Atlanta; “Subparietal Injuries of the Kidney,
with Report of a Case Requiring Immediate
Nephrectomy, by C. W. Roberts, Douglas;
“Hookworm Eradication,” by L. J. Sharp, Com-
merce; “Some Remarks on Flatulence,” by
George M. Niles, Atlanta; “The Results of an
Operation for Suspending the Uterus by the
Round Ligaments,” by J. R. B. Branch, Macon;
“Simultaneous Catheterization of the Ureters,”
by A. L. Fowler, Atlanta; and “The Georgia
State Sanatarium,” by Thomas R. Wright, Au-
gusta.
The members of the Association visited Jeffer-
son, Georgia, April 21st, to witness the unveiling
of a shaft to Crawford W. Long, donated by Dr.
L. G. Hardman, of Commerce, Georgia. Dr.
Woods Hutchinson made a notable address sup-
porting the claims of Dr. Long as the discoverer
of surgical anesthesia. An attempt had been
made for several years by a committee from the
Association to raise money for placing a statue
of Long in Statuary Hall, Washington, D. C.,
where it had been voted a place by the State
Legislature, but the effort did not succeed. In-
stead, in 1926, the statue was erected by a non-
medical organization, known as the Crawford W.
Long Memorial Association.
E. C. Davis, Atlanta, was elected President;
J. C. Bloomfield, Athens, and C. H. Richardson,
Montezuma, First and Second Vice Presidents;
Delegates to the A.M.A., E. E. Murphey, H. F.
Harris; Alternates, T. D. Coleman, and Dunbar
Roy. Rome was selected for the next meeting.
Sixty Second Annual Session
Rome, 1911
In August, 1911, appeared the first number of
the Journal of the Medical Association of Geor-
gia, in which monthly periodical the minutes and
papers of the Association were to be published
hereafter, thus taking place of the Transactions.
Dr. W. C. Lyle, of Augusta, Secretary-Treasurer,
was Editor, and Dr. W. R. Houston, of Augusta,
Associate Editor.
President E. C. Davis called to order the meet-
ing in Rome, when reports were received from
the Council and the House of Delegates. Among
deceased members eulogized by the Committee
on Necrology was Abner Wellborn Calhoun, pio-
neer oculist of the South. The House of Delegates
reported several bills of medical interest which
had been passed by the Legislature, and other
bills which had not been passed.
Officers elected for the ensuing year were:
President, W. L. Fitts, Carrollton; First and
Second Vice Presidents, R. M. Harbin, Rome, and
T. E. Bradley, Cordele. The next meeting was to
take place in Augusta.
Among papers presented were: “The Associa-
tion of Uncinariasis in Cataracts,” by Phinizy
Calhoun, Atlanta; “Salvarsan,” by Edgar G.
98
The Journal of the Medical Association of Georgia
Ballenger, Atlanta; “Goiter and Its Surgical
Treatment,” by W. P. Harbin, Rome; “Report of
Cases of Brain Tumors with Autopsies,” by E.
Bates Block. Atlanta; “Perineal Repair, Com-
plete and Incomplete,” by R. R. Kime, Atlanta;
“Sambon’s New Theory of Pellagra and Its Ap-
plication to Conditions in Georgia,” by Stewart
R. Roberts, Atlanta; “The Gallbladder,” by J. L.
Campbell. Atlanta; “Gas Gangrene, with Report
of Two Cases,” by C. W. Roberts, Douglas;
“Treatment of Pulmonary Tuberculosis by Arti-
ficial Pneumothorax,” by S. T. Harris, Valdosta;
and “Bacilli Carriers and Their Relation to Pub-
lic Health.” by Katherine R. Collins, Atlanta.
Sixty Third Annual Session
Augusta, 1912
The new Journal of the Association carried
the minutes of this session and many of the
papers which were read. W. L. Fitts presided.
The Secretary’s report showed that societies ex-
isted in 69 counties of the State, and all districts
had societies except the twelfth district. No busi-
ness of especial importance came from the House
of Delegates or the Council.
Dr. Hugh H. Young, champion of Crawford
Long, gave an interesting discourse. Many good
papers were read. Among these were: “The
Medical Society and Its Relation to Public
Health,” by Thomas J. McArthur, Cordele; “The
Eugenical Conservation of Man,” by A. L. R.
Avant. Savannah; “Cerebro-spinal Meningitis,”
by W. D. Travis, Covington; “A Clinic with Deaf
Mute Children,” by R. C. Woodard, Adel; “A
Consideration of the Subject of Goiter with Espe-
cial Reference to Surgical Treatment,” by E. G.
Jones, Atlanta; “The Importance of Correct Diag-
nosis of Skin Lesions and Exhibition of a Case of
Dermatitis Herpetiformis,” by Cosby Swanson,
Atlanta; and “The Value of Ureteral Catheriza-
tion,” by W. F. Shalienberger, Atlanta.
Other papers read were: “Intestinal Resection
in Strangulated Inguinal Hernia, with Report of
Cases,” by W. W. Battey, Jr., Augusta; “Three
Cases of Intestinal Obstruction, with Operation.”
by T. J. Carswell, Waycross; “The Relation of the
Eye to Diseases of Other Parts of the Body,” by
B. H. Minchew, Waycross; “Malaria,” by J. C.
Holliday, Athens; “The Value of the X-ray in the
Diagnosis of Foreign Bodies,” by A. B. Elkin,
Atlanta; “My Observation and Personal Experi-
ence on the Improved Technic of Ether Vapor
and the Nitrous-Oxide-Oxygen Anesthetics,” by
T. J. Collier, Atlanta; “So-Called Neurasthenia —
Some Factors Causative and Curative,” by Han-
sell Crenshaw, Atlanta; and “Cystoscopy as an
Aid in Surgical Diagnosis,” by W. S. Goldsmith,
Atlanta.
W. W. Pilcher, Warrenton, was elected Presi-
dent; J. W. Palmer, Ailey, and T. H. Hall, Macon,
First and Second Vice Presidents; W. H. Dough-
ty and T. J. Carlton, Delegates to the A.M.A. ;
and E. G. Ballenger and T. R. Wright, Alternates.
The next place of meeting was Savannah.
Sixty Fourth Annual Session
Savannah, 1913
This meeting, presided over by President Pil-
cher, was marked by heated debate over public
health matters and the proposed new Medical
Practice Act. Many resolutions were introduced,
covering different subjects, but no definite action
was taken about anything. The Secretary, W. C.
Lyle, reported that the Association, in regard to
finances and number of members, was in the best
condition in its history.
Following were some of the papers read: “The
Practice of Medicine and Pharmacy in Georgia
and Some Problems Involved,” by R. C. Wilson.
Ph.G., Professor of Pharmacy, Lhiiversity of
Georgia; “The Care of the Eyes of Children
While Employed Indoors,” by Hugh M. Lokey,
Atlanta; “The Offending Tonsil,” by W. C. Lyle,
Augusta; “A Plea for Psychopathic Wards and
Hospitals,” by Y. H. Yarbrough. Milledgeville;
“Results of Pasteur Treatment in Rabies,” by
C. B. Greer, Pathologist, State Board of Health;
“Medical School Inspection,” by Hinton J. Baker.
Augusta; and “Raynaud’s Disease, Report of
Three Cases in the Negro Race,” by Lawrence
Lee, Savannah.
Other papers read were: “Chronic Nephritis,
Dietetics and Treatment,” by R. F. Wheat, Am-
sterdam; “Cerebral Syphilis,” by R- C. Swint,
Milledgeville; “The Care of the Newborn,” by
M. A. Clark, Macon; “Acute Mastoiditis, with a
Report of Four Cases Treated with Vaccines,” by
Albert B. Mason, Waycross; “Diagnosis and
Treatment of Duodenal and Gastric Ldcers,” by
W. R. Houston, Augusta; and “Clinical Interpre-
tation and Application of the Wassermann Re-
action,” by E. G. Ballenger and Omar F. Elder,
Atlanta.
Atlanta was chosen for the next meeting, and
the following officers were elected: President,
Ralston Lattimore, Savannah; First and Second
Vice Presidents, J. D. Chason, Bainbridge, and
S. R. Roberts, Atlanta; Secretary-Treasurer, W.
C. Lyle, Augusta; Delegates to the A.M.A., T. J.
Charlton, Savannah, and M. A. Clark, Macon;
Alternates, T. R. Wright, Augusta, and C. T.
Nolan, Marietta.
Sixty Fifth Annual Session
Atlanta, 1914
The Association met under the presidency of
Dr. Ralston Lattimore. At the meeting of the
House of Delegates the chairman reported the
passage of the Medical Practice Act. The Treas-
urer stated that there was a balance of $3,550
in the bank. At this time the Secretary-Treasurer
was being paid a salary of $100 per month.
Papers read were: “Suprapubic Prostatec-
tomy,” by W. L. Champion, Atlanta; “Hyper-
nephroma,” by Edward A. Wilcox, Augusta;
“Treatment and Mortality of Cerebro-spinal
Meningitis,” by J. E. Paullin, Atlanta; “Whit-
March. 1950
99
man’s Method of Treating Fractures of the Hip,”
by C. C. Harrold, Macon; “Psychoanalysis,” by
Hansell Crenshaw, Atlanta; “An Experimental
Study of the Aberhalden Test,” by Allen H.
Bunce, Atlanta; “Report of Two Cases Presenting
Symptoms of Mucus Colitis,’ by G. P. Huguley,
Atlanta; and “Cerebro-spinal Syphilis,” by W. R.
Houston, Augusta.
Officers chosen were: President, W. B. Hard-
man, Commerce; First and Second Vice Presi-
dents, C. L. Williams, Columbus, and F. D. Pat-
terson, Cuthbert; Delegates to the A.M.A. : M. A.
Clark and E. C. Davis; Alternates, C. T. Nolan
and F. W. McRae. The next meeting to be held in
Macon.
Sixty Sixth Annual Session
Macon, 1915
The Journal contained no minutes of the meet-
ing of 1915, with Dr. W. B. Hardman presiding.
Among essays on the program were: “Interpreta-
tion of Roentgenograms in Certain Gastro-intes-
tinal Conditions,” by George M. Niles, Atlanta;
“Spinal Anesthesia in Surgery, with Report of
927 Cases,” by G. Y. Massenburg, Macon; “Value
of X-ray in Diagnosis,” by John S. Derr, Atlanta;
“Tonsils and the Rheumatic Group,” by S. R.
Roberts, Atlanta; “Blood Vessel Surgery,” by
Hugh N. Page, Augusta; “The Causes, Preven-
tion and Correction of Abdominal Adhesions,”
by W. F. Westmoreland, Atlanta; “Pulsating
Exophthalmos,” by T. E. Oertel, Augusta; “Con-
cerning the Removal of Foreign Bodies from the
Globe by the Electro-Magnet,” by Phinizy Cal-
houn, Atlanta; and “Toxemias of Pregnancy,”
by G. A. Traylor, Augusta.
In the absence of published minutes the officers
elected were not known. The minutes of the
meeting of 1916, however, showed that W. S.
Goldsmith, of Atlanta, had been elected Presi-
dent, and the next meeting was to be held in
Columbus.
Sixty Seventh Annual Session
Columbus, 1916
With Dr. Goldsmith presiding, M. M. McCord,
of Rome, presented an article on “How We Ex-
pect the Ellis Public Health Bill to Benefit Floyd
County.” The title of the paper by J. 0. Elrod,
Forsyth, was “A Plea for Regulating the Adver-
tising and Sale of Patent Medicines.” Other
papers read were “Hydrotherapy,” by W. W.
Blackman, Atlanta; “The Grave Danger of the
Painless Blind Abscess; the Emetin Flash,” by
Robin Adair, Atlanta; “Acute Torsion of the
Ovary in Young Girls, with Report of Two
Cases,” by H. S. Monroe, Columbus; “Gunshot
Wound of the Spinal Cord,” by W. L. Cooke,
Columbus; “The Acute Abdomen,” by W. F.
Westmoreland, Atlanta; “Conservation of Tissue,
Restoration of Function, Not Removal of Organs,
Should be the Aim of Surgery,” by F. W. Mc-
Rae, Atlanta; “Acute Dilatation of the Stomach.”
by J. T. Rogers, Savannah; “Angina Pectoris,”
by S. R. Roberts, Atlanta; and “Migraine,” by
J. G. Dean, Dawson.
Officers for 1917 were: J. G. Dean, Dawson,
President; J. M. Anderson, Columbus, and C. K.
Sharp, Arlington, First and Second Vice Presi-
dents; F. W. McRae, S. R. Roberts. E. C. Davis,
J. M. Smith and A. G. Fort, Delegates to the
A.M.A. The following meeting was to go to
Augusta. An amendment was passed establish-
ing the Committee on Medical Defense, to inves-
tigate and defend all suits against the Associa-
tion and against individual members for civil
malpractice. The Association was to pay the
expenses of such defense and also pay any judg-
ment rendered against a member.
Sixty Eighth Annual Session
Augusta, 1917
This assemblage, presided over by Dr. Dean,
was memorable in that on April 2nd, sixteen
days before the meeting opened, the United
States had declared war against Germany. Talk
of war was in the air, and several members pres-
ent were already in their uniforms, and many
more were about to join the service. A resolu-
tion was adopted asking members who stayed at
home to care for the practice of those who had
gone to war and, as far as feasible, return the
practice to the member upon his return home.
Sixty-five interesting papers were on the pro-
gram. Among those read were: “The Importance
of Careful Preliminary Examinations Before
Surgical Operations,” by E. C. Davis, Atlanta;
“The Value of the X-ray in Diagnosis of Path-
ology in the Stomach, Duodenum and Appen-
dix,” by John S. Derr, Atlanta; “Observations
on the Preparation of Substances for Intraspinal
Injection in Syphilis of the Central Nervous Sys-
tem,” by Allen H. Bunce, Atlanta; “Southern
Surgeons for Southern Soldiers,” by Major
Charles C. Harrold, Macon; “Hypertension,” by
Stewart R. Roberts, Atlanta; “Dietetic Treat-
ment of Typhoid Fever,” by James E. Paullin,
Atlanta; “Treatment of Infantile Paralysis,” by
Frederick G. Hodgson, Atlanta; and “Emergency
Head Surgery,” by Charles E. Dowman, Atlanta.
Dr. George W. Crile, of Cleveland, delivered an
address on the treatment of gallbladder diseases,
peptic ulcer and diseases of the thyroid gland.
Officers elected were: Major E. E. Murphey,
Augusta, President; A. D. Little, Thomasville,
and E. C. Thrash, Atlanta, First and Second Vice
Presidents. Major W. C. Lyle continued in office
as Secretary-Treasurer. Savannah was chosen for
the next meeting.
Sixty Ninth Annual Session
Savannah, 1918
The war was a matter for much discussion,
and members were urged to join the armed
forces. A Committee for Medical Preparedness
had been appointed to give information about
enlistments, and to aid members to do their part
in the conflict. President Eugene Murphey, one
100
The Journal of the Medical Association of Georgia
of the first to enlist, was in the chair. Colonel
G. E. Bushnell, of the United States Army, spoke,
while Major Joseph C. Bloodgood. of Baltimore,
addressed the session on “Some Principles In-
volving the Treatment of Infected Wounds.”
Major Seale Harris, of Birmingham, also ad-
dressed the meeting urging early enlistment of
members.
Among papers read were: “The Control of
Cancer,” by George R. White, Savannah; “Ba-
bies. Malaria and Quinine,” by W. A. Mulherin.
Augusta: "Direct Alcoholization of the Sensory
Root of the Fifth Nerve in the Treatment of Tic
Douloureux,” by H. H. Martin, Savannah: “Pa-
pillomata of Gallbladder and a Case of Anasta-
mosis of Biliary Sinus to Intestine.” by T. P.
Waring, Savannah; “Plastic and Cosmetic Sur-
gery,” by E. D. Highsmith. Atlanta; “Ten Years’
Experience in the Treatment of Pneumonia,” by
S. T. R. Revell, Louisville; and “Roentgen Diag-
nosis of Empyema Simulating Other Diseases,”
by Wr. A. Cole. Savannah.
Officers elected were: J. W. Palmer, Ailey,
President; George R. White, Savannah, and L. B.
Clarke, Atlanta, First and Second Vice Presi-
dents; S. R. Roberts, H. H. Martin, E. C. Thrash
and A. G. Fort, Delegates to the A.M.A. The
Association accepted the invitation of Atlanta to
meet there in 1919.
Seventieth Annual Session
Atlanta, 1919
W ith Dr. Palmer presiding, Secretary-Treas-
urer Lyle presented an interesting report showing
that the State of Georgia had furnished 750 sur-
geons to the armed forces in W7orld W ar I. The
majority of these came from the 1,025 members
of the Association. It was also stated that 75 per
cent of the local secretaries were in uniform. A
resolution of appreciation was adopted for the
members who had enlisted, for their sacrifice
and services.
J. L. Campbell gave the first report of the
Committee for the Study and Control of Cancer.
Papers read were: “Tonsillar Operations in the
Army,” by R. R. Daly, Atlanta; “Aspiration of
the Pouch of Douglas as an Aid in Differentiating
Atypical Cases of Ectopic Pregnancy and Pyo-
salpinx,” by R. A. Bartholomew, Atlanta; “Sur-
gery in a Base Hospital in France,” by Lieut.
Col. Frank K. Boland. Atlanta; “Ureteral Stric-
ture in Women,” by W. F. Shallenberger, At-
lanta; and “The Feeding of Sick Babies,” by
W. A. Mulherin, Augusta.
Dr. George W. Crile, Cleveland, spoke on
“Abdominal Surgery;” Lieut. Col. W. W. Bab-
cock, Philadelphia, “Notes on Surgery of the
Peripheral Nerves;” W. D. Haggard, Nashville,
“Some of the Surgical Lessons of the War;” and
Col. Seale Harris. Birmingham, “Food Conditions
and Nutritional Disorders in Europe, with espe-
cial Reference to Pellagra.” Col. Charles Wad-
dell Stiles, of the United States Public Health
Service, gave a talk on a new parasite which is
the cause of infection in human beings. The ses-
sions of the second day of the meeting were
held in the Red Cross Hall, Fort McPherson, the
guests of Col. T. S. Bratton, U. S. Army Medical
Corps, Commanding Officer.
Officers chosen were: F. G. Jones, Atlanta,
President; W. H. Hendrix, Tifton, and J. M.
Smith, Valdosta, First and Second Vice Presi-
dents; A. H. Bunce, Delegate to the A. M. A.,
E. E. Murphey, Alternate. Macon was chosen
for the next meeting.
Seventy First Annual Session
Macon, 1920
Four hundred and thirty-seven members assem-
bled for this good meeting, with President E. G.
Jones in the chair. In order to carry out the
plans of the Committee on Defense, the annual
dues were raised to $5.00. The President’s ad-
dress on “Some Observations on Medical Edu-
cation with Particular Reference to Its Present
Status in the South’" was well received.
Among papers read were: “Snapping Hip
with Report of Cases,” by M. C. Pruitt, Atlanta;
“Medical Aspects of Surgical Patients,” by W. H.
Lewis, Rome; “Cancer: Its Treatment by Ra-
dium, by C. C. Harrold, Macon; “Spinal Anes-
thesia, with Report of Cases,” by W. L. Cooke,
Columbus; “Gunshot Wounds of the Chest, and
Their Treatment,” by T. C. Davison, Atlanta;
“The Importance of Ureteral Stricture in Ab-
dominal Diagnosis,” by G. Y. Massenberg, Ma-
con; “Treatment of Chronic Osteomyelitis and
Bone Sinuses,” by Lawson Thornton, Atlanta;
“Bone Diseases by the X-ray,” by J. J. Clark,
Atlanta; and Roentgen-ray Study of the Ab-
dominal Organs following Oxygen Inflation of
the Peritoneal Cavity,” by George M. Niles,
Atlanta.
Dr. Wdlliam Englebach, of St. Louis, read a
paper, by invitation, entitled “Disorders of the
Pituitary Gland.” Other papers heard were:
“Local Anesthesia in Abdominal Surgery, with
Synopsis of 33 Cases,” by Lon Grove, Atlanta,
“Extraction of Foreign Bodies from the Trachea,
Bronchi and Esophagus,” by C. L. Penington,
Macon; “Hypertrophic Stenosis of the Pylorus,”
by W. W. Battey, Augusta; “Tubal Pregnancy,”
by Wr. Frank Wells, Atlanta; and “The Relief of
Menorrhagia and Metrorrhagia by Roentgen
Treatment,” by W. A. Cole, Savannah. Dr. Har-
vey R. Gaylord, of Buffalo, New York, delivered
an address on the “Prevention of Cancer.” Hon.
Hugh M. Dorsey, Governor of Georgia, reviewed
the w'ork done by the Legislature during his ad-
ministration to further the cause of medical
research in the State.
Officers elected were: President, E. T. Cole-
man, Graymont; First and Second Vice Presi-
dents, T. E. Oertel, Augusta, and Fred L. Webb,
Macon; Secretary-Treasurer, Allen H. Bunce,
Atlanta, who also became Editor of The Journal ;
Delegates to the A. M. A., E. G. Jones and W. C.
March, 1950
101
Lyle; Alternates, J. G. Dean and M. A. Clark. The
next place of meeting was Rome.
Seventy Second Annual Session
Rome, 1921
The report of this meeting, as recorded in the
Journal of the Association, was the most com-
plete yet published. Reports of the deliberations
of several important standing committees were
given in detail, such as the Committee on Medi-
cal Defense, Committee on Hospitals, Committee
on Health and Public Instruction, and others.
The President, Dr. E. T. Coleman, was in the
chair.
One session was given over to the unveiling of
a monument to Dr. Robert Battey, a distinguished
member of the Association, whose home was in
Rome. Dr. Howard A. Kelly, of Baltimore, de-
livered an eloquent address on this occasion. A
resolution was passed asking the State Legisla-
ture to appropriate $10,000 for the erection of a
statue of Crawford W. Long in Statuary Hall,
Washington, D. C., where it had been voted a
place by the Legislature. (The Legislature failed
to comply with this request on the ground that it
had no authority to appropriate money to erect a
statue outside of the State of Georgia).
Papers read were: “The Preservation of
Health,” by Cyrus W. Strickler, Atlanta; “The
Illness and Death of Napoleon,” by Walter R.
Holmes, Jr., Atlanta; “Resume of Public Health
Work for 1920 and 1921,” by Joseph P. Bowdoin,
Adairsville; “The Relation of Public Health
Work to Physicians’ Reports,” by T. F. Aber-
crombie, Atlanta; “Plastic Surgery,” by E. D.
Highsmith, Atlanta; “Report of Case of Double
Uterus,” by J. T. McCall, Rome; and “Newer
Aspects of High Blood Pressure,” by Ralston
Lattimore, Savannah. Dr. C. C. Bass, of New
Orleans, by invitation, spoke on “Quinine in Ma-
larial Control,” which was discussed liberally.
Other papers presented were: “Tonsillectomy
Under Local Anesthesia,” by B. H. Minchew,
Waycross; “Some Observations on the Role of
the Tooth and Tonsils as a Causative Factor in
Systemic Infections,” by E. S. Osborne, Savan-
nah; “Sacral Anesthesia,” by H. L. Barker, Car-
rollton ; and “The Enucleation of the Eyeball and
Its Substitute Operation,” by Phinizy Calhoun,
Atlanta.
Officers elected as follows: President, E. C.
Thrash, Atlanta; First and Second Vice Presi-
dents, H. W. Terrell, LaGrange, and R. M. Har-
bin, Rome.
Summary of 1881-1921
One of the most important events in the history
of the Association during this forty-year period
was the inauguration of the House of Delegates.
Other bodies of little less importance, estab-
lished under the sponsorship of the Association,
were the State Board of Health, the State Board
of Medical Examiners, and the State Anatomical
Board. The new Constitution and By-Laws,
adopted in 1905, and suggested by the American
Medical Association for all states, gave the State
Association closer affiliation with the national
organization.
The interesting, memorable era also was
marked by conspicuous improvement in the
quality of papers presented at the annual sessions
and published in The Journal. Many of the
greatest discoveries in medicine were announced
during these exciting years, and received thor-
ough discussion at the meetings. Although Lister
gave antiseptic surgery to the world in 1867, it
was not universally recognized and adopted for
fifteen or twenty years later. Among discoveries
and new methods introduced during the period
were:
1881 — Laveran discovered the malarial para-
site.
1882 — Koch discovered the tubercle bacillus.
1884 — Howard Kelly first used local anes-
thesia.
1886 — Fitz wrote the first paper on appendi-
citis, and gave the disease its name.
1889 — Bier first used local anesthesia.
1895 — Roentgen discovered the x-ray.
1897 — Ross found the mosquito carrying ma-
larial organisms.
1901 — Carroll and Reed found the mosquito
carrying yellow fever.
1905 — Schaudinn discovered the Spirochaeta
pallida of syphilis.
1907 — Wassermann introduced the serodiag-
nosis of syphilis.
1909 — Ehrlich introduced salvarsan.
1906- 1919 — Radium therapy introduced by
Dominici.
1915-1920 — Goldberger and associates re-
vealed avitaminosis as cause of pellagra.
Seventy Third Annual Session
Columbus, 1922
With President E. C. Thrash in the chair, this
meeting was very interesting. A notable event
was the presentation of buttons to the eighteen
living ex-presidents. Since that time every presi-
dent receives a button on his retirement from
office.
A symposium on X-ray and Radium Therapy
was presented, as follows: “The Use of Radium
in Treatment of Cancer of the Cervix,” by O. D.
Hall, Atlanta; “Treatment of Leukemia by means
of the X-ray,” by J. W. Landham, Atlanta; “Re-
sults from Six Months’ Experience with Ra-
dium,” by W. L. Cooke, Columbus; “The X-ray
Treatment of Uterine Hemorrhage and Fibroid
Tumors,” by John S. Derr, Atlanta; and “Men-
tion of Various Diseases in which X-ray is of
Most Value,” by W. F. Jenkins, Columbus.
Other papers heard were: “Syphilis of the
Nervous System,” by Newdigate Owensby;
“Complete Versus Subtotal Hysterectomy,” by
Garnett Quillian, Atlanta; “Conservatism in
Surgery,” by Floyd W. McRae, Jr., Atlanta;
102
The Journal of the Medical Association of Georgia
“Cholecystectomy versus Cholecystostomy, bv
T. C. Davison, Atlanta; “Complemental Breast
Feeding,” by Linton Gerdine, Athens; and “Ab-
scess of the Lung, with Report of Seven Cases,
by J. E. Paullin and H. C. I Jake ) Sauls, Atlanta;
"The Intracutaneous Method of Diagnosis in
Hay Fever and Asthma,” by Hal Davison, At-
lanta; “Interesting Observations in Cataract Ex-
tractions Among Confederate Veterans, by Mur-
dock Equen; “The Ophthalmoscope as an Aid in
General Diagnosis,” by W. C. Lyle, Augusta; “A
Consideration of Eye, Ear, Nose and Throat
Conditions at Georgia State Sanitarium,” by B.
McH. Cline, Atlanta; and “Acute Conditions of
the Abdomen Requiring Surgical Interference,”
by L. C. Fischer, Atlanta.
The following officers were elected: President,
J. M. Smith, Valdosta; First and Second Vice
Presidents, P. A. Tatum, Columbus, and A. R.
Rozar, Macon; Parliamentarian, M. A. Clark.
Macon; Delegate to the A.M.A., W. E. McCurry,
Hartwell; Alternate, Ralston Lattimore, Savan-
nah. The Treasurer’s report showed a balance
of $4,687.10. The next meeting was to be held in
Savannah.
Seventy Fourth Annual Session
Savannah. 1923
The journal of the Medical Association for
June and July, 1923, contained the most com-
plete reports of the sessions yet published. The
proceedings of the House of Delegates and the
Council were given in detail, together with the
reports of all committees. Several minor changes
were made in the Constitution and By-Laws.
President J. M. Smith was in the chair.
Among papers read were: “A Study of Symp-
tomatology in Neurosyphilis,” by Lewis M.
Gaines, Atlanta; “The Important Consideration
of Ovarian Tumors of All Types,” by T. P. War-
ing, Savannah; “Use of Sutures in Tonsillecto-
mies,” by Julian H. Buff. Atlanta; “The Relation
of Tonsils and Adenoids to Growth and Develop-
ment in Children,” by T. D. Walker, Jr., Macon;
“Recurrence of the Prostate,” by W. L. Cham-
pion, Atlanta; “A Consideration of the Kidney
Function,” by W. W. Jarrell, Thomasville; “In-
sulin in the Treatment of Diabetes Mellitus,” by
J. E. Paullin, Atlanta; and “Gastric and Duo-
denal LUcer,” by Charles LTsher, Savannah.
Hugh N. Page, Augusta, read a paper on
“Regional Anesthesia;” Charles E. Dowman,
Atlanta, “Traumatic Cyst of the Brain;” Law-
rence Lee, Savannah, “A Report of Four Cases
of Cicatricial Stricture of the Esophagus;”
Charles H. Watt, Thomasville, “Pyelonephritis
with Report of a Case”; William H. Myers, Sa-
vannah, “The Epidemic of Dengue Fever in Sa-
vannah in 1922;” and B. H. Wagnon. Atlanta,
“Sarcoma of the Back, with Report of Three
Cases.” At the banquet held at the Tybee Hotel,
Dr. Louis M. Warfield, guest speaker, of Ann
Arbor, Michigan, delivered an address on “Some
Tendencies in Modern Medicine.”
Officers elected were: President, John W. Dan-
iel, Savannah; First and Second Vice Presidents.
A. J. Mooney, Statesboro, and H. C. Whelchel.
Douglas; Delegate to A.M.A., J. W. Palmer,
Ailey; Alternate, J. N. Brawner, Atlanta. It was
voted to hold the next meeting in Augusta. This
would be the seventy-fifth, or Diamond Jubilee
session.
Seventy Fifth Annual Session
Augusta, 1924
The following changes were made in the Con-
stitution and By-Laws at this meeting, over
which Dr. J. W. Daniel presided:
1. The Council was made the acting body of
the Association in the interim between annual
meetings.
2. The House of Delegates will meet on the
day preceding the beginning of each annual
meeting.
3. On locating or on change of location a
member may place his card in the local paper
for a period not to exceed one month. He may
state whether or not his practice will be limited,
hut no member may use the word “specialist” in
any connection.
Among papers read were: “Acidified Milk
with Karo Syrup as an Artificial Feeding for
Babies,” by W. A. Mulherin, Augusta; “Modified
Breast Milk,” by W. L. Funkhouser, Atlanta;
“Status Thymicus in Children,” by W. N. Ad-
kins and W. T. Freeman, Atlanta; “A Study in
Tetany,” by Cleveland Thompson, Millen; “In-
testinal Protozoa,” by V. P. Sydenstricker, Au-
gusta; “The Treatment of Bone Tuberculosis,”
by Lawson Thornton. Atlanta; “Concerning
Simple Methods for the Differentiation of Car-
diac Arrhythmia,” by Edgar D. Shanks, Atlanta;
“Adhesions of the Ascending Colon with Obstruc-
tive Symptoms; So-Called Chronic Appendicitis,”
by Lon Grove, Atlanta; and “Cystograms with
Air Injection to Demonstrate Intravesical Hyper-
trophied Prostate,” by E. G. Ballenger, 0. F.
Elder and W. F. Lake, Atlanta.
Other essays heard were: “The Relation of
Adherent Prepuce to Epilepsy,” by E. Bates
Block, Atlanta; “Diabetes,” by J. D. Gray, Au-
gusta; “The Treatment of Pneumonia,” by Stew-
art R. Roberts, Atlanta; “Gas Bacillus Infec-
tion,” by J. K. Quattlebaum, Savannah; and
“Report of a Case of Measles Accidentally Trans-
mitted by Blood Transfusion, Pre-erupted Stage,”
by H. P. Harrell, Augusta.
The following officers were then balloted for
and declared duly elected: J. O. Elrod, Forsyth,
President; W. A. Mulherin, Augusta, and B. H.
Wagnon, Atlanta, First and Second Vice Presi-
dents; Allen H. Bunce, Atlanta, Delegate to the
A.M.A., and W. C. Lyle, Atlanta, Alternate.
Atlanta was chosen for the next meeting.
March, 1950
] 03
Seventy Sixth Annual Session
Atlanta, 1925
This was the best attended meeting in the
Association up to this time, more than 650 mem-
bers being present. A notable event was the
first annual meeting of the newly-organized
Woman’s Auxiliary, with Mrs. James N. Brawn-
er, of Atlanta, as its first president. It also was
interesting that only one essayist on the program
was absent, and he was detained at home by an
operation for appendicitis. The President, Dr.
J. 0. Elrod, was in the chair.
Among the papers presented were: “Myxe-
dema,” by Henry R. Slack, LaGrange; “Infections
of the Biliary Tract Unrelieved by Surgical In-
tervention,” by W. H. Lewis, Rome; “Pellagra
and Its Treatment,” by L. L. Whiddon, Ocilla;
“Intracranial Injuries in the New-Born,” by
C. H. Richardson, Jr., Macon; “Physiological
Pigmentation in the New-Born,” by M. Hines
Roberts, Atlanta; “Further Observations on the
Management of Head Injuries,” by J. Calvin
Weaver, Atlanta; “Chronic Adhesive Mediastino-
Pericarditis, with Review of 150 Cases,” by Eu-
gene E. Murphey, Augusta; and “Local Anesthe-
sia in Surgery,” by G. Y. Massenburg, Macon.
The program was continued with a paper on
“Cancer of the Pancreas and Bile Ducts,” bv Dan
C. Elkin, Atlanta; “History Taking by the Gen-
eral Practitioner,” by W. H. Clark, LaGrange;
“Hexylresorcinol in Bacillus Proteus Pyelitis,”
by W. E. McCurry, Hartwell; “The Surgery of
Inguinal Hernia,” by W. F. Westmoreland; and
“The Treatment of Pyelitis,” by Walter R.
Holmes, Atlanta. Two distinguished guest speak-
ers were on the program. Dr. Edward Francis,
of the United States Public Health Service,
Washington, D. C., delivered an address on
“Tularemia,” while Dr. Walter E. Sistrunk, of
the Mayo Clinic, spoke on “The Diagnosis of
Abdominal Conditions.”
Officers were chosen as follows, and Albany
selected for the next meeting: President, Frank
K. Boland, Atlanta; First and Second Vice Presi-
dents, W. R. Dancy, Savannah, and H. M. Fulli-
love, Athens; Secretary-Treasurer, A. H. Bunce,
Atlanta; Parliamentarian, M. A. Clark, Macon;
Delegate to the A.M.A., R. L. Miller, Waynes-
boro; Alternate, C. W. Roberts, Atlanta.
Seventy Seventh Annual Session
Albany, 1926
For the first time in its history the Association
met in Albany, which proved to be well able to
take care of the convention. Under the presi-
dency of Dr. Frank K. Boland, the following were
some of the papers read: “Sanitation Problems of
Small Cities,” by J. W. Chambliss, Americus;
“Peculiarities of Human Behavior,” by Newdi-
gate Owensby, Atlanta; “Report of a Few Cases
Illustrating the Fallacy of Indigestion as a Diag-
nosis,” by J. C. Patterson, Cuthbert; “Feeding
the Normal Infant,” by R. G. McAliley, Atlanta;
“Toxin-Antitoxin,” by Benjamin Bashinski, Ma-
con; and “Basal Metabolism Rate in Toxic
Goiter,” by T. C. and H. M. Davison, Atlanta.
Dr. Charles C. Bass, of New Orleans, addressed
the session on “Specific Treatment of Malaria,”
and Dr. Seale Harris, a former Georgian, of
Birmingham, spoke on “Relatively High Fat, Low
Carbohydrate and Rich Vitamin Diet in the
Treatment of Gastric and Duodenal Ulcer.”
Other papers read were: “Treatment of Diabetic
Coma,” by Thomas E. Rogers, Macon; “The
Painful Heel,” by Theodore Toepel, Atlanta;
“Surgical Correction of Facial Deformities,” bv
E. D. Highsmith, Atlanta; “Some Personal Ob-
servations in Reference to Deafness,” by Dunbar
Roy, Atlanta; “Some Essentials in Good Surgical
Practice,” by Ralph H. Chaney, Augusta; and
“Types of Gastric and Duodenal Ulcer and Their
Management,” by John B. Fitts, Atlanta.
Officers for the ensuing twelve months: Presi-
dent, V. O. Harvard, Arabi; First and Second
Vice Presidents, J. A. Redfearn, Albany, and
B. H. Minchew, Waycross; Delegates to the
A.M.A., E. C. Thrash, Atlanta, and C. W. Rob-
erts, Atlanta; Alternates, J. W. Palmer, Ailey,
and B. T. Wise, Plains. Treasurer Bunce’s report
showed a balance of $5,667.94 in the bank. The
next place of meeting was to be Athens.
Seventy Eighth Annual Session
Athens, 1927
I he meeting was called to order by the Presi-
dent, Dr. V. 0. Harvard. An important paper
was read by M. E. Winchester, of the State
Board of Health, entitled, “History of Public
Health Work in Georgia,” in which he mentioned
as the first record of any law pertaining to pub-
lic health in Georgia an act passed February 5,
1866, for the control of smallpox in the State.
It was nine years later before a real State Board
of Health was formed. At the regular session of
the Legislature, February, 1875, a bill was passed
creating such a board. This board died, how-
ever, for lack of the appropriation of funds, and
another board was not organized until 1903,
when H. F. Harris became secretary. The labora-
tory was begun two years later, and was operated
solely by him. The Ellis Health Law, which
started functioning in 1914, created a Board of
Health in every county in the State.
Dr. Walter W. Young, of Atlanta, presented an
article on “The Newer Psychology in its Prac-
tical Application to General Medicine;” H. D.
Allen, Jr., Milledgeville, read a paper on “Dried
Yeast Therapy in Certain Psychoses;” M. A.
Fort, State Board of Health. “Popular and Pro-
fessional Misconceptions Regarding Malaria; and
W. W. Anderson, Atlanta, “Rickets.”
"The Use of Banana Diet in the Treatment of
Chronic Intestinal Indigestion in Children” was
104
The Journal of the Medical Association of Georgia
read by Joseph Yampolsky, Atlanta; ‘‘Diagnosis
of Syphilitic Bone Lesions” by J. J. Clark. At-
lanta; "Treatment of Superficial Malignancies
by Combined Method,” by J. W. Landham,
Atlanta; “The Necessity of Pyelograms in Uro-
logical Diagnosis” by Wallace L. Bazemore,
Macon; “Chronic Duodenal Ileus,” by J. K.
Quattlebaum, Savannah; “The Present Status of
Stomach and Duodenal Surgery as Observed in
Various American and European Clinics,” by
Thomas Harrold, Macon; and “Supra-condyloid
Fracture of the Elbow,” by Grady N. Coker,
Canton.
Officers for the following year were elected as
follows: President, William A. Mulherin, Au-
gusta; First and Second Vice Presidents, H. M.
Fullilove, Athens, and Cleveland Thompson,
Millen; Delegate to the A.M.A., Allen H. Bunce;
Alternate, W. R. Dancy. Savannah was the next
place of meeting.
Seventy Ninth Annual Session
Savannah, 1928
This meeting, presided over by W. A. Mul-
herin, was marked by the inauguration of the
A. W. Calhoun Lectureship. Dr. George E.
deSchweinitz, distinguished ophthalmologist of
Philadelphia, was the speaker, the title of his
address being “Headache.” Dr. G. V. I. Brown,
of Milwaukee, spoke on “Plastic Surgery.” Sev-
eral members gave clinics.
Among the papers read were: “Pulmonary
Aspergillosis,” by E. F. Wahl, Thomasville; “The
Prognosis of Tumors with Special Reference to
Cell Type and Its Influence on Treatment,” by
Everett L. Bishop. Atlanta; “Complete Prolapse
of the Rectum,” by W. E. Person, Atlanta; “Uri-
nary Antiseptics,” by M. L. Boyd, Atlanta;
“What Is Needed to Improve the Practice of
Obstetrics?” by J. R. (Bert) McCord, Atlanta;
“Medical Economics,” by W. P. Harbin Rome;
“The Treatment of the Anemias with Liver Frac-
tion,” by Glenville Giddings, Atlanta; and “Rou-
tine Circumcision at Birth,” by T. B. Gay,
Atlanta. Dr. Clifford G. Grulee, Clinical Profes-
sor of Pediatrics, University of Chicago, gave an
address on “Bone Lesions in Children.”
Officers were chosen as follows: President,
C. K. Sharp, Arlington; First and Second Vice
Presidents, W. E. McCurry, Hartwell, and M.
Hines Roberts, Atlanta; Parliamentarian, M. A.
Clark, Macon; Delegates to the A.M.A., William
H. Myers, Savannah, and E. C. Thrash, Atlanta;
Alternates, W. A. Mulherin, Augusta, and C. W.
Roberts, Atlanta. For the first time the Associa-
tion elected a President-Elect, who was W. R.
Dancy, of Savannah, to take office a year later.
The next place of meeting was Macon.
Eightieth Annual Session
Macon, 1929
President C. K. Sharp called the meeting to
order. The Calhoun Lecture was given by Dr.
William S. Baer, Professor of Orthopedic Sur-
gery, Johns Hopkins University, who spoke on
“Arthritis. Dr. Morris Fishbein, Editor of the
Journal of the American Medical Association,
delivered an address on “Fads and Quackery in
Medicine. Dr. Leora G. Bowers, of Dayton,
Ohio, read a paper entitled, “Certain Splenic
Syndromes With Indications for Splenectomy.”
Dry Clinics were held by Macon members as
follows: “Gall Bladder Disease,” by A. R. Rozar;
“Mycosis Fungoides,” by G. Y. Massenburg;
“Pernicious Anemia,” by T. E. Rogers; “Heart
Disease,” by William C. Pumpelly; “Scleroder-
ma,' by C. C. Harrold; “Postoperative Pulmon-
ary Atelectasis,” by C. H. Richardson, Jr.
Among papers read were: “Our Poisonous
Serpents,” by T. E. Oertel, Augusta; “The Chal-
lenge of Industry to Present-Day Medicine,” by
C. W. Roberts, Atlanta; “Spinal Anesthesia — Use
of Spinocain in 100 Cases,” by George W.
Fuller, Atlanta; “Learning Therapeutics,” by
W. R. Houston, Augusta; “Nevi,” by Jack W.
Jones, Atlanta; “The Increasing Importance of
Undulant Fever,” by Evert A. Bancker, Jr., At-
lanta; “Agranulocytosis,” by J. D. Gray, Au-
gusta; “The Epilepsies,” by W. A. Smith, Atlan-
ta; “Position of the Radiologist,” by Robert
Drane, Savannah; “Mesenteric Cysts with In-
testinal Obstruction,” by Ralph H. Chaney,
Augusta; “A New Mode of Artificial Insemina-
tion in the Guinea Pig,” by G. Lombard Kelly,
Augusta; and “Some Problems in Gynecology,”
by Marion T. Benson, Atlanta.
The following officers were elected: President-
Elect, G. Y. Moore, Cuthbert; First and Second
Vice Presidents, C. H. Richardson, Jr., Macon,
and Grady N. Coker, Canton; Delegates to the
A.M.A., Allen H. Bunce; Alternate, 0. H. Wea-
ver. The Association accepted the invitation of
Augusta to meet in that city in 1930. The in-
coming presiding officer, Dr. W. R. Dancy, hav-
ing been elected one year previously, announced
his committee appointments at the conclusion
of the session.
Eighty First Annual Session
Augusta, 1930
The session convened with President W. R.
Dancy in the chair. The usual committee reports
were made before the House of Delegates. As
usual, interesting reports were made by Fraternal
Delegates to surrounding states. Dr. Hal M.
Davison spoke of his visit to the meeting of the
North Carolina Medical Association; Dr. C. K.
Sharp told of his visit to the meeting of the Medi-
cal Association of Alabama; Dr. F. K. Boland
described his trip to Louisville to attend the
meeting of the Kentucky State Medical Associa-
tion. Often the Medical Association of Georgia
had the pleasure of hearing from fraternal dele-
gates from other states.
Dr. Frank H. Lahey delivered the Abner W.
Calhoun lecture, the title being “Goiter.” Dr.
Kenneth M. Lynch, of Charleston, spoke on
March, 1950
105
“Education,” and Dr. Charles B. Wright, Asso-
ciate Professor of Medicine in the University of
Minnesota School of Medicine, addressed the
Association on “Our Responsibility to the State.”
Among the papers read by members were:
“Acute Poliomyelitis,” by Harold I. Reynolds,
Athens; “Acute Osteomyelitis,” by Charles W.
Crane, Augusta; “Vaso-Motor Rhinitis,’ by
Arthur G. Fort, Atlanta; “Laws Governing the
Healing Art in Georgia, by J. 0. Elrod, For-
syth; “Chronic Cystic Mastitis,” by Charles C.
Harrold, Macon; “Diverticula of the Esophagus,
Pulsion Type,” by H. H. McGee, Savannah;
“Carcinoma of the Ureter,” by John B. Cross,
Atlanta; “Tularemia,” by S. E. Sanchez, Bar-
wick; “The Value of the Electrograph to the
General Clinician,” by J. A. Fountain, Macon:
and “Angina Pectoris,” by Charles C. Hinton,
Macon.
The following officers were elected: President-
Elect, Arthur G. Fort, Atlanta; First and Second
Vice Presidents, George A. Traylor, Augusta,
and S. T. R. Revell, Louisville; Secretary-Treas-
urer, Allen H. Bunce, Atlanta; Delegates to the
A.M.A., William H. Myers and E. C. Thrash;
Alternates, W. A. Mulherin, C. W. Roberts and
C. K. Sharp. Atlanta was chosen to entertain the
next meeting.
Eighty Second Annual Session
Atlanta, 1931
This session, described by the Secretary as the
best in the history of the Association, was called
to order by the President, Dr. G. Y. Moore, with
more than 650 members in attendance. Dr.
William Gerry Morgan, President of the Ameri-
can Medical Association, gave an address on
“The Control of Medicinal Alcohol as it Affects
the Practitioner and the Public.” Dr. James B.
Herrick, Professor of Medicine in Rush Medical
College, delivered the A. W. Calhoun Lecture,
“Common Errors in the Treatment of Heart
Disease.” Dr. Charles M. Rosser, Professor of
Clinical Surgery at Baylor University College
of Medicine, Dallas, Texas, spoke on “The Men-
ace of the Medical Underworld.”
Following were papers read by members of
the Association : “Etiology of Mental Diseases,”
George L. Echols, Milledgeville; “Legalized Sur-
gical Prevention of Reproduction in the Unfit.”
E. C. Thrash, Atlanta; “A Discussion of Hyper-
tension,” Steve P. Kenyon, Dawson; “The Clin-
ical Value of the Schilling Blood Count,” Roy R.
Kracke, Atlanta; “Treatment of Pneumonia.”
C. W. Strickler, Atlanta; “Encephilitis,” Lewis
M. Gaines, Atlanta; “Hallux Valgus,” Michael
Hoke, Atlanta; “Treatment of Acute Empyema
by the Closed Method,” D. Henry Poer, Atlanta;
and “Organized or Group Medicine,” by Mon-
tague L. Boyd,” Atlanta.
For the first time the meetings of the Associa-
tion were divided into two groups, Medical and
Surgical. Vice President S. T. R. Revell. pre-
sided over the first section, and Vice President
George A. Traylor presided over the surgical
section. The Crawford W. Long Memorial Prize
was presented to H. M. Tolleson, of Hahira.
Marvin H. Head, of Zebulon, was chosen
President-Elect; Marion C. Pruitt, Atlanta, and
H. M. Tolleson, Hahira, First and Second Vice
Presidents; M. A. Clark, Parliamentarian; O. H.
Weaver, Delegate, and C. K. Sharp, Alternate to
the American Medical Association. A balance
of $5,448.30 was reported in the treasury. Savan-
nah was chosen for the next place of meeting.
Eighty Third Annual Session
Savannah, 1932
The meeting was called to order by President
Arthur G. Fort, followed by the usual very cor-
dial addresses of welcome, and responses. The
scientific program opened with a paper by
Wallace L. Bazemore, of Macon, on “Tubercu-
losis of the Kidney,” followed by a paper on
“Abnormal Ureters,” by Spencer Kirkland, of
Atlanta, and “Perinephritic Abscess,” by E. B.
Anderson, of Americus. Addresses by visiting
guest speakers included the A. W. Calhoun ora-
tion on “The Clinical Manifestations of Malig-
nant Disease,” by Dean Lewis, Professor of Sur-
gery, Johns Hopkins School of Medicine; “Prac-
tical Points in the Care of Patients with Indiges-
tion,” by Walter C. Alvarez, of the Mayo Clinic;
and “The Relation of Diseases of the Nasal Ac-
cessory Sinuses to Systemic Derangements,” by
William Mithoefer, of Cincinnati.
Among other papers read were: “Biopsy,” by
Everett L. Bishop, Atlanta; “Symptoms and Diag-
nosis of Sinus Diseases,” by Francis Blackmar.
Columbus; “Treatment of Sinus Diseases,” by
Calhoun McDougall, Atlanta; “Vitamin Ther-
apy,” by D. H. Garrison, Tate; “Coronary
Thrombosis and Angina Pectoris,” by J. Reid
Broderick, Savannah; “Observations of Some
Common Breast Lesions,” by William Perrin
Nicolson, Atlanta; “Jaundice: The Effects on
the Liver of Experimental Ligation of the Com-
mon Duct and Partial Hepatectomy,” by J.
Gaston Gay, Atlanta; “An Efficient Method of
Traction for Fractures of the Femur,” by C. H.
Watt, Thomasville; and “Common Cold,” by
A. J. Waring, Savannah.
The following officers were chosen: Charles
H. Richardson, Macon, President-Elect; A. A.
Morrison, Savannah, and D. H. Garrison, Tate,
First and Second Vice Presidents; J. W. Sim-
mons, Brunswick, Parliamentarian; W. H. My-
ers, C. W. Roberts, Delegates to the A.M.A.;
W. A. Mulherin and M. C. Pruitt, Alternates.
Macon was selected as the meeting place for
1933.
Eighty Fourth Annual Session
Macon, 1933
The Association convened with President Mar-
vin M. Head in the chair. Among papers read
were “Congestive Heart Failure,” by S. T. R.
106
The Journal of the Medical Association of Georgia
Kevell, Louisville; “The Present Status of Iodine
Therapy in Hyperthyroidism,” by Henry Poer,
Atlanta; “Fibroid Tumors of the Mesentery. '
by Olin H. Weaver; “Neurological Hazards of
Spinal Anesthesia,” by William A. Smith, At-
lanta; “Diagnosis and Treatment of Aneurysms,’
by J. L. Campbell. Atlanta; and “Bismuth Poi-
soning in the Treatment of Syphilis,” by John
W. Brittingham, Augusta. Dr. Merrill C. Sos-
man, of Boston, delivered the Calhoun Lecture,
the title being “Through the Alimentary Canal
with the Fluoroscope."
Dr. Oliver C. Wenger, United States Public
Health Service, of Hot Springs, Arkansas, read
a paper on “The Diagnosis and Treatment of
Syphilis.” The Crawford W. Long Prize was
awarded to Dr. Lombard Kelly, of Augusta. Dr.
Hines Roberts had won the honor the previous
year. Hon. T. W. Oliver, of the Georgia Pharma-
ceutical Association, spoke to the meeting. An
interesting symposium was given on “Hyperten-
sion,” those taking part being Abner W. Cal-
houn. Atlanta; Edgar R. Pund, Augusta; W. W.
Chrisman, Macon; V. P. Sydenstricker, Augusta;
and T. J. Charlton, Savannah. Dr. Roy R.
Kracke, Atlanta, was awarded the Governor L. G.
Hardman Loving Cup for one year.
Among other papers presented were: “Chronic
Recurrent Migratory Colitis,” by Hartwell Join-
er, Gainesville; “Fistula-in-Ano,” by George F.
Eubanks, Atlanta; “Management of the Third
Stage of Labor.” by C. B. 1 pshaw, Atlanta;
“Pylorospasm, or Congenital Hypertrophic Sten-
osis of the Pylorus,” by J. C. Brim, Pelham;
“Cancer of the Larynx,” by Edward S. Wright,
Atlanta; “The Aspiration and Air Injection
Method of Treating Empyema,” by Thomas Har-
rold, Macon; “Appendicitis Complicated by Ad-
hesions and Bands,” by Luther C. Fischer, At-
lanta; “Transurethral Resection of the Prostate
Gland, with Report of 125 Cases,” by E. G. Bal-
lenger, Atlanta; “Correlation of X-ray Findings
with Clinical Symptoms in Brain Lesions,” by
W. F. Lake, Atlanta; and “Thrombo-Angiitis
Obliterans,” by Robert L. Kennedy, Metter.
Officers elected were: C. L. Ayers, Toccoa,
President-Elect; J. D. Applewhite, Macon, and
W. W. Turner, Nashville, First and Second Vice
Presidents; 0. H. Weaver, Delegate to the
A.M.A.; Alternate, C. K. Sharp. Augusta was
chosen for the next meeting place.
Eighty Fifth Annual Session
Augusta, 1934
The August number of The Journal of the
Medical Association of Georgia contains very
full records of meetings of the House of Delegates
at this session in Augusta. Dr. Charles H. Rich-
ardson presided. Reports were heard from all
the officers. The Treasurer showed receipts of
$19,171.54 for the fiscal year, with disbursements
of $12,207.65, leaving a balance of $9,963.89.
Several minor changes were made in the By-Laws,
and the full Constitution and By-Laws were pub-
lished in the April number of the Journal, page
145.
The program of the meeting also was pub-
lished in this number, but the minutes of the
meeting were lacking. Dr. Waltman Walters, of
the Mayo Clinic, delivered an address on “The
Present Status of Gastric Surgery;” Dr. Louis
Hanunan, of Baltimore, gave “A Discussion of
the Diagnosis of Obscure Fever,” and Dr. Emil
Novak, of Baltimore, presented the A. W. Cal-
houn Lecture on “Endocrine Aspects of Gyne-
cology.”
Among papers read were: “Medical Economics
as Related to Patients of the Low Income
Group,” by Lewis M. Gaines, Atlanta; “The
Irritable Colon,” by J. D. Gray, Augusta; “Scar-
let Fever and Its Complications,” by C. P.
Savage, Montezuma; “Allergy,” by M. A. Ehr-
lich, Bainbridge; “Posterior Vaginal Hernia,”
by J. Harris Dew, Atlanta; “A Fatal Reaction
Following Artificial Pneumothorax,” by Joseph
C. Massee, Atlanta; “Cancer of the Bladder,” by
Montague L. Boyd, Atlanta; “Uterine Hemor-
rhage,” by L. C. Allen, Hoschton; “Non-Union
of Fractures,” by Peter B. Wright, Augusta; and
“Hypothyroidism with Special Reference to
Types,” by Ernest F. Wahl, Thomasville.
An important symposium on Typhus Fever
consisted of a paper on “Endemic Typhus Fever
in Georgia,” by Mark S. Dougherty, Jr., Atlanta,
discussed by J. E. Paullin, Lawrence Lee, W. A.
Selman, T. F. Sellers, D. L. Seckinger, R. W.
Fowler and Herbert S. Alden; and a paper on
“Recent Developments in the Knowledge of En-
demic Typhus Fever,” by T. F. Sellers, Chief of
Laboratories, State Department of Health. A
symposium on Gallbladder Disease was presented
by Charles H. Watt, Thomasville, who read a
paper on “Cholecystitis, An Analysis of One
Hundred Cases;” and by Lon Grove and Joseph
C. Read. Atlanta, whose paper was entitled “In-
dications for Surgery in Gallbladder Disease.”
These articles were discussed by Kenneth R. Bell,
Kenneth McCullough, W. S. Goldsmith. Frank
K. Boland, A. D. Little, and Waltman Walters of
the Mayo Clinic.
Officers elected were: President-Elect, James E.
Paullin, Atlanta; First and Second Vice Presi-
dents, George A. Traylor, Augusta, and W. G.
Elliott, Cuthbert; Delegates to the A.M.A., W. H.
Myers and C. W. Roberts; Alternates, W. A.
Mulherin and M. C. Pruitt. It was decided to
hold the next meeting in Atlanta.
Eighty Sixth Annual Session
Atlanta, 1935
This meeting, with President C. L. Ayers in the
chair, was the largest attended ifi the history of
the Association to this time, more than 750
members being present. The Journal for May,
1935, contained “Notes on the History of the
Medical Association of Georgia, 1920-1935,”
written by Allen H. Bunce, Secretary-Treasurer
March, 1950
107
for this period, who retired from this position
after the meeting. Dr. Bunce’s article was very
complete and included a discussion of many sub-
jects of importance, such as the Association and
the Legislature, Education and Medical Schools,
Hospitals and Training Schools for Nurses, the
Cancer Commission, Medical Defense, and
others.
The title of the President’s address was “Medi-
cine as a Career.” A very important paper read
before the House of Delegates was a Report of
the Committee for the Study of Maternal Mor-
tality during the year 1933. Other papers read
were: “The Responsibility of the General Prac-
titioner in Diseases of the Eye,” by Zach W.
Jackson, Atlanta; “The Treatment of Varicose
Veins and Ulcers,” by C. E. Rushin, Atlanta;
“The Trend of Medical Education,” by Russell H.
Oppenheimer, Atlanta; “Multiple Myeloma,” by
W. R. Minnich, Atlanta; “Treatment of Clinical
Acidosis,” by Philip A. Mulherin, Augusta; and
“The Surgical Treatment of Thyroid Diseases,”
by D. Henry Poer, Atlanta.
The following officers were chosen, and Sa-
vannah selected for the next meeting: President-
Elect, B. H. Minchew, Waycross; First and Sec-
ond Vice Presidents, James J. Clark, Atlanta,
and Philip R. Stewart, Monroe; Secretary-Treas-
urer, Edgar D. Shanks, Atlanta; Parliamentarian,
John W. Simmons, Brunswick; Delegates to the
A.M.A., W. H. Myers, C. W. Roberts, and 0. H.
Weaver; Alternates, W. A. Mulherin, M. C.
Pruitt, and C. K. Sharp.
The program included an address on “Newer
Concepts of Immunity and Allergy — Their Im-
portance in Modern Medicine,” by Reuben L.
Kahn, Director of Laboratories of the Universitv
of Michigan, Ann Arbor, Michigan; the A. W.
Calhoun Lecture on “The Treatment by the Gen-
eral Practitioner of the More Common Diseases
of the Nervous System,” by Lewellys F. Barker,
Professor Emeritus of Medicine, Johns Hopkins
University School of Medicine; and a movie
presentation on the American Medical Associa-
tion, by Austin A. Hayden, Head of the Depart-
ment of Otolaryngology and Ophthalmology of
St. Joseph’s Hospital, Chicago.
Eighty Seventh Annual Session
Savannah, 1936
The Presidential address by Dr. James E.
Paullin was entitled “Learning Better How to
Live. Among the papers on the program were:
the Abner W. Calhoun Lecture entitled “Funda-
mental Aspects of the Diagnosis and Treatment
of Anemia, by William Bosworth Castle, Asso-
ciate Professor of Medicine. Harvard University
School of Medicine; “The Problem of the Dia-
phragm.” by Arthur M. Shipley, Professor of
Surgery, University of Maryland School of Medi-
cine; “Management of the Chronic Heart,” by
Jonathan C. Meakins, Professor of Medicine, Mc-
Gill University, and President of the Canadian
Medical Association; and “The Influence of the
Present-Day Depression Upon the Nutritive State
of the American People,” by James S. McLester,
Professor of Medicine, University of Alabama
School of Medicine, and President of the Ameri-
can Medical Association.
Among papers published on the Official Pro-
gram were: “The Dilution and Concentration
Tests of Kidney Function,” by W. Edward Sto-
rey, Columbus; “Some Comments Upon the
Present-Day Practice of Rhinolaryngology Based
Upon Forty-Two Years Experience,” by Dunbar
Roy, Atlanta; “Primary Bronchial Carcinoma,”
by J. D. Gray, Augusta; “Utero-Intestinal Anas-
tomosis,” by George W. Wright, Augusta; “Fried-
man’s Modification of the Aschheim-Zondek Preg-
nancy Test,” by George F. Klugh, Atlanta; “Fur-
ther Observation on Sleep,” by Glenville Gid-
dings, Atlanta; “The Use of Atabrine in the
Control and Treatment of Malaria,” by M. E.
Winchester, Brunswick; “Hemorrhages of the
Brain,” by J. Calvin Weaver, Atlanta; “The
Treatment of Myasthenia Gravis,” by William A.
Smith, Atlanta; and “History of Hysterectomy,
with a Review of Hysterectomies Performed in
the John D. Archbold Memorial Hospital,” by
Arthur D. Little, Thomasville.
Officers elected for the ensuing year were:
President-Elect, George A. Traylor, Augusta;
First and Second Vice Presidents, C. F. Holton,
Savannah, and J. B. Kay, Byron; Delegates to
the A.M.A., W. H. Myers, C. W. Roberts and
0. H. Weaver; Alternates, W. A. Mulherin,
M. C. Pruitt and C. K. Sharp. The next meeting
was to go to Macon.
Eighty Eighth Annual Session
Macon, 1937
The title of the presidential address of Dr.
B. H. Minchew was “The Responsibility of the
Layman in a Public Health Program.” Dr.
Charles F. Craig, Professor of Tropical Medicine,
Tulane, spoke on “Tropical Diseases of Interest
to the Southern Physicians;” Dr. J. H. J. Upham,
President-Elect of the American Medical Associa-
tion, and Dean and Professor of Medicine, Ohio
State University College of Medicine, Columbus,
Ohio, spoke on “Heart Disease in Middle Life;”
and the Calhoun Lecture on “The Story of the
Vitamins in Infant Nutrition” was delivered by
Isaac A. Abt, Professor of Pediatrics, North-
western University Medical School, Chicago. Dr.
Olin West, Secretary of the American Medical
Association, gave a short address, and Dr. Roy
McClure, of the Henry Ford Hospital, Detroit,
discussed “The Control of Thyroid Disease in
Michigan.”
The meeting was well attended, and an inter-
esting program presented throughout. Among
papers read by the members were: “Acute In-
fectious Diseases of the Nervous System,” by
Richard B. Wilson, Atlanta; “Acute Hemor-
rhagic Nephritis in Children with Special Empha-
sis on Treatment,” by Joseph Yampolskv, At-
The Journal of the Medical Association of Georgia
108
lanta; “Treatment and Prophylaxis of Malaria,"
by Roy A. Hill, Thomasville; “Protamine Insulin
in the Treatment of Diabetes Mellitus,” by J. E.
Paullin and W. R. Minnich, Atlanta; and “The
Treatment of Hernia by Injection,” by Enoch
Callaway, LaGrange. An instructive symposium
on Fractures was presented by Grady Coker,
H. H. McGee, Cleveland Thompson, R. L. Rhodes,
Michael Hoke, Calvin Sandison, Lawson Thorn-
ton and Harry L. Cheves. An interesting sym-
posium on Tuberculosis was given by D. T.
Rankin, F. C. Whelchel, H. E. Crow, Daniel
Elkin, C. W. Strickler, Jr., C. D. Whelchel and
A. Worth Hobby.
The Journal always contained many good
papers which were not read during the meetings
of the Association. The minutes of the House
of Delegates were not published, but one resolu-
tion announced the annual dues as $7.00 per
capita. The Treasurer’s report showed receipts
$16,977.71, disbursements $13,800.53, leaving
a balance on hand of $13,518.32. The Woman’s
Auxiliary, as usual, presented a fine program.
The choice of officers resulted in the election
of Grady N. Coker, Canton, President-Elect;
Hall Farmer, Macon, and Hulett Askew, Atlanta,
First and Second Vice Presidents; Olin Weaver,
Macon, re-elected delegate to the A.M.A. The
next annual session was to go to Augusta.
Eighty Ninth Annual Session
Augusta, 1938
George A. Traylor presided. The name of
V. P. Sydenstricker was added to the Hardman
Loving Cup, the preceding names being Roy R.
Kracke, J. A. Redfearn, Glenville Giddings and
J. L. Campbell. The June number of The Jour-
nal contained an abstract of the Proceedings of
the House of Delegates.
Among essays on the Program were: “Relief
of Causalgic-Like Pain in the Isolated Extremity
by Symphathectomy,” by R. Frank Slaughter,
Augusta; “Surgery of Peptic Ulcer,” by John W.
Turner, Atlanta; “Acute Diverticulitis of the
Colon,” by Lon W. Grove, Atlanta; “Infectious
Mononucleosis,” by Allen H. Bunce, Atlanta;
“Some Practical Points of Meeting Poor Surgical
and Anesthetic Risks in Surgical Diseases,” by
T. J. Collier, Atlanta; “Traumatic Rupture of
the Normal Spleen,” by W. W. Battey, Augusta;
and “The Ambulant Proctologic Patient,” by
J. H. McDuffie, Jr., Columbus.
The Abner W. Calhoun Lecture was delivered
by Dr. George H. Semken, of New York City, his
subject being “The Problem of the Lump in the
Breast.” Dr. Irvin Abell, of Louisville, Presi-
dent-Elect of the American Medical Association,
gave an address, as did Hon. Walter F. George,
United States Senator from Georgia.
Officers elected were: W. H. Myers, Savannah.
President-Elect; P. B. Wright, Augusta, and
W. B. Schaefer, Toccoa, First and Second Vice
Presidents; W. H. Myers, C. W. Roberts, and
O. H. Weaver, Delegates to the A.M.A. ; Alter-
nates, W. A. Mulherin, M. C. Pruitt and C. K.
Sharp. Atlanta was chosen for the next place of
meeting.
Ninetieth Annual Session
Atlanta. 1939
With President Grady Coker in the chair, the
meeting opened again with the largest attendance
on record, more than 700 members being pres-
ent. The President’s address was entitled “Mod-
ern Trends of Medical Practice.” Hon. Robert
F. Maddox, of Atlanta, Chairman of the State
Board of Health, spoke on “The Social and Eco-
nomic Value of Health.” “Some Phases of Medi-
cal Economics” was discussed by Dr. H. H.
Shoulders, Assistant Professor of Clinical Sur-
gery, Vanderbilt University, while Dr. Lawrence
S. Fallis, of the Henry Ford Hospital, Detroit,
contributed a paper on the “Operative Treatment
of Inguinal Hernia” to a Symposium on Indus-
trial Surgery.
On the program was a paper on “Prophylactics
and the Common Cold,” by Hartwell Joiner,
Gainesville; “The Importance of the Differential
Diagnosis of Heart Disease,” by L. Minor Black-
ford, Atlanta; “Carotid-jugular Arteriovenous
Aneurysm,” by J. K. Quattlebaum, Savannah;
“Treatment of Sterility,” by C. B. Upshaw, At-
lanta; “Psychiatric Problems in a General Hos-
pital,” by Hervey Cleckley, Augusta; “Principles
Involved in the Treatment of Congenital Club-
feet,” by J. H. Kite. Decatur; and “Autogenous
Vaccines as an Aid in Treating Certain Diseases,”
by Jack Norris, Atlanta. A Cancer symposium
was put on by J. L. Campbell. C. C. Harrold,
Howard Hailey, Enoch Callaway, A. D. Little,
J. J. Collins, Edgar Pund, E. S. Cardwell and
J. E. Scarborough.
New officers elected were: J. C. Patterson,
Cuthbert, President-Elect; Mark S. Dougherty,
Jr., Atlanta, and A. A. Rogers, Commerce, First
and Second Vice Presidents. The next meeting
was to go to Savannah.
Ninety First Annual Session
Savannah, 1940
William H. Myers presided. In a synopsis of
the Proceedings of the House of Delegates ap-
pears this sentence, which illustrates the condi-
tion of the Association: “To our Secretary-
Treasurer and other responsible leaders we would
record our acknowledgment of the real part which
they are playing in carrying forward a program
of medical service to our people second to none
in the country.”
Among the papers on the program were:
“Pancreatitis,” by Guy J. Dillard, Columbus;
“Sulfanilamide and Its Derivatives,” by Eustace
A. Allen, Atlanta; “Pentothal Sodium — Oxygen
Anesthesia from the Viewpoint of the General
Surgeon,” by T. C. Davison and Fred Rudder,
Atlanta; “Treatment of Pneumonia in Adults with
Sulfapyridine,” by J. Fletcher Hanson, Macon;
“Surgical Cure of Hyperparathyroidism — Report
March, 1950
109
of Case,” by Bruce Threatte, W. F. Jenkins and
Ragsdale Hewitt, Columbus; “Bronchography
in Chest Diseases,” by Sherwood H. Lynn, Sa-
vannah; and “Biliary Obstruction Complicating
Hemorrhagic Diseases of the Newborn,” by J. T.
Leslie and Kenneth S. Hunt, Griffin. The Hard-
man Cup was awarded to Drs. Howard and
Hugh Hailey, of Atlanta.
There was a symposium on the Problems of
Medical Care in Georgia, and another symposium
on Obstetrics. The Abner Wellborn Calhoun
Lecture was presented by Rollin T. Woodyatt,
Clinical Professor of Medicine, University of
Chicago, on “Newer Phases of the Diabetic Prob-
lem.” Dr. Frank H. Lahey gave an address on
“Thyroid Disease”; Kenneth M. Lynch, Profes-
sor of Pathology, Medical College of the State
of South Carolina, Charleston, spoke on “Prog-
ress in Knowledge and Control of Cancer;” while
the subject of the paper of Dr. Lloyd Noland,
Chief Surgeon, Tennessee Coal and Iron Cor-
poration, Birmingham, was “The Function of the
Industrial Physician.”
Officers chosen were: President-Elect, Allen H.
Bunce, Atlanta; First and Second Vice Presidents,
J. K. Quattlebaum, Savannah, and Marion T.
Benson, Jr., Atlanta; other officers remaining as
before. The session of 1941 was awarded to
Macon.
Ninety Second Annual Session
Macon, 1941
Not including special essays and the addresses
of visiting guests, twenty-eight papers by members
of the Association appeared on the official pro-
gram. In spite of four-day sessions as compared
with the three-day sessions of former years, the
number of papers on the program were fewer in
number. The extra time consumed was largely
due to an increased number of discussions of
the papers. At this meeting, presided over by
J. C. Patterson, the Calhoun Lecture was given
by Dr. John Alexander, Professor of Surgery,
University of Michigan, on “The Management of
Intrathoracic Tumors.” Dr. Russell L. Cecil,
Professor of Clinical Medicine, Cornell Univer-
sity, New York City, spoke on “The Plight of
the Arthritic;” Dr. Daniel C. Elkin, Professor
of Surgery, Emory University, discussed “The
Special Field of Cardiac Surgery,” while “Mul-
tiple Factors in Deficiency Disease” was the
subject of the address by Virgil P. Sydenstricker,
Augusta, Professor of Medicine, University of
Georgia School of Medicine.
On the program were papers by Thomas Har-
rold, Jr., Macon, on “Further Observations on
the Treatment of Cancer of the Breast;” J. G.
McDaniel, Atlanta, on “Air Embolism as a
Cause of Death;” James E. Bayliss, Colonel,
Medical Corps, U. S. Army, on “Medical Pre-
paredness;” Edgar H. Greene, Atlanta, on “The
Types of Sterility in the Female that are Amen-
able to Treatment;” C. M. Sharp, Alto, and
Linton Smith, Atlanta, on “Pneumothorax;”
Louis L. Williams, Jr., Senior Surgeon, U. S.
Public Health Service, on “Public Health and the
Defense Program;” and “The So-Called Psycho-
pathic Personality,” by Hervey Cleckley, Au-
gusta.
Scientific Exhibits had grown to be of great
importance, there being thirty-one at this meet-
ing. The Commercial Exhibits numbered twenty-
nine. New officers elected were: J. A. Redfearn,
Albany, President-Elect; H. G. Weaver, Macon,
and Lester Harbin, Rome, First and Second V ice
Presidents. Augusta was selected for the next
meeting.
Ninety Third Annual Session
Augusta, 1942
With Allen H. Bunce presiding, the Scientific
Program opened with a symposium on Public
Health Problems, in which T. F. Abercrombie,
Guy G. Lunsford, E. S. Sanderson, Justin An-
drews, L. M. Petrie, J. D. Applewhite and G. T.
Bernard took part. The United States had de-
clared war against Japan December 8, 1941, the
day after the treachery at Pearl Harbor, and the
hours published on the program were marked
“War Time,” which meant one hour before nor-
mal time.
The Calhoun Lecture was given by Dr. Perrin
H. Long, of Baltimore, Professor of Preventive
Medicine, Johns Hopkins University School of
Medicine, and an address presented on “Medical
Problems: National, Economic and Scientific,’
by Dr. Frank H. Lahey, President of the Ameri-
can Medical Association. The Presidential ad-
dress by Dr. Bunce was entitled "Medical Prob-
lems of 1942.”
Four other symposiums were on the program,
the first being one on Psychoses and Psychoneu-
roses, by Hervey Cleckley, J. C. Metts, H. D.
Allen, Jr., Ernest F. Wahl, James N. Brawner,
Sr. and Jr., and E. H. Parsons, Major, Medical
Corps, U. S. Army. The following participated
in the symposium on “Eye, Ear, Nose and Throat
Problems:” S. J. Lewis, Alton V. Hallum, W. 0.
Martin, Jr., Lester Brown and Murdock Equen.
William F. Lake, R. C. Pendergrass, J. J. Clark,
A. A. Rayle and J. W. Landham gave a sym-
posium on “The Roentgenological Problems of
the Gastro-Intestinal Tract;” while a symposium
on “Surgical Problems” was conducted by M. C.
Pruitt, Henry Poer, H. A. Seaman, T. C. Davison,
Richard Torpin, A. Miller, Shelley Davis and
F. B. Brown.
At this session of the Association Secretary-
Treasurer, Edgar D. Shanks, offered the following
resolution, which received enthusiastic support of
the Council, the House of Delegates and the mem-
bers of the Association in general session:
Whereas, The activities of the Medical Association of
Georgia have grown each year; and
Whereas, There should be established a permanent
headquarters office for the routine business of the Asso-
ciation, for the preservation of the archives of the Asso-
ciation, including medical history; and for a medical
110
Thk Journal of the Medical Association of Georgia
package library service for ihe benefit of both the medi-
cal profession and the public; and
Whereas, The finances of this Association are now
favorable to the development of such a plan; and
Whereas, This year — 1942 marks the hundredth anni-
versary of Dr. Crawford W. Long’s discovery of the
anesthetic properties of ether; and
Whereas, It would be appropriate for this Association
to honor the memory of its most distinguished deceased
member — Crawford Williamson Long— by naming the
proposed building the Crawford W. Long Memorial
Building; therefore
Be It Resolved, By the Council of this Association,
and the same is recommended and transmitted to the
House of Delegates and the Association in general ses-
sion, at Augusta, this May 1, 1942, that the Medical
Association of Georgia develop, through its Council,
plans for a permanent headquarters building for the
Association, and that the sum of Five Thousand (S5.Q00)
Dollars be set aside by the Association’s Secretary -Treas-
urer to be known as the Building Fund, the fund to be
added to from year-to-year as the Association directs
until a sufficient amount is available to facilitate a suit-
able building program.
New officers chosen for 1942-43 were; W. A.
Selman, Atlanta, President-Elect; S. J. Lewis,
Augusta, and Cleveland Thompson, Millen. First
and Second Vice Presidents; Allen H. Bunce,
Delegate to the A.M.A., H. C. Sauls. Alternate.
Atlanta was selected as the next meeting place.
Ninety Fourth Annual Session
Atlanta, 1943
With J. A. Redfearn presiding, the House of
Delegates held three important meetings. Dr.
Edgar D. Shanks, Secretary-Treasurer, reported
that more than 500 members of the Association
were in military service. His report also revealed
a balance in the treasury of $40,773.31. The
Committee on Medical Preparedness showed that
efforts were being made to secure physicians for
the armed forces, under what was known as the
Procurement and Assignment Service.
The scientific program contained papers by
R. Bruce Logue, Major. Medical Corps, on “The
Electrocardiogram: Its Indications and Limita-
tions;” “Critique on the Use of the Erythrocyte
Sedimentation Test in Clinical Medicine,” by
Lieut. Charles Purcell Roberts; “Atypical Pneu-
monia.” by Lieut. Comd. Mark S. Dougherty,
Jr.; “Traumatic Shock,” by Everett I. Evans,
Richmond. Va. ; and “Medical Conservation of
Manpower in a Shipyard.” by R. L. Brown,
Brunswick. The Hardman Loving Cup was
awarded to Dr. J. E. Paullin, of Atlanta, for
1943.
Invited guests rendered the following: “Medi-
cal Achievements in This Present War,” the Cal-
houn Lecture, by Rear Admiral Ross T. McIn-
tyre, Surgeon General of the Navy; “Complica-
tions of Acute Coronary Thrombosis,” by Chaun-
cey C. Maher, Associate Professor of Medicine,
Northwestern University Medical School: and
“Practical Points in the Diagnosis and Treat-
ment of Graves’ Disease,” by James H. Means,
Professor of Medicine, Harvard Medical School.
The following new officers were elected:
President-Elect, Cleveland Thompson, Millen:
First and Second Vice Presidents, Major Fowler,
Atlanta, and C. Hall Farmer, Macon. Savannah
was chosen for the next meeting.
Ninety Fifth Annual Session
Savannah, 1944
On the program of this meeting, presided over
by W. A. Selman, were papers by John Persall
and Richard Torpin, Augusta, on “Placenta Pre-
via: Report of 170 Cases:” Elton S. Osborne,
Savannah, on “Psychoanalysis;” “The Manage-
ment of the Obese Diabetic,” by L. Harvey Hamff.
Atlanta; “Hyperglycemia Following Protamine-
Zinc Insulin Therapy,” by George L. Walker.
Griffin: “Low Back and Sciatic Pain: Neurologic
Point of View,” by Edgar F. Fincher. Atlanta;
“Low Back Pain and Disability: Orthopedic
Point of View,” by Fred G. Hodgson. Atlanta;
and “Shock.” by Arthur J. Merrill. Atlanta.
The Abner Calhoun Lecture was given by
Arthur W. Allen, of Boston, on “Gastric and Duo-
denal Ldcers.” Among other papers were:
“Granuloma Inguinale.” bv Gordon G. Allison,
Atlanta; “The Diagnosis of Hvdronephrosis.” by
Donald E. Beard. Atlanta: “Renal Ectopia,” by
Rudolph Bell. Thomasville: “Skin Cancer: Its
Management.” by W. L. Dobes. Atlanta; “Multi-
ple and Solitary Renal Cysts,” by Samuel J.
Sinkoe. Atlanta: “Cardiovascular-renal Prob-
lems,” by L. L. Whitley, Athens; and “Penicillin
in Acute and Chronic Infections,” by Albert L.
Evans, Atlanta. This was the first paper on peni-
cillin read before the Association.
Officers elected were: Ralph H. Chaney, Au-
gusta, President-Elect; Ruskin King, Savannah,
and J. B. Kay, Byron, First and Second Vice
Presidents. Macon was chosen for the next meet-
ing.
Ninety Sixth Annual Session
Macon, 1946
The Office of Defense Transportation, Wash-
ington. D. C., denied the Association’s request
to hold the annual session in 1945, therefore all
officers and committees were continued until
another annual session could be held. The officers
and chairmen of the principal committees at
this time were:
President — Cleveland Thompson, Millen
President-Elect — Ralph H. Chaney, Augusta
First Vice President — Ruskin King. Savannah
Second Vice President — J. B. Kay, Byron
Parliamentarian — J. W. Simmons. Brunswick
Secretary-Treasurer — Edgar D. Shanks, Atlanta.
Delegates to the A.M.A.
Delegates Alternates
W. A. Mulherin, Augusta B. H. Minchew, Waycross
Allen H. Bunce, Atlanta H. C. Sauls, Atlanta
Olin H. Weaver, Macon C. K. Sharp, Arlington
Council
Steve P. Kenyon, Chairman Marion C. Pruitt, Clerk
Committees
Scientific Work — B. H. Minchew, Chairman
Public Policy and Legislation — Spencer A. Kirkland,
Chairman
Medical Defense — Marion C. Pruitt, Chairman
Abner W. Calhoun Lectureship — James E. Paullin,
Chairman
Medical Economics — B. T. Beasley, Chairman
March, 1950
111
*
Memorial Exercises — A. J. Mooney, Chairman
Medical History of Georgia — F. K. Boland, Chairman
Cancer Commission — J. L. Campbell, Chairman
Tuberculosis — C. C. Aven, Chairman
Clinical Pathology — A. J. Ayers, Chairman
Scientific Exhibit — W. F. Hamilton, Chairman
Awards — W. R. Dancy, Chairman
Maternal Mortality and Infant Deaths — H. F. Sharpley,
Jr., Chairman.
The title of President Cleveland Thompson’s
address was “The Doctor in This New Day.”
The A. W. Calhoun Lecture was given by Dr.
Winchell M. Craig, of the Mayo Clinic, the sub-
ject being “The Early Diagnosis of Neurosurgi-
cal Conditions.” Addresses by other visiting
guests were: “Correcting Some of Nature’s Mis-
takes by Surgical Intervention,” by Oswald S.
Lowsley, New York City; “Our Battle for Free-
dom,” by H. H. Shoulders, Nashville, Tenn.,
President-Elect, American Medical Association;
and “Psychosomatic Gynecology,” by J. P. Pratt,
Detroit.
Among papers on the program were: “The
Etiology of Convulsions,” by Homer S. Swanson,
Atlanta; “The Treatment of Epilepsy in Children
with Sodium Dilantin,” by Benjamin Bashinski.
Macon; “Congenital Heart Disease,” by Laura
Lipscomb, Atlanta; “The Surgical Management
of the Obstructive Prostate,” by Glenn J. Bridges.
Atlanta; “Anti-Rh Factors in Blood Typing,” by
A. J. Ayers, Atlanta; “Reactions Due to Topical
Application of Sulfonamides,” by W. L. Dobes.
Atlanta; “Surgery in Elderly Patients,” by W. W.
Baxley, Macon; “The Use of Thiouracil in the
Treatment of Toxic Goiter, and Its Dangers,” by
T. C. Davison, Atlanta; “Newer Concepts of the
Growth of the Placenta,” by Joseph Krafka, Jr..
Augusta; and “Spirotrichosis: Report of Case,”
by D. H. Garrison, Clarksville.
New officers chosen were: Steve P. Kenyon,
Dawson, President-Elect; A. M. Phillips, Macon,
and C. Purcell Roberts, Atlanta, First and Second
Vice Presidents; Edgar D. Shanks, Sr., Atlanta,
Secretary-Treasurer; B. H. Minchew, Delegate to
the A.M.A.; W. R. Dancy, Alternate. One hun-
dred and thirty-two members were reported as
deceased in the two-year period from 1944 to
1946. The Association accepted the invitation of
Augusta to meet in that city in 1947.
Ninety Seventh Annual Session
Augusta, 1947
With R. H. Chaney presiding, the Association
met at the Bon Air Hotel. The Council and House
of Delegates held interesting and important meet-
ings, well reported by the official stenographer.
Following the close of the war, many newcomers
had moved in and were making good active mem-
bers. The title of the President s address was
"Medicine: It’s Problems and Its Solutions.”
Among papers published on the program were :
“Vagotomy,” by John W. Turner, Atlanta; “Car-
cinoma of the Colon,” by J. D. Martin, Jr., At-
lanta; “Surgery of the Colon and Rectum,” by
Edgar Boling, Atlanta; “Silicosis,” by Thomas
J. Dicks, McCaysville; “Chronic Alcoholism,” by
John D. Campbell, Atlanta; “Diverticulitis of the
Sigmoid with Obstruction,” by H. H. McGee,
Savannah; “Influence of Morphine on the Uterus
of Humans,” by R. A. Woodbury, Augusta;
“Differential Diagnosis of Anterior Chest Pain.”
by Bruce Logue, Atlanta; “The Treatment of
Early Syphilis with Penicillin in Peanut Oil and
Beeswax,” by Albert Heyman, Atlanta; “Pig-
mented Lesions of the Eye and Adnexae,” by
Phinizy Calhoun, Jr., Atlanta; and “Metastatic
Cancer of the Lung,” by R. C. Pendergrass,
Americus.
“The Later Years” was the subject of the Cal-
houn Lecture presented by Dr. Edward L. Bortz,
of Philadelphia. “How Is Poliomyelitis to Be
Controlled?” was discussed by Dr. Howard A.
Howe, of Baltimore; and the address of Dr.
Max M. Peet, of Ann Arbor, Michigan, was en-
titled “Bilateral Supradiagphragmatic Splanch-
nicectomy in the Treatment of Arterial Hyper-
tension.”
The following new officers were elected, and
Atlanta chosen for the next meeting: President-
Elect, Edgar H. Greene, Atlanta; First and Sec-
ond Vice Presidents, J. Victor Roule, Augusta,
and Thomas J. Ferrell, Waycross. The delegates
and Alternate Delegates to the A.M.A. were
re-elected.
Ninety Eighth Annual Session
Atlanta, 1948
The Association met at the Academy of Medi-
cine, home of the Fulton County Medical Society,
with Steve P. Kenyon presiding. The Secretary
reported 741 doctors registered for the session,
239 members of the Woman’s Auxiliary, and 102
exhibitors. The Committee on Exhibits awarded
its first prize to Edgar R. Pund and H. E. Nie-
burgs, of the University of Georgia School of
Medicine, for the “Value of Vaginal and Cervical
Spreads for the Early Recognition of Carci-
noma.”
The President’s address was entitled “Cur-
rent Problems of Organized Medicine.” The
Calhoun Lecture was given by Dr. Henry K.
Beecher, of Boston, Dorr Professor of Anesthesia,
Harvard Medical School, his subject being “On
the Relief of Suffering Within the Hospital.”
Other guest speakers were Dr. George R. Herr-
mann, of Galveston, Texas, who spoke on “Coro-
nary Artery Heart Disease;” Dr. Robert B. Law-
son, Winston-Salem, North Carolina, Associate
Professor of Pediatrics, The Bowman-Gray
School of Medicine, whose subject was “Recent
Concepts Regarding the Spread and Treatment of
Poliomyelitis;” and Dr. Thomas Findley, of
New Orleans, Associate Professor of Clinical
Medicine, Tulane University School of Medi-
cine, who discussed “A New Concept concerning
the Pathogenesis of Certain Disorders Associated
with Aging.”
Among the papers on the program were:
112
The Journal of the Medical Association of Georgia
“Streptomycin in the Therapy of Granuloma
Inguinale; Report of 100 Cases,” by Calvin
Chen, Robert B. Greenblatt and Robert B. Dienst.
Augusta; “The Treatment of Influenzal Menin-
gitis with Streptomycin and Sulfadiazine,” by
Joseph Yampolsky, Atlanta, and John Paul Jones.
Macon; “Modern Clues to the Early Identifica-
tion and Proper Treatment of Carcinoma of the
Lung,” by Osier A. Abott and William A. Hop-
kins, Atlanta; “Facial Palsies,” by W. A. Smith.
Atlanta; “Head Enlargement in Infants,” by
Charles E. Dowman, Atlanta; “The Fallacy of
the Basal Metabolic Rate,” by J. K. Fancher.
Atlanta; and “The Cystoscopic Extraction of
LYeteral Calculi.” by Charles Eberhart and James
L. Campbell, Jr., Atlanta.
Enoch Callaway, of LaGrange, was chosen
President-Elect for the ensuing year; Eustace A.
Allen, Atlanta, and F. M. Simonton, Chicka-
mauga, First and Second Vice Presidents; the
other officers remaining as before. The session
adjourned to meet in Savannah the following
year.
Ninety Ninth Annual Session
Savannah, 1949
Thus the Medical Association of Georgia comes
to its centennial meeting, having been organized
in Macon one hundred years ago, in 1849. The
Secretary called attention to the fact that the
Association has the largest membership in its
history, 2.202. He also stated that of this number,
1.045, slightly less than half the total, had re-
sponded to the assessment of the American Medi-
cal Association to prosecute the fight against
socialized medicine. Dr. Shanks further said that
fifty years ago the Association numbered 475
members, with cash assets of $160.09; in 1949
the membership was 2.202, with assets of $97.-
434.51. During this time dues had increased
from $3.00 per member to $10.00, hut until
1917 had been around $7.00.
Dr. Edgar H. Greene presided during this his-
toric meeting. The subject of his address was
“Our Problems at the Beginning of the Associa-
tion’s Second Hundred Years.” On the program
was the Calhoun Lecture. “The Clinical Signfi-
cance of Closure of the Retinal Blood Vessels,”
by Dr. W. L. Benedict, of the Mayo Clinic; a
paper on “Diseases of the Cervix,” by Dr. Conrad
G. Collins, of New Orleans, Professor of Gyne-
cology, Tulane University School of Medicine:
“What the Medical Profession Is Doing About
Your Eyes,” by Dr. Ralph S. McLaughlin.
Charleston, West Virginia; and “The Detection
of Early Cancer by Means of Periodic Examina-
tion,” by Dr. Catharine Macfarlane, of Phila-
delphia, Professor of Gynecology, Woman’s
Medical College of Pennsylvania.
Among other papers published on the program
were: “Present Status of Chemothrepay of Leu-
kemia,” by Tully T. Blalock, Atlanta; “The Use
of Rice Diet in Hypertension — Preliminary Re-
port of 25 Cases,” by R. E. Felder, LaGrange;
“Two Years’ Experience in the Diagnosis of
Uterine Cancer by Means of Vaginal Smears,”
by H. . Freeh. Savannah; “Total Laryngec-
tomy,” by Murdock Equen, Atlanta; “Diabetes
Mellitus in Pregnancy,” by John R. McCain,
Atlanta; “Surgical Management of Exstrophy of
the Bladder.” by M. K. Bailey, Atlanta; “Diag-
nostic and Therapeutic Block for the Treatment
of Pain,” by C. MacKenzie Brown. Albany;
“Roentgen Therapy for Bursitis of the Shoulder,”
by David Robinson, Savannah : and “Breech
Presentation: Is Fetal Extension an Etiologic
Factor?” by Richard Torpin and Guy C. Calk,
Augusta.
The Hardman Loving Cup was awarded for
1949 to Dr. John L. Elliott, of Savannah, for his
work in connection with prepayment medical
care plans in Georgia. The Ware County Medi-
cal Society Cup. presented to the Association by
this society many years ago, was awarded for
the first time, this year to Dr. William R. Dancy,
of Savannah, for meritorious work done in Army
hospitals during World War I. The first prize for
scientific exhibits was given to Robert B. Green-
blatt, of Augusta, of the Department of Endocrin-
ology, University of Georgia School of Medicine.
His exhibit was on “Functional Uterine Bleed-
ing.”
Officers for 1950 were elected as follows: Presi-
dent-Elect, A. M. Phillips. Macon; First and Sec-
ond Vice Presidents, Ralph 0. Bowden, Savan-
nah. and H. Walker Jernigan, Atlanta; Parlia-
mentarian (3 years) J. W. Simmons, Bruns-
wick; Delegate to the A.M.A., C. H. Richardson.
Sr., Macon. C. K. Sharp, of Arlington, agreed
to serve the remainder of 1949 as delegate to the
A.M.A.. to fill the vacancy created by the death
of 0. H. Weaver, of Macon. Edgar D. Shanks,
Sr., Atlanta, was continued as Secretary-Treas-
urer. Macon was selected for the next meeting.
The March. 1946, number of the Journal of
the Medical Association of Georgia con-
tained an interesting article written by John W.
Simmons, of Brunswick, entitled “Forty Years
of Medicine,” in which the main inventions and
discoveries in medicine of that time are de-
scribed. Most of these contributions were men-
tioned in this history in the year 1921. Since that
time several epoch-making additions have been
made, and many of them have received attention
in the papers and discussions of the Association.
Among these may be mentioned:
1922 — The introduction of lipiodol, by Sicard.
1925 — Graham’s use of the bile dye, tetraiodophe-
nophthalein.
1927 — The introduction of liver extracts in the treat-
ment of anemia, by Minot, Murphy and Cohn.
1929 — Theelin isolated from urine of pregnant women,
by Doisy, Veler and Thayer.
1931 — Introduction of sodium pentothal as an anes-
thetic.
1933 — Surgical pneumonectomy first done.
1934 — Discovery that amidopyrine and similar drugs
were the cause of agranulocytopenia, by Madison and
March, 1950
113
Squire, and aided by Kracke and Parker, of Emory
University.
1938 — Value of nicotinic acid in pellagra established,
1939 — Metrazol shock treatment introduced.
1944 — Beginning the use of penicillin.
1947 — Beginning the use of streptomycin.
The employment of these antibiotics and newer
drugs has created the most remarkable revolu-
tion in medicine since the advent of anesthesia
and antisepsis, surgery being especially affected,
due to the elimination of many operations which
formerly were considered necessary for a cure.
While the results at present seem but little short
of miraculous in some cases, the introduction of
the agents is too recent to permit evaluation of
their final permanent place in therapeusis.
Frank K. Boland, M.D.
PRESIDENT’S PAGE
MEDICINE VERSUS POLITICS
The primary desire of men of medicine,
since the earliest days of the profession, has
been to be allowed to care for their patients
without undue interference. They have had
no desire to enter into politics. Many have
felt that to take any active part in politics
would be detrimental to the high regard in
which the profession was held by people of
all parties and political opinions. They have
held the opinion that the high ideals and
aims of the medical profession were im-
mune to political pressure. This attitude is
no longer tenable.
Without any volition on their part the
doctors have been forced into politics. They
are the chief point of attack by the enemies
of individual freedom. They must become
the leaders of those who desire to see this
freedom maintained. The question is not
shall doctors take an active part in politics
but how effectively can they meet this new
responsibility now being thrust upon them.
The medical profession’s potential politi-
cal influence is enormous. Acting as a united
force on a local, State or National level,
they can swing the balance for or against
any candidate or group. To accomplish this
they must be well informed and willing to
sacrifice a part of their time from the prac-
tice of medicine for the benefit of the prac-
tice of medicine, and for the benefit of all
citizens.
They have the intelligence, they have the
ability, they have the sources of information
and the organization. Will they use these to
the utmost or will they allow their enemies
to trample them underfoot? There can be
but one answer.
Enoch Callaway, M.D.
Thk Journal of the Medical Association of Georgia
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
March. 1950
PROGRAM FOR 100TH ANNUAL
SESSION
Elsewhere in this Journal will be found
the program for the 100th annual session of
the Association; also the program for the
Woman’s Auxiliary to the Association.
The Medical Association of Georgia is
now 101 years old, but its records show,
in so far as they are available, that 99 an-
nual sessions have been held. The session
planned for 1945, in Macon, was cancelled
on order of the Office of Defense Transpor-
tation, Washington, D. C.
Complete your plans to attend this his-
toric session. If for any reason you experi-
ence trouble in obtaining proper accommo-
dations, communicate with the Committee
on Hotels of the Bibb County Medical So-
ciety, Macon.
A.M.A. JOURNAL REFUTES MEDICAL
EDUCATION CRITICISM
The latest report from the American Medical
Association s Council on Medical Education and
Hospitals offers a convincing reply to critics who
doubt the effectiveness of the present orderly
progression in medical education to meet the
health needs of the nation, says an editorial in
the February 11 Journal of the A.M.A.
The editorial follows:
In recent discussions concerning the supply of
physicians some critics of the present methods
of training have compared the number of medical
students enrolled in the medical schools in the
Lhiited States today with the number enrolled in
1905, the first year for which accurate data for
student enrolments are available. They claim that
today’s enrolment is smaller.
While the American Medical Association, the
Association of American Medical Colleges and
others concerned with medical education have
pointed out repeatedly that many of the medical
students of the earlier period were enrolled in
substandard schools and could not therefore be
considered the equivalent of medical students in
the present day approved schools, quantitative
studies on this point have not been made until
recently.
The Council on Medical Education and Hos-
pitals of the American Medical Association has
just made a study to determine the comparative
enrolments in approved medical schools during
the 40 years since 1910, when the Council pub-
lished its first list of approved medical schools.
This study reveals that in 1910 there were 66
class A medical schools with a total enrolment of
12,530 students; in 1920 there were 70 class A
medical schools with a total enrolment of 12,559
students; in 1930 there were 76 approved medi-
cal schools with a total enrolment of 21,597; in
1940 there were 77 approved medical schools
with a total enrolment of 21,271; in 1950 there
are 79 approved medical schools with an esti-
mated total enrolment of 24,800 students.
These data clearly show that the opportunities
to study medicine in approved medical schools
have practically doubled in the last 40 years and
have more than kept pace with the growth in
population.
The number of physicians per 100,000 popu-
lation in the United States declined from 149 in
1909 to 125 in 1929. Since 1929 the ratio has
steadily risen to 137 in 1949. These new data
showing the increasing number of students en-
rolled in approved medical schools reveal clearly
that the decline in the physician-population ratio
from 1909 to 1929 was due entirely to the clos-
ing of substandard medical schools. A physician-
population ratio that included only physicians
who were graduated from approved medical
schools would reveal a steadily rising trend in
the past four decades.
Even the poorest of the approved medical
schools today have better staffs and facilities
than most of the approved medical schools of 30
or 40 years ago, and the leadership of the medi-
cal profession and the medical colleges has re-
sulted in the training of a greatly increased
number of well qualified physicians to serve the
American people.
This accomplishment is important in the in-
creasing life expectancy. In the last 40 years life
expectancy at birth in the United States has
increased more than 1 7 years. This accomplish-
ment also is important in the reduction of ma-
ternal mortality, which in the last 20 years has
been reduced by more than 85 per cent, and has
influenced considerably the over-all crude death
rate for the nation, which has shown a gradual
decrease despite the aging of the population.
The general health of the population of the
ETnited States is constantly improving. No one
can deny this without resorting to falsification.
Those who claim that a health crisis exists in this
country cannot prove it, and yet by inference,
and often more directly, they plead a crisis to
bolster their arguments for enlargement of medi-
cal schools and increase in enrolments of stu-
March, 1950
115
dents.
The latest report from the Council on Medical
Education offers a convincing reply to those who
doubt the effectiveness of the present orderly
progression in medical education to meet the
health needs of the nation. To heed the pleas of
those who would discard order for chaos would
cause a farrago that would return the level of
medical education and care to that of several
decades ago.
USE PENICILLIN TO PREVENT RHEUMATIC
FEVER RECURRENCE
Encouraging results from use of penicillin to
prevent recurrence of rheumatic fever in children
are reported by a Chicago research group.
“The recurrence rate was zero in the penicillin-
treated group compared with 11 and 19 per cent
in control groups,” Kate H. Kohn, M.D., Albert
Milzer, Ph.D., and Helen MacLean, A.B., of
Michael Reese Hospital say. Their study appears
in the January 7 Journal of the American Medi-
cal Association.
Rheumatic fever commonly affects children and
often results in permanent and serious damage
to the heart. The disease is related to infection
of the upper respiratory tract with streptococcus
microbes.
All the children studied had recovered from an
acute attack of rheumatic fever and were living
in their own homes and attending public school.
“They present a different problem from chil-
dren residing in the controlled atmosphere of
the hospital or convalescent home, not only be-
cause they are exposed to infections prevalent in
the general community, but also because medi-
cal care, especially of seemingly mild upper res-
piratory infections, infrequently is delayed,” the
researchers say.
A hundred and twenty-six children were chosen
and divided into two groups equal in sex, race,
age and economic level. One group received
penicillin tablets for periods covering a week
or more of each month during three school
years. The second group received no medication.
A third and comparable group also was used as a
control.
The penicillin was effective in significantly
reducing the incidence of streptococcic infections
in the throats of the children, the researchers
found.
This observation and the difference in recur-
rence rates in the penicillin-treated group and
the non-treated groups are “sufficiently encour-
aging to warrant continued study,” the research-
ers say.
LACK OF CALCIUM IS COMMON DIETARY
DEFICIENCY
American habits of diet make calcium defi-
ciency a common defect of nutrition in this
country, according to a report to the Council on
Foods and Nutrition of the American Medical
Association.
The report, written by Genevieve Stearns,
Ph.D., of the State University of Iowa College of
Medicine, Iowa City, appears in the February 18
Journal of the American Medical Association.
“Milk and its derivatives, such as cheese and
ice cream, are the chief sources of calcium in
the diet and provide ample phosphorus for its
utilization,” the report points out.
“Other protein-rich foods, such as meat, eggs,
fish and cereals, add little or no calcium to the
diet.”
Overweight individuals (principally adults)
who must cut down on the food they eat can get
their full quota of milk minerals from buttermilk
or skimmed milk.
Maintenance of an adequate supply of vitamin
D is important in regulating the ability of the
body to absorb and retain calcium, the report
emphasizes. Sometimes called the “sunshine vita-
min,” vitamin D is found in fish liver oils and
vitamin D fortified milk and is produced in the
body on exposure to sunlight. Some other foods,
such as butter and egg yolk, contain small
amounts of the vitamin but are unreliable
sources.
The report recommends that to obtain ade-
quate calcium, healthy adults drink a pint of
milk and eat a serving of milk products (such as
cheese, ice cream or coffee-flavored milk) daily.
Three glasses of milk provide an ample daily
intake of calcium for average adults, according
to Dr. Stearns.
Drinking one quart of milk daily provides an
ample amount of calcium for children and adol-
escents, the report says. Calcium intake can be
substantially increased by liberal use of evap-
orated milk instead of cream in coffee.
American eating habits and wide distribution
in foods make dietary deficiency of phosphorus
and magnesium unlikely in this country, accord-
ing to the report.
“The supply of bone-building minerals (prin-
cipally calcium) during periods of growth is an
important factor in determining the eventual
stature of a person,” the report says. “Study of
dietary habits of various groups tends to show
that peoples whose diets provide adequate cal-
ories, protein and calcium are tall in stature and
those whose diets are poor in these substances
tend not only to be short in stature but small
framed, with finer bone structure.
“If children of such small skeletoned peoples
are more liberally fed, significant increase in
stature is observed even in one generation. It is
not the province of this review to discuss the
proper height or skeletal size of the American
people, yet to speak of requirement of these sub-
stances for any age group presupposes a stand-
ard both for final stature and for rate of skeletal
growth.
116
The Journal of the Medical Association of Georgia
“The discussion of requirements herein has
been based primarily on growth rates of nutri-
tionally favored population groups. The term
allowance as used by the National Research
Council is probably preferable to the term re-
quirement. Certainly, a considerable part of our
own population has lived to maturity, reared
children and died without ever achieving a daily
intake as recommended here.
“It is equally certain that a considerable per-
centage of our population shows some degree of
malnutrition, as judged by present standards.
The prevalence of osteoporosis in older persons
is often considered evidence of such malnutri-
tion.
“Whether better dietary habits, including a
more ample intake of bone-building materials,
will result in a more vigorous old age remains
to be proved. The evidence is strong that better
nutrition is one of the chief factors in the increase
of stature and rate of growth of present day
Americans over those of 50 years ago. As the
mean age of our population increases, we are
concerned with postponement of senescence.
Maintenance of a well mineralized skeleton
throughout adult life may well be a factor in
the maintenance of physical vigor into old age.
“Our present knowledge of the requirements
for skeleial minerals can be summarized simply.
Ample evidence exists that deficiency of intake
or utilization of these minerals results in slowing
of growth and lengthening of the growth period;
it is possible that such deficiencies in adult life
may hasten senescence. There is no evidence of
any ill effects from ample intake of these sub-
stances over long periods of time. The evidence
favors strongly the maintenance of an adequate,
even ample, intake of these minerals throughout
the entire life span.”
A.M.A. COUNCIL SUMMARIZES RESEARCH
ON VITAMIN E THERAPY
Protagonists of vitamin E therapy have not
reported any results derived from critical clinical
tests, says a report of the Council on Pharmacy
and Chemistry of the American Medical Asso-
ciation.
The report, which appears in the February 18
Journal of the A.M.A., says in part:
“More than three years ago, stories appeared
concerning a remarkable new treatment for pa-
tients with circulatory disease. The treatment
was said to have been discovered by some inves-
tigators in London, Canada. It was alleged that
large doses of vitamin E could effect remarkable
recoveries in patients with a wide variety of
cardiovascular disorders who had not been
benefited by more orthodox therapy.
“The protagonists of vitamin E therapy have
not reported any results derived from critical
clinical tests, although medical and lay literature
contain reports which, to the uncritical, might
appear to lend support to the hypothesis that
vitamin E is useful in the treatment of heart
disease.
"It is regrettable that the hopes of sufferers
from heart disease and other cardiovascular con-
ditions, as well as those of countless diabetic
persons, should be falsely raised by unbridled
enthusiasm.”
1 he A.M.A. report cites a number of “care-
fully conducted and adequately controlled”
studies which, according to the Council on Phar-
macy and Chemistry, failed to substantiate early
reports of the usefulness of vitamin E in heart
disease and diabetes.
SURGEONS TATTOO EYEBALL IN NEWER
SIGHT-GIVING OPERATION
Blindness caused by a film or opacity over the
eye (not a cataract) can be relieved by a newer
operation described in the February issue of
Hygeia , health magazine of the American Medi-
cal Association.
“Esually a patient who can be helped by this
operation suffers from vision so reduced that he
is unable to pursue a gainful occupation requir-
ing the use of the eye,” says Dr. Arthur A. Knapp
of New York.
“The operation is suitable if the patient’s
minimum sight permits him to distinguish be-
tween day and night. A healthy retina is neces-
sary for a good result.
“The cloudy area of the cornea is tattooed and
then an operation is performed to create a new
aperture or pupil. The eye is not tattooed with
needles. That method has been outmoded; it
has been superseded by chemicals.
“Fundamentally, the chemical solutions are ap-
plied on the outside of the eyeball to change the
whitish film of the cornea to a dark color. The
reason for this is that the w'hitened cornea acts
like a ground glass to scatter the incoming rays
of light; it disperses the rays all over the back
of the eye instead of focusing them distinctly on
that vital visual spot in the center of the retina.
“The result is glare and poor vision. Tattooing
does away with these troublesome rays of light.
The chemically treated area absorbs them. The
surgeon has a choice of colors; he may use
black, brown or blue, depending on the back-
ground of the patient’s eye.
“At conversational distance the tattooed area
cannot be distinguished. The eye looks normal.
“This newer method is a definite advance in
the forward march of surgery. It gives a high
percentage of excellent results, and the range of
its applicability is very wide. It is devoid of the
hazards of a delicate and intricate technique.
Much more blindness can now be cured. At a
conservative estimate, vision is improved in 95
per cent of patients.”
March, 1950
117
OFFICERS OF THE MEDICAL
ENOCH CALLAWAY, M.D.
LaGrange
President, 1949-1950
Ralph O. Bowden, M.D. H. Walker Jernigan, M.D.
Savannah Atlanta
First Vice-President Second Vice-President
The officers of the Medical Association of Georgia
urge its members to attend the One Hundredth Annual
Session of the Association, Macon, April 18-21, 1950.
Note pages 124-127 of this Journal.
ASSOCIATION OF GEORGIA
ALPHEUS MAYNARD PHILLIPS, M.D.
Macon
President-Elect 1949-1950
Edgar Shanks, M.D., Atlanta John W. Simmons, M.D.
Secretary-Treasurer and Brunswick, Parliamentarian
Editor of The Journal
The House of Delegates will convene, Tuesday, April
18, at 2:00 p.m. at the City Auditorium. The scientific
session will open April 19, at 8:30 a.m., at the City
Auditorium.
118
The Journal of the Medical Association of Georgia
Allen H. Bunce, M.D. C. H. Richardson, Sr., M.D. Benj. H. Minchew, M.D. Wm. R. Dancy, M.D.
Atlanta Macon Waycross Savannah
Delegate to the A.M.A. Delegate to the A.M.A. Delegate to the A.M.A. Alt. Delegate to the A.M.A.
Walter W. Daniel, M.D.
Atlanta
Alt. Delegate to the A.M.A.
C. L. Ayers, M.D.
Toccoa
Alt. Delegate to the A.M.A.
Lee Howard, M.D.
Savannah
Councilor, First District
C. K. Wall, M. D.
Thomasville
Councilor, Second District
W. G. Elliott, M.D. J. W. Chambers. M.D. Marion C. Pruitt, M.D. H. D. Allen, Jr., M.D.
Cuthbert LaGrange Atlanta Milledgeville
Councilor, Third District Councilor, Fourth District Councilor, Fifth District Councilor, Sixth District
mmm
March, 1950
119
D. Lloyd Wood, M.D. Wm. F. Reavis, M.D. Bruce Schaefer, M.D. H. L. Cheves, M.D.
Dalton Waycross Toccoa Union Point
Councilor, Seventh District Councilor, Eighth District Councilor, Ninth District Councilor, Tenth District
Chas. T. Brown, M.D.
Guyton
Vice-Councilor, First District
Chas. H. Watt. M.D. Guy J. Dillard, M.D.
Thomasville Columbus
Vice-Councilor, Second District Vice-Councilor, Third District
Clarence B. Palmer, M.D.
Covington
Vice-Councilor, Fourth District
David Henry Poer, M.D. H. G. Weaver, M.D. M. M. Hagood, M.D. Alton M. Johnson, M.D.
Atlanta Macon Marietta Valdosta
Vice-Coumrilor, Fifth District Vice-Councilor, Sixth District Vice-Councilor, Seventh District Vice-Councilor, Eighth District
120
The Journal of the Medical Association of Georcia
D. H. Garrison, M.D. J. Victor Roule
Clarkesville Augusta
Vice-Councilor, Ninth District Vice-Councilor, Tenth District
Viola Berry
Atlanta
Executive Secretary
ONE HUNDREDTH ANNUAL SESSION
Macon
April 18, 19, 20, 21, 1950
Officers
President Enoch Callaway, LaGrange
President-Elect A. M. Phillips, Macon
First Vice-President Ralph . O. Bowden, Savannah
Second Vice-President H. Walker Jernigan, Atlanta
Parliamentarian Jno. W. Simmons, Brunswick
Secretary-Treasurer Edgar D. Shanks, Atlanta
Delegates to A. M. A
B. H. Minchew (1948-1950)
Alternate, W. R. Dancy_
Allen H. Bunce (1948-1950)
Alternate, Walter W. Daniel
C. H. Richardson, Sr. (1950-1951)
Alternate, C. L. Ayers
Council
W. F. Reavis, Chairman Waycross
Marion C. Pruitt, Clerk —.Atlanta
Councilors
1. Lee Howard (3 years)- Savannah
2. C. K. Wall (3 years) Thomasville
3. W. G. Elliott (3 years) Cuthbert
4. J. W. Chambers (3 years) LaGrange
5. Marion C. Pruitt (1 year)_ Atlanta
6. H. D. Allen, Jr. (1 year) Milledgeville
Waycross
Savannah
Atlanta
Atlanta
Macon
Toccoa
7. D. Lloyd Wood (1 year) Dalton
8. W. F. Reavis (1 year I W'aycross
9. Bruce Schaefer (2 years)- Toccoa
10. II. L. Cheves (2 years)... Union Point
Vice-Councilors
1. Clias. T. Brown Guyton
2. C. H. Walt Thomasville
3. Guy J. Dillard __ Columbus
4. Clarence B. Palmer Covington
5- D. Henry Poer Atlanta
6. H. G. Weaver . Macon
7. M. M. Hagood Marietta
8. Alton M. Johnson Valdosta
9. I). H. Garrison Clarkesville
10. J. Victor Roule Augusta
Executive Committee
Enoch Callaway, President LaGrange
W. F. Reavis, Chairman, Council Waycross
Edgar D. Shanks, Secretary-Treasurer Atlanta
Honorary Advisory Board
W. S. Goldsmith President, 1915-1916
Eugene E. Murphey President, 1917-1918
J. W. Palmer President, 1918-1919
J. W. Daniel _ President, 1923-1924
Frank K. Boland President, 1925-1926
C. K. Sharp President, 1928-1929
Wm. R. Dancy President, 1929-1930
M. M. Head President, 1932-1933
C. H. Richardson President, 1933-1934
Clarence L. Ayers — President, 1934-1935
James E. Paullin President, 1935-1936
B. H. Minchew President, 1936-1937
Grady N. Coker President, 1938-1939
J. C. Patterson President, 1940-1941
Allen FI. Bunce President, 1941-1942
James A. Redfeam President, 1942-1943
W. A. Selman President, 1943-1944
Cleveland Thompson President, 1944-1946
Ralph H. Chaney President, 1946-1947
Steve P. Kenyon President, 1947-1948
Edgar H. Greene President, 1948-1949
BIBB COUNTY MEDICAL SOCIETY
Officers and Committees
President C. H. Richardson, Jr., Macon
President-Elect Robert W. Edenfield, Macon
Vice-President John I. Hall, Macon
Secretary-Treasurer Henry H. Tift, Macon
Delegate J. B. Kay, Byron
Delegate J. D. Applewhite, Macon
Alternate Delegate C. N. Wasden, Macon
Alternate Delegate W. W. Baxley, Macon
Censors: C. H. Richardson, Sr.; Wallace L. Bazemore,
and W. W. Baxley.
COMMITTEES
All of Macon
General Committee
Leon Porch, Chairman; Henry H. Tift, C. H. Richard-
son, Robert W. Edenfield, Willard R. Golsan, and Robert
W. McAllister.
Hotels
J. Benliam Stewart, Chairman; R. M. Reifler, John P.
Jones, E. C. McMillan, and Alvin E. Siegel.
Entertainment
Robert W. McAllister, Chairman ; Charles C. Benton,
Edwin R. Watson, Leo J. Blum, Jr., L. P. James, and
W. Holloway Bush.
Alumni Dinner
University of Georgia School of Medicine
H. G. Weaver, Chairman; W. W. Baxley, Evelyn
Swilling, Jule C. Neal, and Frank Vinson.
Alumni Dinner
Emory University School of Medicine
W. C. Boswell, Chairman; J. B. Kay, E. A. Brannen,
Ralph G. Newton, J. L. King, and E. C. McMillan.
Publicity
C. N. Wasden, Chairman; Milford B. Hatcher, W. K.
Jordan, Samuel E. Patton, and W. D. Hazlehurst.
March, 1950
121
Golf
Carl L. Anderson, Chairman; C. Hall Farmer. W. A.
{Newman. Ernest Corn, Raymond Suarez, and C. II. Rich-
ardson, Sr.
T ransportation
W. Earl Lewis, Chairman; C. L. Ridley, Jr., W. D.
Jarratt, John T. DuPree, and W. L. Barton.
MEDICAL ASSOCIATION OF GEORGIA
Committees
Scientific W'ork
Carter Smith, Chairman Atlanta
W. C. McGeary Madison
Richard Torpin Augusta
Edgar D. Shanks Atlanta
Public Policy and Legislation
S. A. Kirkland, Chairman (1950) Atlanta
Jack C. Norris (1951) Atlanta
James A. Johnson, Jr. (1952) - Manchester
T. F. Sellers Atlanta
Enoch Callaway LaGrange
Edgar D. Shanks Atlanta
Medical Defense
M. C. Pruitt, Chairman _
B. H. Minchew
Marcus Mashburn
W. F. Reavis
Edgar D. Shanks
Advisory State Board of Health
Edgar H. Greene, Chairman
H. G. Weaver
D. H. Garrison
Marcus Mashburn
R. K. Winston
0. R. Styles
J. C. Brim
C. S. Pittman
C. L. Ayers
W. G. Elliott
C. Purcell Roberts
B. Russell Burke
Atlanta
Waycross
— . Cumming
— Waycross
Atlanta
Atlanta
Macon
Clarkesville
-Cumming
Tifton
Cedartown
Pelham
Tifton
Toccoa
Cuthbert
Atlanta
Atlanta
Medical Education and Hospitals
R. Hugh Wood, Chairman Emory University
G. Lombard Kelly Augusta
Julian K. Quattlebaum Savannah
Ernest F. Wahl Thomasville
J. A. Thrash Columbus
C. Mark Whitehead ._ LaGrange
L. Minor Blackford Atlanta
B. T. Beasley Atlanta
Charles B. Fulghum Milledgeville
John T. McCall, Jr Rome
A. G. Little, Jr Valdosta
Marcus _ Mashburn, Jr. Cumming
Sam Talmadge Athens
Richard B. Wilson ._ Atlanta
Hervey M. Cleckley Atlanta
Albert F. Brawner Atlanta
Abner W ellborn Calhoun Lectureship
James E. Paullin, Chairman Atlanta
J. R. Broderick Savannah
Eugene E. Murphey Augusta
Frank K. Boland Atlanta
Guy 0. Whelchel Athens
J. Calhoun McDougall Atlanta
Memorial Exercises
M. Preston Agee, Chairman Augusta
Ruskin King Savannah
J. C. Patterson Cuthbert
George H. Lang Savannah
Frank K. Boland Atlanta
J. R. S. Mays Macon
M. T. Edgerton Atlanta
Marion McH. Hull Atlanta
Medical History of Georgia
Frank K. Boland, Chairman Atlanta
Allen H. Bunce Atlanta
J. Calvin Weaver Atlanta
T. F. Abercrombie _ Decatur
Eugene E. Murphey Augusta
William R. Dancy Savannah
McClaren Johnson Atlanta
Orthopedics
Fred G. Hodgson, Chairman Atlanta
Thomas P. Goodwyn _ - - Atlanta
F. Bert Brown Savannah
J. Hiram Kite - Atlanta
L. H. Muse - Atlanta
Peter B. Wright Augusta
W. A. Newman Macon
H. Walker Jernigan Atlanta
Ed Irwin - - - Warm Springs
W. L. Funkhouser Atlanta
Lawson Thornton Atlanta
Industrial Health
J. Harry Rogers, Chairman
Thomas P. Goodwyn
T. V. Willis —
L. M. Petrie
W. W. Battey
Chas. E. Lawrence
W. A. Newman
C. F. Holton .—
John P. Garner
J. H. Mull
Rufus Askew' .
Harry Talmadge
Student Loan Fund
Mrs. Lon King. Chairman
G. Lombard Kelly
R. Hugh Wood
Scientific Exhibits
Robert B. Greenblatt, Chairman
J. Elliott Scarborough
Marion T. Benson, Jr -
Lee Howard
Helen W. Bellhouse -
J. K. Quattlebaum
J. Hiram Kite —
Don F. Cathcart — -
Clair A. Henderson
Estelle P. Boynton
Atlanta
Atlanta
Brunswick
Atlanta
Augusta
Atlanta
Macon
Savannah
Atlanta
Rome
Atlanta
Athens
Macon
Augusta
Atlanta
Augusta
Emory University
Atlanta
Savannah
Atlanta
Savannah
Atlanta
Atlanta
Savannah
Atlanta
Medical Preparedness
John B. Fitts, Chairman Atlanta
A. 0. Linch Atlanta
Edgar D. Shanks Atlanta
Post-Graduate Study
G. Lombard Kelly, Chairman Augusta
R. Hugh Wood Emory University
R. H. Oopenheimer Atlanta
Thomas Ross, Jr Macon
Hollis Hand LaGrange
Richard Torpin Augusta
Cleveland Thompson Millen
C. H. Richardson, Jr Macon
Robert Martin, III - Cuthbert
W. F. Reavis Waycross
Vernon E. Powell Atlanta
John Sharpley Savannah
McClaren Johnson Atlanta
Liaison Committee
Georgia State Medical Association
(Negro)
J. R. McCord, Chairman — — , Atlanta
W. E. Storey Columbus
Lee H. Battle, Jr. Rome
J. F. Hanson Macon
H. H. Allen Decatur
E. Van Buren Atlanta
Pediatrics
W. W. Anderson, Chairman Atlanta
Philip Mulherin Augusta
Frank Schley Columbus
Hall Farmer Macon
122
The Journal of the Medical Association of Georcia
M. M. McCord _ Rome
Howard J. Morrison Savannah
R. W. Fowler -Marietta
A. M. Johnson Valdosta
Awards
William R. Dancy, Chairman Savannah
T. Schley Gatewood Americus
M. M. McCord Rome
T. C. Williams Valdosta
Henry M. Moore Thomasville
J. Dean Paschal - — Dawson
W. J. Cranston Augusta
Francis Martin Shellman
T. Luther Byrd Atlanta
Cancer Commission
Everett L. Bishop, Chairman Atlanta
James J. Clark Atlanta
J. Elliott Scarborough Emory University
R. C. Pendergrass Americus
Thomas Harrold Macon
D. Henry Poer Atlanta
Enoch Callaway - LaGrange
Lee Howard Savannah
W. F. Jenkins —Columbus
D. Lloyd Wood Dalton
J. T. McCall Rome
Chas. R. Andrews, Jr Canton
Hoke Wammock Augusta
John H. Sherman Augusta
Calvin Stewart - Atlanta
D. M. Bradley — Waycross
F. G. Eldridge —Valdosta
Maxwell Berry Atlanta
John Funke Atlanta
Sam Talmadge Athens
W. J. Murphy Atlanta
J. J. Collins -Thomasville
Wadley Glenn Atlanta
Advisory Woman's Auxiliary
Murdock Equen, Chairman ..Atlanta
Eustace Allen Atlanta
Bruce Schaefer Toccoa
Ralph H. Chaney Augusta
C. F. Holton... . Savannah
Thomas Ross, Jr. .. Macon
J. Harry Rogers — Atlanta
W. G. Elliott Cuthbert
Shelley C. Davis Atlanta
Revision of Pharmacopeia of U. S.
C. C. Aven, Chairman (1959) Atlanta
Allen H. Bunce (1959) Atlanta
Hal M. Davison (1959). Atlanta
Prepayment Medical Care Plans
W. S. Dorough, Chairman Atlanta
John L. Elliott Savannah
Steve P. Kenyon Dawson
Kenneth D. Grace LaGrange
A. M. Phillips Macon
P. 0. Chaudron Cedartown
W. L. Pomeroy Waycross
Committee to Revise the Constitution
D. Henry Poer, Chairman Atlanta
Allen H. Bunce _ Atlanta
L. Minor Blackford Atlanta
Bruce Schaefer Toccoa
Charley K. Wall Thomasville
J. W. Simmons Brunswick
W. R. Minnich Atlanta
Peter B. Wright Augusta
John Elliott Savannah
A. M. Phillips Macon
John A. Dunaway, Attorney for Association Atlanta
Liaison Committee of 53 Constituent
State Medical Associations to Coordinate
Educational Program of A. M. A.
Jack C. Norris Atlanta
Public Relations
Eustace Allen, Chairman Atlanta
W. W. Daniel Atlanta
W. G. Elliott Cuthbert
J. E. Penland _ Waycross
W. D. Hall Calhoun
Thomas Ross, Jr. — Macon
Hartwell Joiner Gainesville
Ralph H. Chaney _ - .Augusta
Emery C. Herman 1 LaGrange
Group Insurance
John W. Turner, Chairman Atlanta
Kenneth S. Hunt Griffin
James H. Arnold Newnan
Medical Civilian Preparedness
Edgar M. Dunstan, Chairman Atlanta
Robert W. Candler Atlanta
Charles E. Dowman Atlanta
Joseph S. Skobba Atlanta
Walter M. Bartlett ...Atlanta
Fraternal Delegates to Other States
Alabama — M. M. Head, Zebulon; John E. Walker,
Columbus; D. S. Reese, Carrollton; H. B. Jenkins,
Donalsonville.
Florida — W. W. Anderson, Atlanta; Jas. L. Campbell,
Jr., Valdosta; T. J. Ferrell, Waycross; J. C. Keaton,
Albany.
North Carolina — James H. Semans, Atlanta; J.
Hubert Milford, Hartwell; Hartwell Joiner, Gainesville;
D. N. Thompson, Elberton.
South Carolina — R. G. Stephens, Washington; F. H.
Killam, Greensboro; D. R. Thomas, Augusta; Anne
Hopkins, Savannah.
State Board of Health*
First District: James M. Bvne, Jr., Waynesboro, Sept.
1, 1951.
Second District: C. K. Sharp, Arlington, Sept. 1, 1951.
Third District: R. C. Montgomery, Butler, Sept. 1, 1954.
Fourth District: M. M. Head, Zebulon, Sept. 1, 1955.
Fifth District: Spencer A. Kirkland, Atlanta, Sept. 1,
1954.
Sixth District: C. L. Ridley, Macon, Sept. 1, 1950.
Seventh District: W. P. Harbin, Jr., Rome, Sept. 1, 1950.
Eighth District: B. H. Minchew, Waycross, Sept. 1, 1950.
Ninth District: Robert L. Rogers, Gainesville, Sept 1,
1951.
Tenth District: Thos. W. Goodwin, Augusta, Sept. 1,
1955.
State of Georcia at Large**
Georgia Dental Association
W. K. White, Savannah, Sept 1, 1951.
J. G. Williams, Atlanta, Sept. 1, 1951.
Georgia Pharmaceutical Association
George Wright, Tifton, Sept. 1, 1953.
J. B. Butts, Milledgeville, Sept. 1, 1953.
•Nominated by their respective district medical societies
and appointed for six-year terms.
••Nominated by their respective associations.
State Board of Medical Examiners
J. W. Palmer Ailey
Steve P. Kenyon Dawson
Grady N. Coker Canton
Edgar H. Greene Atlanta
R. H. McDonald Newnan
Phil E. Roberson Albany
Fred J. Coleman Dublin
Alexander B. Russell Winder
Rufus A. Askew Atlanta
W. H. Powell Hazlehurst
DISTRICT SOCIETIES
Officers and Meeting Dates
First District
President — A. Bird Daniel, Statesboro
Secretary — Wm. H. Fulmer, Savannah
Third Wednesday — March and July.
March, 1950
123
Second District
President — J. C. Brim, Pelham
Secretary — Frank A. Little, Thomasville
Second Thursday — April and October.
Third District
President — Carl P. Savage, Montezuma
Secretary — T. Schley Gatewood, Americus
Third Wednesday in June — Second Wednesday in No-
vember.
Fourth District
President — Harry C. King, Griffin
Secretary — H. Hilt Hammett, Jr., LaGrange
Second Wednesday — February and August.
Fifth District
President — Carter Smith, Atlanta
Secretary — L. M. Blackford, Atlanta.
No set dates.
Sixth District
President — John I. Hall, Macon
Secretary — A. M. Phillips, Macon
Last Wednesday in June — First Wednesday in December.
Seventh District
President — S. M. Howell, Cartersville
Secretary — S. B. Kitchens, Lafayette
First Wednesday in April — last Wednesday in September.
Eighth District
President — J. B. Avera, Brunswick
Secretary — James L. Campbell, Jr., Valdosta
Second Tuesday — April and October.
Ninth District
President — R. E. Shiflet, Toccoa
Secretary — Hartwell Joiner, Gainesville
Dates not specified.
T enth District
President — M. C. Adair, Washington
Secretary — A. W. Simpson, Jr., Washington
Second Wednesday — February and August.
DELEGATES TO THE 1950 SESSION
• Counties Names and Addresses
Appling James A. Bedingfield, Baxley
Baldwin Y. H. Yarbrough, Milledgeville
Banks J. S. Jolley, Homer
Bartow _ _
Ben Hill
Bibb
Blue Ridge ... _ .
J. D. Applewhite, Macon
J. B. Kay, Byron
Brooks
Bulloch-Candler-Evans
Louie H. Griffin, Claxton
Burke
Carroll-Douglas-Haralson ...
Chatham —
.. Roy L. Denney, Carrollton
Georgia Medical Society - John L. Elliott, Savannah
Ruskin King, Savannah
Ralph 0. Bowden, Savannah
Chattooga G. H. Little, Trion
Cherokee-Pickens
Clarke M. A. Hubert, Athens
Clayton-Fayette Y. R. Coleman, Fayetteville
Cobb
Coffee L. H. Shellhouse, Willacoochee
Colquitt
Columbia
Coweta H. D. Meaders, Newnan
Crisp P. L. Williams, Cordele
Decatur-Seminole Harry B. Baxley, Donalsonville
DeKalb John T. Leslie, Decatur
Dooly 0. K. Coleman, Vienna
Dougherty Paul T. Russell, Albany
Elbert
Emanuel D. D. Smith, Swainsboro
Floyd
Forsyth
Franklin
Fulton A. 0. Linch, Atlanta
Stephen T. Brown, Atlanta
Hal M. Davison, Atlanta
Eustace A. Allen, Atlanta
A. Worth Hobby, Atlanta
William G. Hamm, Atlanta
Jack C. Norris, Atlanta
Cyrus W. Strickler, Jr., Atlanta
John W. Turner, Atlanta
Major F. Fowler, Atlanta
Shelley C. Davis, Atlanta
.1. D. Martin, Jr., Atlanta
C. Purcell Roberts, Atlanta
Glynn Thomas W. Collier, Brunswick
Gordon
Grady
Greene
Gw innett
Habersham J. L. Walker, Clarkesville
Hall Billy S. Hardman, Gainesville
Hancock C. S. Jernigan, Sparta
Hart
Henry
Houston-Peach A. Smoak Marshall, Fort Valley
Jackson-Barrow .
Jasper
Jefferson
Jenkins H. G. Lee, Millen
Lamar
Laurens
Macon .
McDuffie
Meriwether-Harris C. E. Irwin, Warm Springs
Mitchell J. C. Brim, Pelham
Monroe
Montgomery J. W. Palmer, Ailey
Morgan W. C. McGeary, Madison
Muscogee _.
Newton .
Ocmulgee —
Bleckley-Dodge-Pulaski
Polk W. H. Lucas, Cedartown
Rabun
Randolph-Terrell Robert B. Martin, III, Cuthbert
Richmond - Robert C. McGahee, Augusta
David R. Thomas, Jr., Augusta
John M. Martin, Augusta
Rockdale Harvey E. Griggs, Conyers
Screven
South Georgia: Berrien-Clinch-Cook-Echols-
Lanier-Lowndes A. G. Little, Jr., Valdosta
Spalding Kenneth S. Hunt, Griffin
Stephens Robert E. Shiflet, Toccoa
Sumter
Tattnall A. G. Pinkston, Jr., Glennville
Taylor R. C. Montgomery, Butler
Telfair S. T. Parkerson, McRae
Thomas Rudolph Bell, Thomasville
Tift Eugene M. Flowers, Tifton
Toombs H. D. Youmans, Lyons
Tri-County:
Calhoun-Early-Miller J. G. Standifer, Blakely
Tri-County: Liberty-Long-Mclntosh
Troup
Turner
Walker-Catoosa-Dade Fred H. Simonton, Chickamauga
Walton Charles S. Floyd, Loganville
Ware W. L. Pomeroy, Waycross
Warren
Washington William Rawlings, Sandersville
Wayne Robert A. Pumpelly, Jesup
Whitfield G. L. Broaddrick, Dalton
Wilcox -.V. L. Harris, Rochelle
Wilkes Albert G. LeRoy, Thomson
Worth J. L. Tracy, Jr., Sylvester
ANNOUNCEMENTS
Be sure to go to the Registration Desk at the City
Auditorium after your arrival, present your 1950 member-
ship card, register and procure a badge and program.
Discussion of papers is open to all members and guests
of the Association; it is not limited to those named on
the program.
On arising to discuss a paper the speaker will please
124
The Journal of the Medical Association of Georcia
announce his name and address clearly for the benefit
of the Association and the reporter.
Meetings will be called to order at the hour fixed on
the program. It is especially desired that the members
be prompt in their attendance.
All manuscripts should be typewritten, double spaced,
and on one side of the paper only. Papers must be
handed to the reporter immediately after being read.
IMPORTANT NOTICE
Delegates must present written credentials to the
Committee on Credentials of the House of Delegates to
secure delegates’ badges.
Members may not take part in the proceedings until
they have registered and procured official badges.
PUBLIC MEETINGS
City Auditorium
Wednesday, April 19, 8:30 A. M.
Eastern Standard Time
Open Meeting
Wednesday, April 19, 8:00 P. M.
President's Address
The President's Address will be at an open session
to which the public and visitors are invited.
Presentation of the President's Gold Key to President
Enoch Callaway, LaGrange, by David Henry Poer,
Atlanta.
Thursday, April 20, 12:00 Noon
Memorial Exercises
M. Preston Agee, Augusta
Chairman, Committee on Necrology
ENTERTAINMENT
At the time of going to press, plans for the various
entertainments have not been completed. All such plans
will be listed in the final pocket edition of the program.
MEETINGS OF THE HOUSE OF DELEGATES
City Auditorium
Tuesday, April 18, 2:00 P. M.
Eastern Standard Time
First meeting of the House of Delegates
1. Call to order by the President
2. Roll Call
3. Appointment of Reference Committees
4. Reports of officers:
President
President-Elect
Vice-Presidents
Parliamentarian
Secretary-Treasurer: Financial report
Reports of Delegates to the A.M.A.
5. Reports of committees:
Scientific Work
Public Policy and Legislation
Arrangements
Medical Defense
Advisory State Board of Health
Medical Education and Hospitals
Necrology
Cancer Commission
History
Abner Wellborn Calhoun Lectureship
Industrial Health
Awards
Advisory — Woman’s Auxiliary
Medical Economics
Orthopedics — Advisory, State Department of
Public Welfare.
Ophthalmology — Advisory, State Department of
Public Welfare
Syphilis
Tuberculosis
Special Committees
6. Unfinished business.
7. New business.
Tuesday, April 18, 8:00 P. M.
Eastern Standard Time
City Auditorium
Second meeting of the House of Delegates.
1. Call to order by the President
2. Reading of minutes
3. Announcements
4. Report of President of Woman’s Auxiliary
5. Reports of committees (continued)
6. Reports of Fraternal Delegates
7. Unfinished business
8. New business
Friday, April 21, 8:30 A. M.
Eastern Standard Time
Hotel Dempsey
Third meeting of the House of Delegates
1. Call to order by the President
2. Reading of minutes
3. Reports of committees
4. Llnfinished business
5. New business.
OFFICIAL REPORTER
The Master Reporting Company, Inc.
MEETINGS OF THE COUNCIL
Tuesday, April 18, 4:30 P. M.
Eastern Standard Time
City Auditorium
The first meeting of the Council will be held Tuesday,
April 18, following the afternoon session of the House
of Delegates. Each Councilor will render a report of
conditions of each county of his district. Other meetings
of the Council will be held on the call of the chairman.
SCIENTIFIC PROGRAM
Wednesday, April 19, 8:30 A. M.
Eastern Standard Time
City Auditorium
The papers for each meeting must be read as sched-
uled on the program.
Call to order by the President, Enoch Callaway,
LaGrange.
Invocation
Rev. Mack Anthony. Macon
Pastor, Vineville Methodist Church
Addresses of Welcome
Hon. Lewis B. Wilson, Mayor, City of Macon
C. H. Richardson. Jr., Macon
President, Bibb County Medical Society
Response to Addresses of Welcome
Edgar Hill Greene, Atlanta
Nomination of Officers and A.M.A. Delegates
SCIENTIFIC PROGRAM
Wednesday, April 19, 8:30 A. M.
Eastern Standard Time
City Auditorium
The time allotted to each paper, which INCLUDES
the showing of slides or moving pictures, is 12 minutes.
1. Further Studies on the Significance of Nipple Dis-
charge in the Female Breast.
B. T. Beasley, Atlanta.
2. Endometriosis: The Urgency for Early Diagnosis and
Treatment.
Edgar H. Greene, Atlanta.
3. The Routine Use of Exfoliative Cytologic Examina-
tions for the Detection of Asymptomatic Cancer of
the Cervix Uteri.
Herbert Nieburgs, Augusta.
4. The Rh Factor.
E. B. Saye, Thomasville.
To open the discussion of papers 1, 2, 3 and 4:
H. C. Freeh, Savannah.
Max Mass, Macon.
Recess of 15 minutes to visit exhibits.
March, 1950
125
5. The Diagnosis of Obstructive Lesions of the Gastro-
intestinal Tract of the Newborn Infant.
M. Hines Roberts, Atlanta.
6. Diagnosis and Early Treatment of Acute Poliomye-
litis.
Marvin L. Davis, Atlanta.
7. Rehabilitation of the Crippled Child.
Harriet E. Gillette, Atlanta.
8. Flat Feet in Children.
J. H. Kite, Atlanta.
To open the discussion of papers 5, 6, 7 and 8:
A. M. Johnson, Valdosta.
Robert L. Bennett, Warm Springs.
Wednesday, April 19, 12:00 Noon
Eastern Standard T ime
City Auditorium
ABNER WELLBORN CALHOUN LECTURE
Reaction and Relation of Host Cells to Viruses
Thomas M. Rivers
Rockefeller Institute for Medical Research,
Physician in Chief to the Rockefeller Hospital,
New York City
Introduction by Frank K. Boland, Atlanta.
Wednesday, April 19, 2:30 P. M.
Eastern Standard Time
City Auditorium
The time allotted to each paper, which INCLUDES
the showing of slides or moving pictures, is 12 minutes.
1. Gastroscopy in Gastric Disorders.
John S. Atwater, Atlanta.
2. Pancreatic Disease.
Charles Hock, Augusta.
3. Adenocarcinoma of the Colon and Rectum.
D. F. Mullins, Jr., Athens.
4. The Choice of Operation in Gastric and Duodenal
Ulcer.
C. H. Richardson, Jr., Macon.
5. Intussusception.
John W. Turner, Atlanta.
6. Peritoneal Drainage.
J. Benham Stewart, Macon.
7. Studies on Gastro-Intestinal Allergy.
John L. Jacobs, Atlanta.
8. The Color of Feces Following the Instillation of
Citrated Blood at Various Levels of the Small In-
testine.
J. H. Hilsman, Atlanta.
9. The Metabolic Effects of Testosterone Propionate and
Cortisone in Patients with Addison’s Disease.
Harley E. Cluxton, Jr., Savannah.
To open the discussion of above papers:
McClaren Johnson, Atlanta.
Grady Coker, Canton.
Wednesday, April 19, 8:00 P. M.
Eastern Standard T ime
City Auditorium
President’s Address
The W'elfare State versus The Welfare of the State
Enoch Callaway, LaGrange
Presentation of the President’s Gold Key to the Presi-
dent, Enoch Callaway, LaGrange, by David Henry Poer,
Atlanta.
Address
Ernest E. Irons, Chicago, 111.
President, American Medical Association.
Handling the Emotional Problems of the Cancer Patient.
Jacob E. Finesinger, Baltimore, Maryland.
Department of Psychiatry, University of Maryland
School of Medicine.
Medical Services in the Department of Defense.
Richard Lewis Meiling, Washington, D. C.
Director of Medical Services, Department of Defense,
United States Military Medicine.
Thursday, April 20, 8:30 A. M.
Eastern Standard Time
City Auditorium
The time allotted to each paper, which INCLUDES
the showing of slides or moving pictures, is 12 minutes.
1. Trauma.
Peter B. Wright, Augusta.
2. Horizons of Plastic Surgery.
John R. Lewis, Jr., Atlanta.
3. The Treatment of Fractures of the Middle Third of
the Face.
Frank F. Kanthak, Atlanta.
4. The Early Signs and Symptoms of Brain Tumors.
Charles E. Dowman, Atlanta.
5. The Relief of Distressing Pain by Interrupting Nerve
Pathways.
Exum Walker, Atlanta.
To open the discussion of papers 1, 2, 3, 4 and 5:
W. A. Risteen, Augusta.
C. F. Holton, Savannah
Recess of 15 minutes to visit exhibits.
6. The Use of Antabuse in the Treatment of Alcoholism.
James N. Brawner, Jr., Atlanta.
7. Hypnosis — Some of its Uses in Psychiatry and Gen-
eral Practice.
Corbett Thigpen, Augusta.
8. Sudden Death in a Psychiatric Practice.
Joseph D. McElroy, Atlanta.
To open the discussion of papers 6, 7 and 8:
H. D. Allen. Jr., Milledgeville.
Newdigate M. Owensby, Atlanta.
9. Cortical Adrenal Tumors — 'Unusual Case.
Ralph H. Chaney, Augusta.
Robert B. Greenblatt, Augusta.
10. The Common Tumors of the Genito-Urinary Tract
Clinical Aspects.
Robert W. McAllister, Macon.
To open the discussion of papers 9 and 10:
William E. Goodyear, Atlanta.
Charles L. Prince, Savannah.
Thursday, April 20, 12:00 Noon
Eastern Standard Time
City Auditorium
Memorial Exercises
M. Preston Agee, Augusta
Chairman, Committee on Necrology.
Thursday, April 20, 2:30 P. M.
Eastern Standard Time
City Auditorium
The time allotted to each paper, which INCLUDES
the showing of slides or moving pictures, is 12 minutes.
1. The Management of Cardiac Arrhythmias.
Bruce Logue, Atlanta.
2. The Differential Diagnosis and Treatment of the
Coronary Diseases.
Paul T. Russell, Albany.
3. Practical Aspects of Treatment of Dicumarol Poison-
ing.
David F. James, Atlanta.
4. Methods and Uses of Cardiopulmonary Function
Tests.
Robert F. Ellison, Augusta.
William F. Hamilton, Jr., Augusta.
To open the discussion of papers 1, 2, 3 and 4:
Arthur M. Knight, Jr., Waycross.
J. A. Redfeam, Albany.
5. Streptomycin Failures in the Treatment of Tubercu-
losis.
Rufus F. Payne, Rome.
To open the discussion of paper 5:
H. C. Atkinson, Macon.
Joe S. Cruise, Atlanta.
126
The Journal of the Medical Association of Georgia
6. The Treatment of Intractable Dysmenorrhea by Pre-
Saeral Sympathectomy.
Albert L. Evans, Atlanta.
7. Essentials in the Diagnosis and Preoperative Man-
agement of Congenital Atresia of the Esophagus,
With Esophago-Tracheal Fistula.
Osier A. Abbott, Atlanta.
William A. Hopkins, Atlanta.
8. Fasciotomy in the Treatment of Gravitational Leg
Ulcers.
C. K. Wall, Thomasville.
9. Lesions of the Shoulder.
Paul L. Rieth, Atlanta.
10. Melanoma.
Irvin H. Trichner, Atlanta.
Robert L. Brown, Atlanta.
Everett L. Bishop, Atlanta.
To open the discussion of papers 6, 7, 8, 9 and 10:
Charles H. Richardson, Sr., Macon.
Charles E. Rushin, Atlanta.
Friday, April 21, 9:00 A. M.
Eastern Standard Time
City Auditorium
The time allotted to each paper , which INCLUDES
the showing of slides or moving pictures, is 12 minutes.
1. Management of the Ambulant Arthritic Patient.
Arthur M. Pruce, Atlanta.
2. Headaches.
Ellison R. Cook, 111, Savannah.
3. Hemangioma of the Vertebrae as a Cause of Gastro-
intestinal Symptoms — Report of Case.
Spalding Schroder. Atlanta.
To open the discussion of papers 1, 2 and 3:
W. W. Chrisman, Macon.
J. W. Chambers, LaGrange.
4. Tbe Management of Ureteral Obstruction in Children.
Peter L. Scardino, Savannah.
5. Bladder Dysfunction Due to Congenital Causes.
J. Robert Rinker, Augusta.
To open the discussion of papers 4 and 5:
W. L. Bazeinore, Macon.
Rudolph Bell, Thomasville.
6. The Use of Radioactive Iodine in the Diagnosis and
Treatment of Diseases of the Thyroid.
Charles M. Huguley, Jr., Atlanta.
7. The Use of Folic Acid Antagonists in the Treatment
of Acute and Subacute Leukemia.
Milton H. Freedman, Atlanta.
8. Pulmonary Sarcoidosis.
James J. Clark, Atlanta.
Robert M. Tankesley, Atlanta.
9. Recent Advances in the Treatment of Early Syphilis.
Rudolph W. Jones, Jr., Atlanta.
To open the discussion of papers 6, 7, 8 and 9:
W. Holloway Bush, Macon.
Henry Schmidt, Augusta.
ANNOUNCEMENT OF ELECTION OF OFFICERS
AND DELEGATES TO A. M. A.
President-Elect
First Vice-President
Second Vice-President
Delegates to the A. M. A.
Councilors:
Fifth District
Sixth District
Seventh District
Eighth District
Selection of meeting place for 1951.
CONSTITUTION AND BY-LAWS
Chapter II, Section 2. No papers or addresses before
the Association, except those of the President and
invited essayists, shall occupy more than fifteen minutes
in their delivery; and no member shall speak longer
than five minutes, nor more than once on any subject,
provided that each essayist shall have five minutes in
which to close the discussion of his paper.
Chapter VIII, Section 1. The deliberations ot tins
Association shall be governed by parliamentary usage
as contained in Robert's Rules of Order, when not in
conflict with this Constitution and By-Laws.
Chapter VIII, Section 2. All papers read before the
Association shall become its property. Each paper shall
be deposited with the Secretary when read, and if this
is not done it shall not be published.
No miscellaneous or business matters will be discussed
before the scientific meetings, but will be referred to
the House of Delegates.
We are instructed by the President to announce to
all essayists that the sessions of the Scientific Program
of the Association will begin on time, and that the
above regulations of the By-Laws in reference to the
program will be strictly enforced.
Committee on Scientific Work
Carter Smith, Chairman Atlanta
W. C. McGeary Madison
Richard Torpin Augusta
Edgar D. Shanks Atlanta
IN MEMORIAM
Adair. Robert Edgar, Cartersville, June 17, 1949, aged
83.
Anthony, Joseph Render, Griffin, February 15, 1949,
aged 66.
Atwood, George Elliott. Waycross, September 30. 1949.
aged 72.
Ayers, Amos Jefferson. Atlanta, September 18, 1949,
aged 60.
Baker, James Oscar, Savannah, December 6, 1949, aged
82.
Bowen, John Hiram, Cobbtown, December 4, 1949, aged
83.
Bowling, Jackson Murrell, Forest Park, September 6.
1949, aged 42.
Brannen, Clemmie C., Moultrie, November 16, 1949.
aged 61.
Brown, Barton, Savannah, January 28, 1950, aged 83.
Camp, Joseph Abner, Roberta, October 22, 1949, aged
72.
Carter, George B., Shellman, October 4, 1949, aged 88.
Collins, George Harwood, Lumber City, June 12, 1949.
aged 31.
Colvin, Jackson T„ Jesup, December 8, 1949, aged 69.
Connor, James Clarence, Cave Spring, August 24, 1949,
aged 58.
Cooper, John Jesse, Cedartown, August 5, 1949, aged
82.
Cox, Clarence Goolsby, Milledgeville, December 2, 1949,
aged 62.
Davis, Claude Lester, Hinesville, May 21, 1949, aged 58.
Dellinger, Arthur Herman, Rome, August 26, 1949, aged
61.
Ellis, Samuel B., Pitts, October 8, 1949, aged 64.
Garrard, James Isaac, Milledgeville, June 12, 1949. aged
79.
Green, Samuel, Atlanta, Augusta 18, 1949, aged 60.
Griffith, Daniel Henry, Atlanta. June 2, 1949, aged 65.
Hafford, Wilbur Claire, Waycross, February 26, 1950,
aged 63.
Harris, Raymond, Ocilla, June 1, 1949, aged 37.
Holmes, John Parham, Macon. November 20, 1949, aged
64.
Jackson, John Brady, Clarkesville, July 3, 1949, aged 69.
Johnson, James Clarence, Atlanta, November 7, 1949,
aged 84.
Kerr, George S., Dalton, November 24, 1949, aged 42.
Lake, William Fay, Atlanta, December 20, 1949, aged 61.
McAllister, James Arren, Atlanta, February 16, 1950.
aged 58.
McCullough, Kenneth. Waycross, October 28, 1949, aged
58.
Murray, James, Atlanta, November 3, 1949, aged 72.
Parham, John Bernard, Tallapoosa, October 2, 1949,
aged 59.
March, 1950
127
Pettit. John Thomas, Canton, August 10, 1949, aged 69.
Prince, Ephriam LaFayette, Morganton, September 2,
1949, aged 82.
Puckett, A. Madison, Atlanta, November 27, 1949, aged
59.
Rozar. Allen Robert, Macon, December 11, 1949, aged 62.
Schwall, Edward Walker, Gracewood, September 27,
1949, aged 45.
Scofield. Irving F.. Tate, October 18, 1949, aged 70.
Sewell. James A., Atlanta. September 11, 1949, aged 80.
Shaw, Lowndes Walton, Savannah, January 26, 1950,
aged 58.
Steed, John Henry, Dalton, August 18, 1949, aged 73.
Story, Warren L., Ashburn, September 24, 1949, aged
84.
Tankersley, James Simpson, Ellijay, February 11. 1950,
aged 90.
Tootle, G. W., Glennville, August 15, 1949, aged 79.
Turner, William A., Newnan, January 21, 1950, aged 75.
Wisdom. Wilbur David, Atlanta, July 25, 1949, aged 30.
Young, Seaborn E., Midland, February 11, 1950, aged 83.
SCIENTIFIC EXHIBITS
City Auditorium
1. Activities and Training Program, Department of
Ophthalmology and Otolaryngology — Lawson VA
Hospital in conjunction with Emory University
School of Medicine, T. W. O. Meissner, A. Paul
Keller, Augustus Gafford, John Howard, F. Phinizy
Calhoun, Jr., Nathan I. Gershon, and Lester A.
Brown, Atlanta.
2. The Colcher-Sussman Technic of X-Ray Pelvimetry
and Cephalometry — Eugene L. Griffin, and J. Lon
King, Atlanta.
3. Teamwork in Cancer Diagnosis — Georgia Division,
American Cancer Society.
4. The Treatment of Flat Feet in Children — J. Hiram
Kite, and W. W. Lovell, Atlanta.
5. Angiograph in Cerebral Vascular Lesions — Edgar
F. Fincher, Homer S. Swanson, and William C.
Warren, Department of Surgery, Neurosurgical Sec-
tion, Emory University School of Medicine, Atlanta.
6. Paget’s Disease — Peter B. Wright, and Lane H.
Allen, Department of Orthopedic Surgery and De-
partment of Anatomy, Medical College of Georgia,
Augusta.
7. Perineal Prostatectomy with Primary Closure of
the Prostatic Capsule — James H. Semans, Atlanta.
8. Oxycephaly — Morgan B. Raiford, Emory LIniversity
Eye Bank, from the Clay Memorial Eye Clinic and
the Grady Memorial Hospital, Atlanta.
9. Gallbladder Roentgenology — Ted F. Leigh, and
Edgar A. Thompson, Department of Roentgenology,
Emory University School of Medicine, Atlanta.
10. Mental Hygiene — A Preventive Program— Georgia
Department of Public Health; Divisions of Maternal
and Child Health and Mental Hygiene, Atlanta.
11. Illustrative Literature and Official Academy Reports
— American Academy of General Practice, Georgia
Division, J. B. Kay, Byron.
12. Therapeutic Interviews with Psychogenic Patients —
Carl Whitaker, Department of Psychosomatic Medi-
cine, Emory University School of Medicine, Atlanta.
13. Occupational Disease in Differential Diagnosis —
Georgia Department of Public Health, Division of
Industrial Hygiene, in cooperation with the United
States Public Health Service, Atlanta.
14. Cineradiography — H. S. Weens, J. V. Warren, and
J. L. Cannon, Department of Radiology and Depart-
ment of Physiology, Emory University School of
Medicine, Atlanta.
15. X-Ray Investigation of Renal Tumors — H. M.
Olnick, J. V. Rogers, Jr., and H. S. Weens, Depart-
ment of Radiology, Emory University School of
Medicine, Atlanta.
16. Replacement Transfusion — Joseph Patterson, Craw-
ford W. Long Memorial Hospital, Atlanta.
17. Carcinoma of the Thyroid — David Henry Poer,
Atlanta.
18. New Hospitals in Georgia Ruilt Under the Hospital
Construction Program — Georgia Department of Pub-
lic Health, Division of Hospital Services and Re-
gional Office, United States Public Health Service,
Atlanta.
19. Some Conditions Exhibiting Periosteal Reaction in
Children — L. P. Holmes, S. W. Brown, W. F. Ham-
ilton, Jr., D. C. Burns, Jr., and Neal F. Yeomans.
Department of Roentgenology, Medical College of
Georgia, Augusta.
20. Endocrine Laboratory Procedures — R. B. Greenblatt,
Sarah Clark, and Nelson Brown, Department of
Endocrinology, Medical College of Georgia, Au-
gusta.
21. Physical Medicine in Child Rehabilitation — (This
exhibit will show children getting actual treatment
by physical therapists every hour on the hour and
equipment will be demonstrated), Harriet E. Gil-
lette, and Fred Hodgson, Cerebral Palsy Society of
Georgia, Crippled Children's Department of Public
Welfare, and Aidmore, Atlanta.
22. Your Blood Is Life — National Blood Program,
American Red Cross.
23. If hat the General Practitioner Should Know About
Tuberculosis — LInited States Public Health Service,
Communicable Disease Center, Atlanta.
24. The Educational Aspects of Nutrition Service in
Outpatient Medicine — Estelle P. Boynton and Elea-
nor Thompson, Veterans Administration Regional
Office, Atlanta.
25. Mycosis Fungoides and Other Skin Lesions — J. M.
Bazemore, and E. C. Hopkins, Department of Der-
matology, Medical College of Georgia, Augusta.
26. Curable Forms of Heart Disease — Georgia Heart
Association, Inc.
TECHNICAL EXHIBITS
City Auditorium
2. Lullaby Diaper Service
Mr. Earl Alcorn
582 Piedmont Avenue, N. E., Atlanta, Ga.
5. The Nestle Company, Inc.
155 East 44th Street, New York 17, N. Y.
6. Sharp & Dohme, Inc.
Philadelphia 1, Pa.
7. The Doho Chemical Corporation
100 Varick Street, New York 13, N. Y.
8. Brayten Pharmaceutical Company
3802 St. Elmo Avenue, Chattanooga 9. Tenn.
Mr. Ben Perryman, P. O. Box 242, Atlanta, Ga.
9. Parke, Davis & Company
Detroit 32, Mich.
Mr. C. O. Church, 232 Courtland St., N. E.,
Atlanta, Ga.
11. J. A. Majors Company
1301 Tulane Avenue, New Orleans 12, La.
14. Southern Spring Bed Company
290 Hunter Street, S. E., Atlanta, Ga.
15. The Wm. S. Merrell Company
Lockland Station, Cincinnati 15, O.
16. General X-Ray Corporation
1383 Spring Street, N. W., Atlanta, Ga.
17. U. S. Vitamin Corporation
250 East 43rd Street, New York 17, N. Y.
18. A. H. Robbins Company, Inc.
1322-24 West Broad Street, Richmond 20, Va.
19. Eli Lilly and Company
Indianapolis 6, Ind.
20. Estes Surgical Supply Company
56 Auburn Avenue, N. E., Atlanta, Ga.
21. C. B. Fleet Company, Inc.
921-27 Commerce Street, Lynchburg, Va.
22. American Surgical Supply Company
489 Peachtree Street, N. E., Atlanta, Ga.
23. Philip Morris & Company, Ltd., Inc.
100 Park Avenue, New York 17, N. Y.
128
The Journal of the Medical Association of Georgia
24. Surgical Selling Company
139 Forrest Avenue, N. E., Atlanta. Ga.
29. Hoffman-La Roche Inc.
Roche Park, Nutley 10. N. J.
30. Marks & Marks, Inc.
412-16 Sixth Street, Augusta, Ga.
31. The Borden Company
350 Madison Avenue, New York 17, N. Y.
33. Spencer Incorporated
New Haven 7, Conn.
34. The Liebel-Flarsheim Company
Cincinnati 2, 0.
35. VanPelt and Brown, Inc.
Richmond, Va.
36. Mead Johnson & Company
Evansville 21, Ind.
Mr. J. H. Gilmore, 1672 Emory Road, N. E.,
Atlanta, Ga.
37. Picker X-Ray Corporation
300 Fourth Avenue, Newr Tork 10, N. Y.
38. Winthrop-Stearns Inc.
170 Varick Street, New York 13, N. Y.
39. Wm. P. Poythress & Company, Inc.
Richmond, Va.
40. Lederle Laboratories Division
American Cyanamid Company
30 Rockefeller Plaza. New York 20. N. Y.
41. Ciba Pharmaceutical Products, Inc.
556 Morris Avenue, Summit, N. J.
42. E. R. Squibb & Sons
745 Fifth Avenue, New York 22, N. Y.
43. Carnation Company
5045 Wilshire Boulevard, Los Angeles 36, Calif.
SCIENTIFIC PRESENTATIONS
Scientific presentations have been omitted from this
number of The Journal in order to present to its readers
certain facts regarding the early history of the Medical
Association of Georgia. Present and future medical
historians must therefore refer to the contents of the
journals of 1950, as a whole, to ascertain the quality
of the scientific medical work of Georgia physicians of
this period. — Ed.
CONSTITUTION AND BY-LAWS OF
THE MEDICAL ASSOCIATION
OF GEORGIA, 1950
Constitution
ARTICLE I.— NAME OF THE ASSOCIATION
The name and title of this organization shall be
The Medical Association of Georgia.
ARTICLE II.— PURPOSES OF THE ASSOCIATION
The purposes of this Association shall be to federate
and bring into one component organization the entire
medical profession of the State of Georgia; to extend
medical knowledge and advance medical science; to
elevate the standard of medical education and to secure
the enactment and enforcement of just medical laws;
to promote friendly intercourse among physicians; to
guard and foster the material interests of its members
and to protect them against imposition; and to enlighten
and direct public opinion in regard to the great problems
of state and medicine, so that the profession shall
become more capable and honorable within itself, and
more useful to the public, in the prevention and cure of
disease, and in prolonging and adding comfort to life.
ARTICLE III.— COMPONENT SOCIETIES
Component societies shall consist of those county
societies which hold charters from this Association.
ARTICLE IV.— COMPOSITION OF THE
ASSOCIATION
Section 1. This Association shall consist of members
and delegates.
Sec. 2. Members: The members of this Association
shall be the members of the component county medical
societies to which only white physicians shall be eligible.
Sec. 3. Delegates: Delegates shall be those members
who are elected in accordance with this Constitution
and By-Laws to represent their respective component
societies in the House of Delegates of this Association.
ARTICLE V.— HOUSE OF DELEGATES
The House of Delegates shall be the legislative body
of the Association, and shall consist of: <1) delegates
elected by the component county societies; (2) the
officers of the Association enumerated in Section 1 of
Article IX of the Constitution: (3) ex-presidents and
delegates to the American Medical Association.
ARTICLE VI.— COUNCIL
The Council shall be the Board of Trustees and
Finance Committee of the Association. The Council
shall have full authority and power of the House of
Delegates to be called into session as provided in the
Constitution and By-Laws.
It shall consist of the Councilors, the President, the
President-Eelect and the Secretary-Treasurer of the
Association. Five of its members shall constitute a
quorum.
ARTICLE VII.— SESSIONS AND MEETINGS
Section 1. The annual session shall take place on
the second Wednesday in May at such place as shall be
designated by the Association, provided that in case of
conflict with the annual session of the American Medical
Association or on petition of the county society of the
host city made at least six months before the fixed dates
for the annual session, the Council may change the dates
by publishing a notice in the Journal of the Medical
Association of Georgia three months before the ses-
sion.
Sec. 2. Special meetings of either the Association or
the House of Delegates may be called by a two-thirds
vote of the Council, or upon the petition of twenty
delegates.
ARTICLE VIII.— SECTIONS AND DISTRICT
SOCIETIES
Section 1. The House of Delegates may provide for
a division of the scientific work of the Association into
appropriate sections, and for the organization of such
Councilor district societies as will promote the best
interests of the profession, such societies to be composed
exclusively of members of component county societies.
ARTCLE IX.— OFFICERS
Section 1. The officers of this Association shall be a
President, President-Elect, two Vice-Presidents, a Sec-
retary-Treasurer, a Parliamentarian, and one Councilor
for each congressional district in the State.
Sec. 2. The officers, except the Secretary-Treasurer,
Parliamentarian and Councilors, shall be elected an-
nually, provided that after the annual meeting of 1928
a President-Elect and not a President shall be elected
annually. The President-Elect shall assume his office
as President immediately after the next annual meeting
March, 1950
129
following his election. The terms of the Councilors shall
be for three years, as may be arranged, viz: the Coun-
cilor for the first, second, third and fourth districts for
three years; those for the fifth, sixth, seventh, and eighth
districts for one year; those for the ninth and tenth
districts for two years. The Secretary-Treasurer shall
be elected for a term of five years, and the Parliamen-
tarian for a term of three years. All these officers shall
serve until their successors are elected and installed
(1933).
Sec. 3. The officers of this Association shall be elected
by ballot. The nomination for office shall be made
orally, on the first day of the annual session immediately
after the response to the address of welcome and just
before the first paper of the scientific program. The
nominating speech shall not exceed two minutes.
The Councilors shall be nominated at the same time
by their respective district societies, but if no nomina-
tion from a district society is brought before the Asso-
ciation, the nomination for Councilor may be presented
from the floor.
A locked ballot box shall be set up by 12:00 noon
of the first day of the annual scientific session, at the
registration booth. Official ballots, with a blank space
for writing in tbe name of the candidate for each office,
shall be printed and kept in the custody of the Secretary
Treasurer, who shall check the eligibility of each voter
before handing him an unnumbered ballot. Votes shall
be deposited in the locked ballot box.
Voting shall take place during the hours the scien-
tific program is in session, from 12:00 noon on the first
day of the annual session until 10:30 a.m. of the third
day of the annual session. A committee, appointed by
the President, shall count the votes in the ballot box at
10:30 a.m. of the last day of the annual session and
report their findings to the Association. The candidate
receiving the highest number of votes shall be declared
elected.
Delegates to the American Medical Association shall
be elected at the same time and in the same manner.
ARTICLE X.— FUNDS AND EXPENSES
Funds shall be raised by an equal per capita assess
ment on each component society. The amount of the
assessment shall not exceed the sum of $10.00 per capita
per annum. Funds may be appropriated by the House
of Delegates to defray the expenses of the Association,
for publications, and for such other purposes as will
promote the welfare of the profession. All resolutions
appropriating funds must be approved by the Finance
Committee before action is taken thereon.
ARTICLE XI.— RATIFICATION
The House of Delegates shall submit all questions
before it to the Association for ratification.
ARTICLE XII.— THE SEAL
The Association shall have a common seal, with power
to break, change or renew the same at pleasure.
ARTICLE XIII.— AMENDMENTS
Any amendment that may be offered to the Constitu-
tion shall lie over until the next annual session; and for
its adoption at such session shall require a two-thirds
vote of all present and voting.
By-Laws
CHAPTER I.— MEMBERSHIP
Section 1. The name of a physician on the properly
certified roster of members of a component society,
which has paid its annual assessment, shall be prima
facie evidence of membership in this Association.
Sec. 2. Any person who is under sentence of suspen-
sion or expulsion from a component society or whose
name has been dropped from its roll of members, shall
not be entitled to any of the rights or benefits of this
Association, nor shall he be permitted to take part in
any of its proceedings until he has been relieved of
such disability.
Sec. 3. Each member in attendance at the annual
session shall enter his name on the registration book,
indicating the component society of which he is a mem-
ber. When his right to membership has been verified
by reference to the roster of his society, he shall receive
a badge which shall be evidence of his right to all the
privileges of membership at that session. No member
shall take part in any of the proceedings of an annual
session until he has complied with the provisions of this
section.
Sec. 4. Special membership. In addition to Regular
members, component societies may elect to membership
in their organizations, for membership in this Associa
tion, the following groups of members:
(a) Honorary members. Any member for old age,
length of service, or other good reasons, may be elected
an honorary member of his county medical society, for
membership in this Association. Such member shall,
after election, be issued a certificate of honorary mem-
bership in this Association.
Non-resident physicians and resident or non-resident
lay persons who have distinguished themselves in fields
of endeavor devoted to the advancement of human wel-
fare, may be nominated by county medical societies, or
by the House of Delegates of this Association, for hon-
orary membership in this Association. A county medical
society shall not nominate for this class of membership
more than one person each year. The name of such
person shall be sent to the Secretary-Treasurer of this
Association thirty days in advance of the annual session.
Such person shall be issued an appropriate certificate of
honorary membership in this Association if, and when,
he is elected to honorary membership by this Associa-
tion.
(b) Associate members. Eligible to this classification
are (1) those regular members of component societies
to whom the ppayment of dues would be an undue hard-
ship; (2) interns, and (3) commissioned medical officers
(see Chapter VII, Sec. 5 of these By-Laws) of the
United States Army, the United States Navy and the
United States Public Health Service while engaged
actively in their respective services or if they have been
retired on account of age or physical disability, or
after long and honorable service, under the provisions
of an Act of Congress.
(c) Honorary and Associate members shall not be
subject to the payment of dues to the State Association.
They shall enjoy the privileges of full participation in
the scientific, social and educational activities of this
130
Thk Journal of the Medical Association of Georgia
Association. They shall not vote nor hold office and do
not receive the Journal or benefits of Medical Defense.
Sec. 5. Any physician applying for membership in a
component medical society of this Association, who ha-
previously practiced in a county in which affiliation
with a component society is provided, and who moves
to another county without having affiliated with the
medical society in the jurisdiction of previous residence,
before he is admitted to membership, the cause of his
lack of affiliation in the society of his previous residence
shall he ascertained.
CHAPTER II.— GENERAL MEETINGS
Section 1. All registered members may attend and
participate in the proceedings and discussions of the
general meetings. Visitors duly accredited to represent
the associations of other states, or of the District of
Columbia, not exceeding two in number for each organi-
zation, may attend upon, and participate in. the discus-
sion of the general meeting, but shall not have a vote.
Such delegates may read papers upon invitation of the
Committee on Scientific Work. The general meetings
shall be presided over by the President or by one of the
Vice-Presidents.
Sec. 2. No papers or addresses before the Association,
except those of the President and invited essayists, shall
occupy more than fifteen minutes in their delivery; and
no member shall speak longer than five minutes, nor
more than once on any subject, provided that each
essayist shall have five minutes in which to close the
discussion of his paper.
Sec. 3. Entertainment. Any social entertainment which
may be given by this Association shall be confined to
the evening of the second day.
Sec. 4. Guests. Any physician not a resident of this
State but a member of his state association, or any
distinguished scientist not a physician, may be counted
a guest during any annual session on invitation of the
President, and shall be accorded the privilege of par-
ticipating in the scientific work of that session.
CHAPTER III.— HOUSE OF DELEGATES
Section 1. The House of Delegates shall meet on the
day preceding the first day of the annual session, the
time to be fixed by the Committee on Scientific Work.
It may adjourn from time to time as may be necessary
to complete its business; provided that its hours shall
conflict as little as possible with the general meetings.
The order of business shall be arranged as a separate
section of the program.
Sec. 2. Each component county society shall be en-
titled to send to the House of Delegates each year one
delegate for every fifty members, and one for each
fraction thereof, but each component society which has
made its annual report and paid its assessment as pro-
vided in this Constitution and By-Laws shall be entitled
to one delegate. Slrould the regular delegates from any
county not be present at the meeting, the President shall
appoint a substitute from that county to act.
Sec. 3. Twenty delegates present shall constitute a
quorum.
Sec. 4. It shall, through its officers, council and
otherwise, give diligent attention to and foster the
scientific work and spirit of the Association, and shall
constantly study and strive to make each annual session
a stepping-stone to future ones of higher interest.
Sec. 5. It shall consider and advise as to the material
interest of the profession, and of the public in those
important matters wherein it is dependent on the pro-
fession, and shall use its influence to secure and enforce
all proper medical and public health legislation, and
to diffuse popular information in relation thereto.
Sec. 6. It shall make careful inquiry into the con-
dition of the profession of each county in the State,
and shall have authority to adopt such methods as may
be deemed most efficient for building up and increasing
the interest of such county societies as already exist,
and for organizing the profession in counties where
societies do not exist. It shall especially and system-
atically endeavor to promote friendly intercourse among
physicians of the same locality, and shall continue these
efforts until, if possible, every physician in every county
of the State has been brought under medical society
influence.
Sec. 7. It shall encourage post-graduate and research
work as w'ell as home study, and shall endeavor to have
the results utilized, and intelligently discussed in the
county societies.
Sec. 8. It shall divide the State into councilor dis-
tricts, one for each congressional district, and when the
best interests of the Association and profession will be
promoted thereby, organize in each a district medical
society, and all members of component county societies
and no others shall be members in such district societies.
Sec. 9. It shall have authority to appoint committees
for special purposes from among members of the Asso-
ciation who are not members of the House of Delegates.
Such committees shall report to the House of Delegates
and may be present and participate in the debate
thereon.
CHAPTER IV.— DUTIES OF OFFICERS
Section 1. The President shall preside at all meetings
of the Association and of the House of Delegates; shall
appoint all committees not otherwise provided for, and
shall perform such other duties as custom and parlia-
mentary usage may require. He shall be the real head
of the profession of the State during his term of office,
and as far as practicable, shall visit, by appointment,
the various sections of the State and assist the Coun-
cilors in building up the county societies, and in mak-
ing their work more practical and useful.
In order to give him a better opportunity of becoming
more fully acquainted with his duties and with the
needs of the Association, the President shall be elected
one year prior to taking office. During this time he
shall be known as President-Elect and shall be ex-
officio member of standing committees, and shall make
recommendations at the next annual session.
Sec. 2. The Vice-Presidents shall assist the President
in the discharge of his duties. In the event of the
President’s death, resignation or removal, the Vice-
Presidents, in their order, shall succeed him.
Sec. 3. The Secretary-Treasurer shall give bond in
the sum of One Thousand Dollars. He shall demand
March, 1950
131
and receive all funds due the Association, together with
the bequests and donations.
Sec. 4. The Secretary-Treasurer shall attend the gen-
eral meetings of the Association and the meetings of
the House of Delegates, and shall keep the minutes of
their respective proceedings in separate record books.
He shall be ex-officio Secretary of the Council. He shall
be custodian of all record-books and papers belonging
to the Association. He shall provide for the registration
of the members, delegates and accredited visitors at
the annual session. He shall, with the cooperation of
the secretaries of the component societies, keep a card-
index register of all the legal practitioners of the State
by counties, noting on each his status in relation to his
county society, and on request transmit a copy of this
list to the American Medical Association. He shall aid
the Councilors in the organization and improvement of
the county societies in the extension of the power and
usefulness of this Association. He shall conduct the
official correspondence, notifying members of meetings,
officers of their election, and committees of their appoint-
ments and duties. He shall employ such assistants as
may be ordered by the House of Delegates with the
approval of the Association, anil shall make an annual
report to the Association. He shall supply each com-
ponent society with the necessary blanks for making
their annual reports; shall keep an account with the
component societies, charging against each society its
assessment and collect the same. Acting with the Com-
mittee on Scientific Work, he shall prepare and issue
all programs. The amount of his salary shall be fixed
by the Association. He shall be editor of the Journal
of the Medical Association of Georcia. He shall
employ such assistants as may be ordered by the Council
or the House of Delegates. He shall annually make a
report of his doings to the House of Delegates.
He shall furnish a balance sheet at each annual
meeting for the past fiscal year to be published in the
Journal. This shall consist of an itemized statement
of all financial transactions of the past year, all accounts
made, money received and from whom, all moneys
disbursed, to whom, and for what purpose, with vouchers
attached. A fiscal year includes the period of time
between the first day of May and the last day of April.
CHAPTER V.— COUNCIL
Section 1. The Council shall meet on the day pre-
ceding the annual session and daily during the session,
and at such other times as necessity may require, subject
to the approval of the President. It shall meet on the
last day of the annual session of the Association to
organize and outline work for the ensuing year. It shall
elect a chairman and clerk, who, in the absence of the
Secretary of the Association, shall keep a record of its
proceedings. It shall, through its chairman, make an
annual report to the House of Delegates. It shall be
the business body of the Association and attend to
the business of the Association in the interim between
meetings.
Sec. 2. Each Councilor shall be organizer and peace-
maker for his district. He shall visit each county in his
district at least once a year for the purpose of organizing
component societies where none exist, for inquiring into
the conditions of the profession, anil for improving anil
increasing the zeal of the county societies and their
members. He shall make an annual report of his work
and of the condition of the profession of each county in
his district at the annual session of the House of Dele-
gates. The necessary traveling expenses incurred by
such Councilor in the line of the duties herein imposed
may be allowed by the House of Delegates on a properly
itemized statement, but this shall not be considered to
include his expense in attending the annual session of
the Association. Each Councilor may appoint a Vice-
Councilor to assist him in the performance of his duties
in his district.
Sec. 3. The Council shall be the board of censors of
the Association. It shall consider all questions involving
the right and standing of members, whether in relation
to the members, to the component societies, or to this
Association. All questions of an ethical nature brought
before the House of Delegates or the general meeting
shall be referred to the Council without discussion. It
shall hear and decide all questions of discipline affect-
ing the conduct of members of a component society, on
which an appeal is taken from the decision of an indi-
vidual Councilor, or to which attention has been called
by the Councilor or interested members. It shall hear
and decide all questions affecting unethical conduct on
the part of any member of any annual session, and its
decision in all such matters shall be final when ratified
by the Association.
Sec. 4. In sparsely settled sections it shall have
authority to organize the physicians of two or more
counties into societies, to be suitably designated so as
to distinguish them from district societies, and the
societies, when organized and chartered, shall be
entitled to all rights and privileges provided for com-
ponent societies until such counties shall be organized
separately.
Sec. 5. The Council shall provide for and superintend
the publication and distribution of all proceedings,
transactions and memoirs of the Association, and shall
have authority to appoint such assistants to the editor as
it deems necessary. It shall manage and conduct the
Journal of the Medical Association of Georgia,
which is the organ of the Association, and all money
paid into the treasury as dues shall be received as
subscriptions to the Journal.
All money received by the Council and its agents,
resulting from the discharge of the duties assigned to
them, must be paid to the Secretary-Treasurer of the
Association. As the Finance Committee it shall annually
audit the accounts of the Secretary-Treasurer and other
agents of this Association, and present a statement of
the same in its annual report to the House of Delegates,
which report shall also specify the character and cost
of all the publications of the Association during the
year, and the amount of all other property belonging to
the Association under its control, with such suggestions
as it may deem necessary. In the event of a vacancy in
the office of the Secretary-Treasurer, the Council shall
fill the vacancy until the next annual election.
Sec. 6. All reports on scientific subjects and all
scientific discussions and papers heard before the Asso-
132
The Journal of the Medical Association of Georgia
ciation, shall be referred to the Journal of the
Medical Association of Georgia for publication. The
editor, with the consent of the Councilor for the dis-
trict in which he resides, may curtail or abstract papers
or discussions, and the Council may return any paper
to its author which it may consider not suitable for
publication.
Sec. 7. All commercial exhibits during the annual
sessions shall be within the control and direction of
the Council.
Sec. 8. In the absence of a Councilor and Vice-Coun-
cilor the President is empowered to appoint a repre-
sentative from the district as acting Councilor, who
shall have full rights and powers of a Councilor.
Sec. 9. Each Councilor shall render at every session
a written report of each county in his district.
Sec. 10. Any member of the Council who fails to
attend two regular successive sessions of the Council,
or whose district does not show evidence of the per-
formance of his duties during the year, unless he
renders an acceptable excuse to the Council, is subject
to have his position declared vacant by the President
and a successor appointed by the President.
CHAPTER VI.— COMMITTEES
Section 1. The standing committees shall be as
follows:
A Committee on Scientific Work.
A Committee on Public Policy and Legislation.
A Committee on Arrangements.
A Committee on Medical Defense, and such other
committees as may be necessary.
Sec. 2. The Committee on Scientific Work shall con-
sist of four members, one of whom shall be the Secre-
tary-Treasurer. The other three members shall be
appointed for terms of one, two, and three years, respec-
tively. The vacancy which will occur each year by the
expiration of the term of one member shall be filled by
the President with an appointment of three years. The
member who lias the shortest time to serve shall be
chairman. The committee shall determine the character
and scope of the scientific proceedings of the Associa-
tion for each session. Thirty days previous to each
annual session it shall prepare and issue a program
announcing the order in which papers, discussions and
other business shall be presented.
This By-Law shall not prohibit the Committee on
Scientific Work from inviting not more than two dis-
tinguished members of the national organization to
deliver addresses or read papers at any annual meeting.
Sec. 3. The Committee on Public Policy and Legis-
lation shall consist of three members and the President
and Secretary, the Commissioner of Health of the State
of Georgia, and a sub-committee of three members from
each Councilor District appointed by the chairman when
needed. It shall represent the Association in securing
and enforcing legislation in the interests of public
health and of scientific medicine. It shall keep in touch
with professional and public opinion, shall endeavor to
shape legislation so as to secure the best results for the
whole people, and shall strive to organize professional
influence so as to promote the general good of the
community in local and national affairs and elections.
Sec. 4. The Committee on Arrangements shall be
appointed by the component society in which the annual
session is to be held. It shall provide suitable accom-
modations for the meeting places of the Association and
of the House of Delegates and their respective commit-
tees, and shall have general charge of all arrangements.
Its chairman shall report an outline of the arrangements
to the Secretary-Treasurer for publication in the pro-
gram, and shall make additional announcements during
the session as occasion may require.
Sec. 5. The Committee on Medical Defense shall
consist of five members, of whom the Chairman of the
Council and the Secretary-Treasurer of the Association
shall be members. The other members, one of whom
shall act as chairman of the committee, shall be elected
by the Council for a period of five years. Those elected
at this meeting (April 19, 1916), shall serve one, three
and five years, respectively.
It shall be the duty of the Committee on Medical
Defense to investigate and defend all damage suits
against the Medical Association of Georgia; to investi-
gate all claims of civil malpractice made against its
members, to take full charge of such cases, which
after investigation they decide to be proper cases for
defense; to defend all such cases in the courts of last
resort, to furnish General Counsel and pay court cost
usual to such litigation, and reasonable fees for local
attorneys as shall be arranged by General Counsel.
Provided that any member who has indemnity insurance
shall have such insurance bear its portion of the expense.
However, they shall not pay, or obligate the Medical
Association of Georgia to pay any judgment rendered
against any member upon the final determination of
any case. They shall be empowered to contract with
such agents or attorneys as they may deem necessary
for the proper carrying out of this By-Law.
The assistance for defense, as herein provided, shall
be available only to members of the Medical Association
of Georgia in good standing. Any member who has not
paid his annual dues by April 1st shall not be con-
sidered in good standing in the application of this
By-Law.
Any member or members of the Association threatened
with suit for civil malpractice shall immediately com-
municate with the Secretary of the Association and
shall give full and complete information in reference to
all the circumstances alleged in the complaint. The
Secretary shall proceed immediately to investigate the
circumstances reported and shall advise with the attor-
neys or agents employed by the committee for this
purpose. The member sued, or threatened with suit,
shall be consulted and shall have the complete con-
fidence of the committee in all transactions connected
with the investigation in question. The committee shall
have the authority to require of a constituent society or
the president thereof, the appointment of a committee
of investigation in any such case, and it may direct the
committee so appointed to report to the Committee on
Medical Defense and not to the society from which it
was appointed.
The Committee on Medical Defense may also, at its
discretion, arrange to prosecute illegal practitioners in
March, 1950
1 33
Ihe State of Georgia and assist in the enforcement of
the Medical Practice Act of this State.
CHAPTER VII.— COUNTY SOCIETIES
Section 1. All county societies now in affiliation with
this Association, or those which may hereafter be
organized in the State, which have adopted principles
of organization not in conflict with this Constitution
and By-Laws, shall, on application, receive a charter
from and become a component part of this Association.
Sec. 2. As rapidly as can be done after the adoption
of this Constitution and By-Laws, a medical society
shall be organized in every county in the State in
which no component society exists, and charter shall
be issued thereto.
Sec. 3. Charters shall be issued only on approval of
the Council, and shall be signed by the President and
Secretary of this Association. The Association shall
have authority to revoke the charter of any component
society whose actions are in conflict with the letter or
spirit of this Constitution and By-Laws.
Sec. 4. Only one component medical society shall
be chartered in any county.
Sec. 5. Each county society shall judge of the quali-
fications of its own members, but as such societies are
the only portals of this Association, every legally reg-
istered white physician who does not practice or claim
to practice, nor lend his support to any exclusive
system of medicine, shall be eligible to membership.
Physicians who have been legally registered in other
states or who have been licensed by the National Board
of Medical Examiners, or who are employed as teachers
in the medical schools, or are in the service of the
State, a county, a municipality, or the United States
Government other than the regular medical corps of the
United States Army, the United States Navy and of the
United States Public Health Service, may be accepted
for membership in county medical societies, for mem-
bership in this Association, provided they meet the
requirements of regular membership. Before a charter
is issued to any county medical society, full and ample
notice and opportunity shall be given to every such
physician in the county to become a member.
Sec. 6. No matter what the unethical conduct or
discipline of the members of the county society may be,
both plaintiff and defendant shall have the right to
appeal to the Council, whose decision shall be final
when ratified by the Association.
Sec. 7. In hearing appeals the Council may admit
oral or written evidence, as in its judgment will best
and most fairly present the facts, but in case of every
appeal, both as a board and as individual Councilors
in district and county work, efforts at conciliation and
compromise shall precede all such hearings.
Sec. 8. When a member in good standing in a com-
ponent county society moves to another county in this
State, he shall be given a written certificate of these
facts by the secretary of his society, without cost, for
transmission to the secretary of the society in the county
to which he moves. Pending his acceptance or rejection
by the society in the county to which he moves, such
member shall be considered to be in good standing in
the county society from which he was certified and in
the Medical Association of Georgia to the end of the
period for which his dues have been paid.
Sec. 9. A physician living on or near a county line
may hold his membership in that county most con-
venient for him to attend, on permission of the com-
ponent society in which jurisdiction he resides.
10. Each component society shall have general direc-
tion of the affairs of the profession in its county, and
its influence shall be constantly exerted for bettering
the scientific, moral and material conditions of every
physician in the county; and systematic efforts shall be
made by each member and by the society as a whole,
to increase the membership until it embraces every
qualified physician in the county.
Sec. 11. At some meeting in advance of the annual
session of this Association each county society shall
elect a delegate or delegates to represent it in the
House of Delegates of this Association, in the propor-
tion of one delegate to each fifty members, or fraction
thereof, and the Secretary of the society shall send a
list of such delegates to the Secretary of this Association
at least ten days before the annual session.
Sec. 12. The Secretary of each component society
shall keep a roster of its members, and of the non-
affiliated registered physicians of the county, in which
shall be shown the full name, address, college and date
of graduation, date of license to practice in this State,
and such other information as may be deemed necessary.
In keeping such roster the Secretary shall note any
changes in the personnel of the profession by death, or
by removal to or from the county, and in making his
annual report he shall be certain to account for every
physician who has lived in the county during the year.
Sec. 13. The Secretary of each component society
shall forward its assessment, together with its roster
of officers and members, list of delegates, and list of
non-affiliated physicians of the county, to the Secretary
of this Association each year thirty days before the
annual session.
Sec. 14. Any county society which fails to pay its
assessment, or make the report required on or before
April 1 of each year, shall be held as suspended, and
none of its members or delegates shall be permitted to
participate in any of the business or proceedings of the
Association, or of the House of Delegates, until such
requirement has been met.
Sec. 15. The Secretary of each county society shall
report to the Journal of the Medical Association
of Georgia full minutes of each meeting and forward
to it all scientific papers and discussions which the
society shall consider worthy of publication.
CHAPTER VIII.— RULES AND ETHICS
Section 1. The deliberations of this Association shall
be governed by parliamentary usage as contained in
Robert’s Rules of Order, when not in conflict with this
Constitution and By-Laws.
Sec. 2. All papers read before the Association shall
become its property. Each paper shall be deposited
with the Secretary when read, and if this is not done
it shall not be published.
Sec. 3. The principles of medical ethics of the Ameri-
can Medical Association shall be those of this Associa-
134
The Journal of the Medical Association of Georcia
tion.
Sec. 4. Any member of ibis Association, on locating
in a new place for practicing his profession, may place
his professional card, containing name, address, tele-
phone number, and statement as to whether or not his
practice will be limited to any particular class of
diseases, in the local paper for a period of not longer
than one month. The placing of such card for this
period of time shall not be considered unethical. The
use of the word “specialist” by any member in con-
nection with his name in any newspaper, telephone
directory, or other public places, shall be considered
unethical.
CHAPTER IX. — AMENDMENTS
These By-Laws may be amended at any annual session
by a majority vote of the Association after the amend-
ment has lain on the table for one day.
GEORGIA PHYSICIANS WHO HAVE PRACTICED
MEDICINE FIFTY YEARS OR MORE
Arnold. John Thomas, Parrott
Belcher. Francis S., Monticello
Bell. Peyton E., Sylvester
Boland, Frank Kells, Atlanta
Born. Wade Hampton, McRae
Brock, Walker Bell, Tallapoosa
Byne, James Miller, Sr., Waynesboro
Campbell, William H., Columbus
Carter, Curtis Braxton, Columbus
Chapman, William Allen, Cedartown
Chisholm, Julian Ford, Savannah
Clements, Henry W., Adel
Collier, Thomas Jefferson, Atlanta
Crawford. James Harden, Atlanta
Crow, Leonidas Hamilton, Athens
Crozier, Richard T., Fort Gaines
Dove, William B„ Macon
Ellis, John W., Kennesaw
Frederick. Donald Barton, Marshallville
Garner, James Ryan, Atlanta
Green. Thomas E., Chatsworth
Greenleaf, James S., Savannah
Harrell, David Braxton, Tifton
Hines, Joseph Howard, Atlanta
Horton, Barney Elliott, Atlanta
Hudson, Benjamin B., Columbus
Humphries, William Clayton. Acworth
Hunt, G. M. D., Cordele
Jefford. Thomas C., Sylvester
Jelks, Edwin Lankin. Quitman
Johnson, Joseph E. L., Roberta
Keiser, John M., Athens
Knight, Wyatt Edward, Mansfield
Lanier, John Edward, Moultrie
Lokey, Hugh Montgomery. Atlanta
McElroy, Stephen L., Ocilla
Miller, John N.. R. F. D., Mitchell
Patrick, Jekyl Zylba, Pulaski
Pharr, Lucius P., Auburn
Quillian, Willard Earl, Atlanta
Roberts, C. A., Leary
Roundtree, Walter, Summit
Smith, Claude A., Stockbridge
Swift, Addison K., Woodbine
Train, John Kirk, Savannah
Wade, Arthur C., Augusta
Ward, John W., Baconton
Warnell, John Braxton, Cairo
Watkins, Edward Willis, Ellijay
Weeks, John Luther, Harlem
West, S. A., Dahlonega
White, Henry Fleetwood, Crawfordville
NEWS ITEMS
The Alto Medical Center announces that Dr. W. G.
Simpson has succeeded Dr. Eldis M. Christensen as
director of the State Venereal Disease Rapid Treatment
Center, Alto. Dr. Christensen who has served as director
at Alto since September, 1948 has accepted a residency
in surgery at Hines General Hospital in Chicago. Dur-
ing bis term of office, Alto Medical Center gained
national recognition as one of the nation’s leading rapid
treatment centers and was designated as a national
training center for Venereal Disease Investigators and
nurses. Dr. Simpson of Atlanta, graduated from Emory
University Medical School in 1944 and joined the staff
at Alto in April, 1949. “Under the leadership of Drs.
Christensen and Simpson. Alto Rapid Treatment Center
has become a hospital of which Georgia may w'ell be
proud. Thousands of Georgians have returned to their
homes after treatment for syphilis and other venereal
diseases and have been able to lead normal lives without
endangering other people,” Dr. C. D. Bowdoin, Director
of the Division of Veneral Disease Control of the Georgia
Department of Public Health, said.
* * *
The Albany Heart Clinic was held in the Kiwanis
Clinic section of Phoebe Putney Hospital, Albany, Jan-
uary 18. Certifications went out to indigent heart disease
patients who were examined at the first Albany Heart
Clinic. Dr. J. A. Redfearn. Albany heart specialist, said
all physicians of the medical staff of Phoebe Putney
Hospital attended the opening session. With the work
of the National Heart Association and the Georgia Heart
Association spreading, many citizens, unable to pay for
treatment when suffering from heart ailments, were
served. Dr. David M. Wolfe, Albany, county health
commissioner and his personnel, State Public Welfare
Department personnel, Phoebe Putney Hospital, the
Kiwanis Clinic participated in assisting the clinic.
* * *
Dr. J. D. Applewhite, Macon physician, recently re-
signed his position as Jones County Health officer. Dr.
Applewhite has served as Jones County Health officer for
the past 12 years. He said that the pressure of private
practice and other duties necessitated the change. The
resignation was announced by W. E. Knox, secretary of
the board who said: “Dr. Applewhite has done an
outstanding work in public health during bis years as
county health officer, and his resignation is a serious
blow to the excellent health program in the county.”
* * *
The Appling County Medical Society held its monthly
dinner meeting at the Mimosa in Baxley February 14.
Dr. Corbett Thigpen, Augusta psychiatrist, University
Hospital, and a member of the Speakers Bureau gave an
interesting lecture on "Depression.” Doctors from the
neighboring counties also were present. At the next
meeting in March Dr. Thorek’s moving picture on “Sur-
gery of the Gallbladder” will be shown and a paper
on jaundice will be read. The Appling County Hospital
has been approved and bids are now being received for
the construction of the building. A new Health Center
building is being promoted at this time. Dr. J. B.
Brown, Jr., secretary.
* * *
The Atlanta Chapter, American Red Cross blood pro-
gram has 11 doctors appointed to the medical advisory
committee, according to announcement made by Dr. A.
O. Linch, president of the Fulton County Medical
Society. The committee is Dr. Irving L. Greenberg,
chairman, Drs. T. I. Willingham, R. Hugh Wood, W.
Perrin Nicolson, James P. Hanna, Warren B. Matthews,
Charles M. Huguley, Jr., Darrell Ayer, Milton Freed-
man, John Funke and Caroline K. Pratt.
* * *
The Atlanta Graduate Medical Assembly is rapidly
becoming one of the important meetings of its kind in
March, 1950
135
the country, which means the world, said Dr. L. Minor
Blackford. For the meeting of February 6, 7 and 8,
1950, the Assembly moved to the Annex of the Municipal
Auditorium, Atlanta, the total attendance, including
physicians who paid the $15.00 registration fee, house
officers and medical students, nurses and technicians, a
few doctors’ wives and other guests, amounted to 2,005.
A large factor in this extraordinary increase was Col-
ored Television. The apparatus for this was provided
through the kindness of Smith, Kline and French Labo-
ratories, who were persuaded to make Atlanta the sixth
city in the world to see it. This program was opened
with a splendid speech by Governor Herman Talmadge.
In part he said: “This sixth annual meeting of the
Atlanta Graduate Medical Assembly is a significant
milestone in the whole history of medical and scientific
progress. May I congratulate Dr. Letton and his com-
mittee; the Fulton County Medical Society; Smith,
Kline and French Laboratories, Philadelphia, and the
Columbia Broadcasting System for bringing to Georgia
this unique method of teaching surgery through the
new medium of color television. It is reassuring to me
that you doctors have given this part of your time in
order to be here and bring yourselves abreast of tbe
latest in operating technics. This graduate assembly of
medical men has no connection with any government
agency but is being held here on a cooperative basis
squarely under our system of free enterprise and indi-
vidual initiative. The greatest menace we face in this
country today and to the peace and security of the
world are the twin evils of communism and socialism.
You have my solemn pledge, both personally and offi-
cially, that all of my energies are dedicated toward
helping you preserve the gains you have made and in
going forward to even greater achievement.”
Mayor Hartsfield expressed himself as being in
entire accord with the Governor and welcomed the visi-
tors to Atlanta.
The color television even exceeded the fondest ex-
pectations of the two thousand who saw' it. Too much
credit cannot be given to the authorities of Grady Me-
morial Hospital, to Dr. Ira A. Ferguson, Dr. R. Hugh
Wood, Dr. Philip K. Bondy, and the various surgeons
who operated anonymously, explaining as they went, and
to the physicians who demonstrated various medical con-
ditions and procedures. Perhaps the most spectacular
exposition was the transplant of a cornea: the screen
showed only the eye and a few inches around it;
certainly in no other way could anyone but the surgeon
and his first assistant have witnessed the procedure half
so well as did the five hundred who watched it in
colored television. Illness of one guest speaker required
a substitution a few days before the Assembly; other-
wise the program was carried through as originally an-
nounced.
Social features were held to a minimum as the pri-
mary object of the Assembly is educational. Dr. Edgar
R. Pund, Augusta, professor of pathology of the Medical
College of Georgia, was the only Georgia physician listed
among the nation’s leading specialists in medicine and
surgery who participated on the program of the assem-
bly. Dr. L. Minor Blackford, secretary.
* * *
The Bibb County Medical Society held its dinner
meeting at the S & S Cafeteria, Macon, February 14.
Scientific program: “New Developments in Antibiotic
Therapy” by Dr. Harold Atkinson. Dr. Henry H. Tift,
secretary.
* * *
The Bibb County Tuberculosis Association, Inc., helps
discover new cases of tuberculosis and provide equip-
ment and aid to patients, Dr. R. Frank Cary, Macon,
city-county health officer, said. Tuberculosis is the
“major health problem” in Bibb County. It, he said,
is a disease which must be fought by “every citizen.”
One sure way to help in the battle against it, he con-
tinued, is to support the association, which is financed
through the annual sale of Christmas Seals. Twelve new
cases of tuberculosis were discovered during January
by the health department.
* * *
The Minnie G. Boswell Memorial Hospital medical
staff held its regular monthly meeting at the hospital,
Greensboro, January 4. The following physicians were
present: Drs. H. L. Cheves, Union Point, T. W. Middle-
brooks, Crawfordville. J. Lee Parker, Jr., F. H. Killam,
W. N. Etheridge, Easley and Lawrence, all of Greens-
boro. Dr. D. E. Mullins, Jr., Athens, consulting path-
ologist of the Minnie G. Boswell Memorial Hospital,
was also present. Guests were: Drs. Richard Torpin and
Taylor, University Hospital, Augusta, and Dr. Bird of
Athens. Dr. Torpin discussed “Some Obstetric Emer-
gencies. ’ Officers for last year were reelected to serve
another year: Dr. H. L. Cheves, chief of staff, Dr. F. H.
Killam, assistant chief of staff, and Dr. W. N. Etheridge,
secretary.
* * *
Dr. Louis G. Cacchioli and Dr. J. Hubert Milford,
both of Hartwell, were elected to serve on the staff of
the Cobb Memorial Hospital, Royston, at a meeting of
tbe Board of Trustees held at the hospital, January 12.
* * *
The Chatham-Savannah Health Council held its annual
meeting in the Gold Room of the DeSoto Hotel, Savan-
nah. January 23. Dr. Lucille J. Marsh, Atlanta, regional
medical director for the Children’s Bureau of the U. S.
Department of Labor, was guest speaker, who recom-
mended that the council consider the establishment of a
nursery school for handicapped children which would
prepare them, during pre-school age, for the inevitable
adjustment demanded of them later. At the conclusion
of her address, Dr. Clair A. Henderson, city-county
health officer, informed the audience that a Children’s
Council committee was studying that very problem and
expressed the hope that progress along the lines sug-
gested could be reported. Dr. Albert J. Kelley succeeds
Dr. Ruskin King as president of the Chatham-Savannah
Health Council, Dr. H. H. McGee, was named president-
elect. Other physicians elected to serve on the board
are Drs. Lawrence Lee, H. M. Kandel, Ruskin King,
Anne Hopkins, T. A. Peterson, S. P. Stoddard and
Bland Tucker. A rising vote of thanks was tendered
Dr. King as he relinquished office.
* * *
The Colquitt Medical Society held its meeting at
Moultrie, January 10. Officers for 1950 are Dr. R. E.
Stegall, president, Dr. John F. McCoy, vice-president,
Dr. R. E. Fokes, secretary-treasurer, and Dr. J. E.
Lanier, president emeritus. Board of Censors: Drs.
A. G. Funderburk, R. M. Joiner, and Edgar Holmes.
Following the meeting of the medical society, the Vereen
Memorial Hospital staff elected Dr. J. R. Paulk, presi-
dent for 1950, and Dr. R. E. Stegall was named vice-
president.
* * *
Dr. E. D. Colvin, Atlanta, was recently named presi-
dent-elect of the South Atlantic Association of Obstetri-
cians and Gynecologists at the twelfth annual meeting
of the association held at Roanoke, Va. Dr. Colvin,
former secretary-treasurer, was succeeded in that post
by Dr. John Burwell, of Greensboro, N. C. President
for 1950 is Dr. Lester A. Wilson, of Charleston, S. C.
* * *
Dr. William A. Dodd, Dublin, w7as named county
physician by the Laurens County Board of Commission-
ers of Roads and Revenues for 1950. Dr. Dodd succeeds
Dr. R. G. Ferrell who has served as county physician
for some years. Dr. Dodd, a native of Macon, went to
Dublin approximately a year ago to become associated
with Dr. A. T. Coleman at the Coleman Hospital.
* * *
Dr. M. J. Egan, Savannah physician, was re-elected
president of the Hospital Service Association at the
annual meeting held January 17. Dr. E. C. Demmond
was elected vice-president. Dr. T. P. Waring repre-
senting Oglethorpe Hospital, and Dr. E. C. Demmond,
Telfair Hospital, were named members of the executive
committee.
136
The Journal of the Medical Association of Georgia
Or. John L. Elliott. Savannah, recently addressed the
student nurses of St. Joseph’s and Warren A. Candler’s
schools of nursing. His subject was "The General Prin-
ciples of Treatment of Tuberculosis.” The address was
part of the course in tuberculosis given each year by the
Chatham-Savannah Tuberculosis and Health Association.
» * *
Dr. Marion Estes, Augusta, assistant professor of
psychiatry at the University of Georgia School of
Medicine, discussed "Psychological Aspects of Cerebral
Palsy” at a meeting of the members of the Augusta
Area Chapter of the Cerebral Palsy Society, held at
the Georgia Power Company auditorium. Dr. Estes
outlined the basic needs of every child as: 1. Need for
security, including backing of both parents; 2. Need
for love and understanding; 3. Need for satisfactory
emotional expression.
* * *
Dr. Murdock Equen, Atlanta, recently attended the
meeting of the American Laryngological, Rhinological
and Otological Society held in Memphis, Tenn.
* * *
The Fulton County Medical Society held its semi-
monthly dinner meeting at the Academy of Medicine,
Atlanta, February 2. Scientific program opened with
Dr. William Cleve Ward presiding as moderator. "Pene-
trating Wounds of the Chest”, Dr. Hilton Wall and
Dr. Roy E. Campbell; “Case of Virus Encephalitis”,
Dr. David Ginder and Dr. Alvan Foraker; “deQuervain's
Disease”. Robert P. Kelly. Dr. A. Worth Hobby, secre-
tary.
* * *
Dr. Lester Brown, Atlanta, has been named president-
elect of the medical and surgical staff of Crawford W.
Long Memorial Hospital, Atlanta.
* * *
The Georgia Baptist Hospital medical staff held its
dinner meeting in the cafeteria of the hospital, Atlanta,
February 21. Dr. A. L. Evans, Atlanta, chairman of the
Clinico-Pathological Committee reported two short and
interesting cases for discussion. Dr. J. G. McDaniel,
secretary.
* * *
The Georgia Medical Society held its regular meeting
at 612 Drayton Street, Savannah, February 14. Scien-
tific program: “Dietary Treatment of Hypertension”,
Dr. Harry E. Rollings, and "Retinal Vascular Changes
in Hypertension”, Dr. J. Harry Duncan. Dr. Sam Young-
blood, Jr., secretary.
* * *
The Georgia physicians participating on the program
of the Southeastern Allergy Association at its fifth
annual meeting held in Columbia Hotel, Columbia,
S. C., February 11 and 12, were Dr. Lewis D. Hoppe,
Atlanta, was moderator of the panel on pediatric allergy,
and introduced Dr. Lee Bivings, Atlanta, who read a
paper entitled “Dermatological Allergy”, and Dr. Wil-
liam Kiser, Atlanta, also presented a paper “Psycho-
somatic Aspects of Allergy.”
* ' * *
Dr. Louie H. Griffin, Claxton physician since 1939,
was recently admitted to the courtesy and medical staff
of the Bulloch County Hospital, Statesboro. Dr. Griffin
graduated from the University of Georgia School of
Medicine, Augusta, in 1937, and began the practice of
medicine in Claxton in 1939. After almost five years in
the Medical Corps during World War II, he returned to
Claxton in 1945 to resume his practice of medicine.
* * *
The Habersham County Medical Society held its
monthly meeting at the home of Dr. and Mrs. B. J.
Roberts, Cornelia, February 9. Dr. H. E. Valentine, Jr.,-
Gainesville, spoke on “The Management of the Cardiac
Patients.” Dr. Valentine is on the associate staff at
Downey Hospital, Gainesville. The Woman’s Auxiliary
to the Habersham Medical Society also met with Dr.
and Mrs. Roberts.
* * *
Dr. C. W. Harwell, CoTdele, county health commis-
sioner for Crisp and Worth Counties has resigned to
accept a similar position for the counties of Mitchell
and Grady with headquarters at Camilla. Dr. L. E.
Williams, Cordele, chairman of the Crisp County Com-
missioners said the board of commissioners accepted
the resignation and praised the work Dr. Harwell has
done since he came to Cordele in 1941.
* * *
Dr. Harriet E. Gillette, Atlanta, recently conducted a
diagnostic cerebral palsy clinic at the University of
Georgia School of Medicine, Augusta. The clinic marked
a new and major milestone in the progress being made
toward securing a treatment and training center for the
cerebral palsied children of the Augusta area. Dr.
Gillette, nationally known authority on cerebral palsy,
is a pediatrician and specialist in physical medicine.
* * *
Dr. Frank P. Holder, Jr., Eastman physician, was one
of 14 to be sworn in by Governor Herman Talmadge
as appointees to boards January 16. He will serve as a
member of the Workmen’s Compensation Medical
Board.
* * *
Dr. Leon Holloman, Savannah physician, addressed
the members of the Savannah Society of Medical Tech-
nicians, on the subject of “Cancer of the Breast” and
later a movie on the subject was shown the technicians.
He advised women to undergo a careful examination at
regular intervals and cautioned that a physician should
be immediately consulted if a lump develops in the
breast.
* * *
Dr. M. L. Howard, former Dawsonville physician, an-
nounces the opening of his offices in the Jordan Drug
Store Building, Ellaville, for the practice of medicine. A
native of Dawson County, Dr. Howard graduated from
George Washington University School of Medicine,
Washington, D. C. in 1942. After serving in the Medical
Corps of the U. S. Navy during World War II for three
years, he returned to Dawsonville to establish his practice
of medicine.
* * *
Dr. Harry Hutchins, Buford physician, was recently
released from the U. S. Navy Medical Corps and has
resumed his duties at the Hutchins Memorial Hospital,
Buford.
* * *
The Jenkins County Medical Society held its annual
meeting in January and elected the following officers:
Dr. Austin P. Fortney, Sylvania, president; Dr. Cleve-
land Thompson, Millen, secretary-treasurer; Dr. Grady
Lee, Millen, delegate to the annual session of the
Medical Association of Georgia to be held in Macon,
April 18-21; Dr. W. G. Simmons, Sylvania, alternate
delegate. Dr. A. P. Mulkey, Millen, is the outgoing
president. Dr. Fortney began the practice of medicine
in Sylvania following his release from the U. S. Army
Medical Corps during 1949. He is associated with Dr.
James Freeman in the operation of Huldah Cail Memo-
rial Hospital, Sylvania.
* * *
Dr. J. E. L. Johnson, beloved family doctor of Roberta
and Crawford County for more than 50 years, was re-
cently honored when the people from throughout the
county joined in a celebration in appreciation for the
services of this “grand man of medicine.” Dr. Johnson
moved to Roberta in 1896, and now at the age of 82
still does office practice and makes occasional calls. He
is a Mason and a Woodman of the World member, join-
ing the orders years ago. He has served as mayor of
Roberta for several years. He is an outstanding citizen
and successful physician. Sharing honors with Dr.
Johnson was Mrs. Johnson. On February 19 they
celebrated their sixtieth wedding anniversary and this
celebration was a two-purpose celebration. Congratula-
tions to Dr. and Mrs. Johnson!
* * *
Dr. H. M. Kandel, Savannah physician, president of
the Georgia Medical Society and president of the Sa-
vannah Reserve Officers Association, was recently pre-
sented with the first officers’ identification card issued to
March, 1950
137
personnel taking part in the reserve program. The
identification card is similar to the one issued regular
army personnel. Lt. Col. Kandel recently finished active
duty at Ft. Benning, having been called to service by
the Surgeon General of Third Army Headquarters be-
cause of an extreme shortage of physicians in army
hospitals in this area. Dr. Kandel returned to Savannah
on February 1.
* * *
Dr. Albert J. Kelley, Savannah, a Northwestern Uni-
versity Medical School, Chicago, graduate in 1928, has
been appointed by Northwestern University to serve as
Georgia state chairman in a drive to raise 1500,000 among
alumni for the university’s medical school by 1951. The
funds will be used as endowment for the Archibald
Church Library at the medical school, one of the five
largest medical school libraries in the nation.
* * *
Dr. G. Lombard Kelly, Augusta, dean of the Uni-
versity of Georgia School of Medicine, recently returned
to Augusta following a trip to Kansas City and Chicago,
where he attended meetings of importance.
* * *
The Fulton County Medical Society held its dinner
meeting at the Academy of Medicine, Atlanta, February
16. Scientific meeting called to order by Dr. John W.
Turner, moderator. “Cardiac Arrhythmias: Their Recog-
nition and Treatment”, Dr. Jeff L. Richardson; The
Heart in Anesthesia: The Effects of Different Anesthetic
Agents”, Dr. Hayward S. Phillips; “Rheumatic Dis-
ease”, Dr. L. Minor Blackford. Dr. A. Worth Hobby,
secretary.
* * *
Dr. Edgar H. Greene, Atlanta, president-elect of the
State Board of Medical Examiners, represented the
Georgia board at the 46th Annual Congress on medical
education and licensure held at the Palmer House, Chi-
cago, February 5-7, which was a joint meeting with
the following: the National Board of Medical Education,
Advisory Board for Medical Specialties and the Federa-
tion of State Medical Boards of the Llnited States.
* * *
Dr. Edgar H. Greene, Atlanta, immediate past-presi-
dent of the Medical Association of Georgia, recently
spoke before the Civitan Club of Buckhead. His subject
was "The Threat of Socialized Medicine.” He discussed
the plans proposed by the Medical Association of
Georgia.
* * *
Dr. Spencer A. Kirkland. Dr. Jack C. Norris and Dr.
Edgar D. Shanks, all of Atlanta, represented the Medical
Association of Georgia at the second annual conference
of the National Education Campaign of the American
Medical Association held at the Drake Hotel, Chicago,
February 12.
* * *
The Laurens County Medical Society members were
guests of Dr. Tyrus R. Cobb, Jr., retiring president, at
a dinner meeting at the Dublin Country Club, Dublin,
February 2. Guest speaker was Dr. Thomas L. Ross,
Jr., Macon cardiologist, whose subject was “Coronary
Heart Disease.” Officers elected for 1950 were: Dr. M.
Fernan-Nunez, Dublin. VA Hospital, president; Dr.
Charles A. Hodges, Dublin, vice-president, and Dr.
O. H. Cheek, Dublin, secretary-treasurer. This marks
Dr. Cheek’s twenty-fifth successive year in this office of
the Laurens County Medical Society.
* * *
Dr. J. J. Lott, Broxton physician, loved by the entire
town and community, observed his sixty-seventh birth-
day, January 6, in a quiet and normal manner as he
went about ministering to the needs of not only his
patients but his friends. As he concluded his day‘s work
and retired to his home he was surprised to find many
useful gifts that had been sent in by thoughtful friends
and loved ones.
* * *
Dr. Robert F. Mabon, Atlanta, announces the opening
of his office at 478 Peachtree St., N. E., Atlanta. Practice
limited to neurologic surgery.
The Mercy Hospital, Macon, announced that an
80-doctor medical staff has been named to work with
the institution during 1950. Dr. James B. Kay, Byron,
is president; Dr. W. D. Jarrett, Macon, president-elect;
Dr. J. D. Applewhite, Macon, vice-president, and Dr.
E. C. McMillan, secretary. Dr. Willard R. Goslan,
Macon urologist, was elected by the board of governors
as a member to serve a three-year term. The medical
staff's active membership includes 39 Macon physicians.
The eight physicians pn Mercy’s consulting staff are:
Drs. F. R. Cary, R. W. Edenfield, C. Hall Farmer,
J. F. Hanson, M. B. Hatcher, Max Mass, Alvin E.
Siegel, and Frank Vinson. There are 33 doctors on
Mercy’s courtesy list for 1950. Dr. Kay appointed two
committees with identical memberships which deal with
related subjects. Named to the medical records com-
mittee and the program committee, with Dr. J. F.
Hanson as chairman of both, were: Drs. Jule C. Neal,
C. L. Ridley, Jr., and Charles Rumble. Drs. Willard
R. Golsan, J. D. Applewhite and Henry H. Tift are
members of the board of governors.
* * *
Dr. Carey A. Mickel, Jr., Elberton surgeon, announces
the removal of his offices for the practice of general
surgery to his new clinic building at 35-37 Chestnut
St., Elberton.
* * *
Dr. Seward E. Miller, Atlanta, has been appointed
director of the Federal Security Agency’s Region 5,
Chicago. For the past five years he has been chief of
laboratory services for the U. S. Public Health Service
Communicable Disease Center, Atlanta. His successor
will be Dr. Ralph B. Hogan, now in charge of research
for the venereal disease division of the Public Health
Service, in Washington.
* * *
Dr. William Benjamin Nalley, formerly of Gainesville,
who recently received his discharge from the U. S.
Army, announces the opening of his office for the prac-
tice of medicine at Helen and White County.
* * *
The Marietta Hospital Authority has named Dr.
Mayes Gober, Marietta surgeon, president of the medical
staff of the new Kennistone Hospital; Dr. Ralph Fowler,
Marietta, staff vice-president, and Dr. W. C. Mitchell,
Smyrna, secretary. The new officials will serve for one
year and cannot succeed themselves. Members of the
Cobb County Medical Society form the nucleus of the
105-bed hospital’s present staff. It will elect a perma-
nent credentials committee to recommend further staff
appointments. All appointments must be endorsed by
the seven-member hospital authority.
* * *
The Polk General Hospital, Cedartown, elected Dr.
J. Howard Hagan, Rockmart, vice-president of the
professional staff at a meeting held in Cedartown, Janu-
ary 17 ; he succeeds Dr. Raymond F. Spanjer, Cedar-
town. Other officers elected include Dr. Raymond F.
Spanjer, chief of staff, to succeed Dr. C. B. Elliott, and
Dr. P. O. Chaudron, secretary, to succeed Dr. J. J.
Word, who moved to Tallapoosa. Members of the staff
from Rockmart are Drs. J. Howard Hagan, R. B. Goldin,
Harold Goldin, J. E. Griffith, George M. White and
T. E. McBryde.
* * *
The Randolph-Terrell Medical Society, the Georgia
Heart Association and the Georgia Department of Public
Health held the fourth of a series of symposiums to be
held throughout Georgia under the sponsorship of the
Georgia Heart Association, in cooperation with the
Georgia Department of Public Health, at Cuthbert, Feb-
ruary 10. Dr. Arthur M. Knight, Jr., Waycross physi-
cian, spoke on “The Diagnosis and Treatment of the
Cardiac Arrhythmias.” “The Treatment of Coronary
Thrombosis and the use of Anticoagulants”, Dr. James
W. Chambers, LaGrange. and “The Modern Treatment
of Heart Failure”, Dr. Ernest Wahl, Thomasville.
* * *
The Richmond County Medical Society held its
138
The Journal of the Medical Association of Georgia
monthly meeting in the Old Medical College Building on
Telfair Street, Augusta, January 24. The program began
at 7 o’clock, and was followed by a dinner and reception,
and was held jointly with the Tenth Seminar which was
in progress at the University of Georgia School of
Medicine. Guest speakers were Dr. Herbert R. Haw-
thorne, Philadelphia, professor of surgery at the Uni-
versity of Pennsylvania Post-Graduate School of Medi-
cine, and Dr. Henry J. Tuman, Philadelphia, associate
professor of medicine at the University of Pennsylvania
School of Medicine. The speakers discussed “The Sur-
gical and Medical Aspects of Carcinoma of the Stom-
ach.”
* * *
Dr. Frank M. Ridley, LaGrange physician, has been
reappointed as Troup County physician by the Troup
County Board of Commissioners of Roads and Reve-
nues.
* * *
Dr. C. L. Ridley, Sr., Macon, superintendent of Macon
Hospital, recently attended the meeting of the District
Hospital Convention held at Warm Springs. There were
13 hospitals represented at the session, which meets
once a month. The district comprises and extends from
Columbus, LaGrange to Macon.
* * *
Dr. Thomas L. Ross, Jr., Macon physician, was guest
speaker at a symposium on cardiovascular diseases at
the Washington Woman's Club in Washington, January
26. This was the third of a series of symposiums on
this subject to be held throughout Georgia under the
sponsorship of the Georgia Heart Association, in con-
nection with the Georgia Department of Public Health.
Other speakers were Dr. Hartwell Joiner, Gainesville,
and Dr. C. B. Fulghum, Milledgeville. The Wilkes
County Medical Society also participated in sponsorship
of the symposium.
* * *
The Southeastern Section of the American Urological
Association comprising nine southern states including
Georgia, held its annual meeting at the Edgewater Gulf
Hotel, Gulfport, Miss., February 1-4. Dr. Carl Rusche,
of Hollywood. Calif., president of the American Urologi-
cal Association, was one of a number of prominent
urologists addressing the meeting. Other speakers from
Georgia included Drs. C. A. Fort, Harrison Harlin,
James H. Semans, and Dr. Harold P. McDonald, all of
Atlanta. Other Georgia members present were: Drs.
Spencer A. Kirkland, Reese C. Coleman, Jr., M. K.
Bailey, Earl Floyd, Montague L. Boyd, Stephen T.
Brown, Major F. Fowler, Charles Rieser, Samuel J.
Sinkoe, Atlanta; Dr. J. Robert Rinker, Augusta; Drs.
J. Zeb McDaniel and J. C. Keaton, Albany; Dr. W. F.
Reavis, Waycross; Dr. Peter L. Scardino, Savannah;
Dr. Rudolph Bell, Thomasville; Dr. Wallace L. Baze-
more, Macon, and Dr. James L. Campbell, Jr., Valdosta.
* * *
The South Georgia Medical Society held its dinner
meeting at the Country Club, Valdosta, January 10. The
purpose of the society is to keep practicing physicians
abreast of new developments in the field of medicine
and to provide a united group to cope with situations
which may arise in South Georgia. Officers for 1950 are
Dr. J. Raymond Smith, Haliira, president; Dr. Harry
Mixson, Valdosta, vice-president; Dr. Jesse Parrott,
Hahira, secretary-treasurer; Dr. Alex G. Little, Jr.,
Valdosta, and Dr. Fred N. Clements, Adel, delegates to
the annual session of the Medical Association of Georgia;
Dr. James S. Peters, Jr., Nashville, censor, and Dr.
James L. Campbell, Jr., Valdosta, program chairman.
Dr. C. W. Ketchum, Valdosta, is the retiring president.
Dr. James H. Semans, Atlanta urologist, recently held
a surgical clinic at Charity Hospital, New Orleans, dem-
onstrating radical perineal prostatectomy for early cancer
of the prostate.
Dr. William P. Stoner, Waycross, chief of staff of
A.C.L. Railroad Hospital, announces the removal of his
office to Sylvester, where he will be in charge of the new
hospital.
* * *
The University of Georgia School of Medicine, Au-
gusta, held in cooperation with the American Cancer
Society and the cancer control division of the Georgia
Department of Public Health, a four day seminar on
cancer, under the supervision of Dr. Hoke Wammock,
the cancer coordinator of the department of oncology
of the medical school. The seminar was held for the
benefit of general practitioners of medicine, practicing
physicians who devote considerable time to tumors, and
specialists in the field of tumors. Lecturers at the
seminar included Dr. Herbert R. Hawthorne, Philadel-
phia, professor of surgery at the University of Penn-
sylvania Post-Graduate School of Medicine, and Dr.
Henry J. Tuman, Philadelphia, associate professor of
medicine at the University of Pennsylvania School of
Medicine. Also Drs. J. M. Bazemore, G. T. Bernard,
E. R. Pund, J. Elliott Scarborough, David Henry Poer,
V. P. Sydenstricker, Sam Singal, M. Belkin, J. R. Heller,
W. A. Risteen, R. C. Major, Stephen Brown, Everett L.
Bishop, H. E. Nieburgs, Enoch Callaway, F. Bayard
Carter, Richard Torpin, R. B. Greenblatt, W. L. Shep-
eard, Charles W. Hock, J. H. Sherman. J. R. Rinker,
Peter B. Wright, and Dr. Hoke Wammock.
* * *
Dr. T. A. Sappington, Thomaston physician, was re-
elected vice-president of the Georgia Mutual Hos-
pitalization Service at the meeting of the board of di-
rectors held at the Upson Hotel, Thomaston, January
17. Drs. B. C. Adams and John D. Blackburn, of Thom-
aston, were elected to the board of directors. The meet-
ing was held jointly with the Georgia Life and Health
Insurance Company, with W. L. Bryan, president and
Hal Griffin, both of Atlanta attending.
* * *
The Upson County Medical Society recently appointed
Dr. R. E. Dallas, Thomaston physician, to serve on a
committee to work out the Constitution and By-Laws
for the new Upson County Hospital, from a medical
standpoint, and to form the hospital staff. Other mem-
bers of the committee are Drs. R. L. Carter, John D.
Blackburn, James Woodall, and H. D. Tyler.
* * *
Dr. Perry P. Volpitto, Augusta, professor of anesthesi-
ology, University of Georgia School of Medicine, was a
member of the guest faculty of the fifth annual series
of intensive postgraduate courses of the George Wash-
ington Llniversity School of Medicine, Washington,
D. C., in the section on anesthesiology, February 27-
March 3. The course was held in the Main Conference
Room of the George Washington University Hospital
where Dr. Volpitto presented two papers and partici-
pated in three conferences during the postgraduate
courses.
* * *
Dr. Ernest F. Wahl, Thomasville physician, was in
charge of the Heart Campaign in the second congres-
sional district and also director of the Thomas County
campaign. February is devoted throughout the country
to the collection of funds for the continuation of heart
research and the establishment of clinics. It is regarded
as one of the major health operations of the country,
with many chances of reducing the heart diseases that
are taking too many lives each year.
* * *
The Ware County Medical Society held its dinner
meeting at the Hotel Ware, Waycross, with Dr. B. H.
Minchew and Dr. Braswell E. Collins as hosts. Dr.
B. H. Minchew introduced the guest speaker, who is
his nephew, Dr. Wilbur C. Sumner, of Jacksonville, Fla.
Dr. Sumner discussed the modern methods of treating
cancer and reported that 60 per cent of cancer cases are
being cured with radium, x-ray and surgery. Guests at-
tending the meeting included Drs. Earl Mackey and
Tom Smith, Valdosta; Dr. J. B. Brown, Jr., Baxley;
Dr. Richard K. Winston, Tifton; Minchew Harrell and
Tom Kerby. Dr. W. A. Hendry, Blackshear, president.
March, 1950
139
presided over the meeting which was attended by 28
physicians.
* * *
The Whitfield County Medical Society held its monthly
meeting in Dalton, December 6. The society paid tribute
to the memory of Drs. John Henry Steed and George S.
Kerr, recently deceased members. In paying tribute to
Drs. Kerr and Steed, the document cited their self-
sacrificing devotion to the high purpose of the medical
profession, their skill, and their unselfish devotion to
all mankind. Officers for 1950 elected are Dr. Truman
Whitfield, Dalton, president; Dr. E. A. Rosen, Dalton,
vice-president; Dr. H. J. Ault, Dalton, secretary-treas-
urer; Dr. G. L. Broaddrick, Dalton, delegate; Dr. Paul
Bradley, Dalton, alternate delegate, and Dr. James R.
Whitley, Dalton, censor. The society consists of twenty
physicians and surgeons from Whitfield County and im-
mediate vicinity.
* * *
Dr. Peter B. Wright, Augusta, professor of orthopedic
surgery of the Medical College of Georgia, recently
attended the annual meeting of the American College
of Orthopedic Surgeons held in New York City. Dr.
Wright presented an exhibit on “Paget’s Disease”.
Drs. T. P. Waring and F. B. Brown, both of Savannah,
also attended the above named meeting.
* * *
Dr. Frank K. Boland, Atlanta surgeon, holds the honor
of being selected as the first guest speaker at the annual
lectureship honoring Dr. Urban Maes at the Louisiana
State University School of Medicine, New Orleans,
February 8. Dr. Boland discussed “The Beginning of
Surgical Anesthesia.” The Phi Chi Medical Fraternity
sponsored the meeting.
* * *
Dr. Roger W. Dickson, Atlanta, recently attended
the meeting of the educational committee of the Ameri-
can Academy of Pediatrics held in Winston-Salem, N. C.
* * *
Dr. Laura L. Lipscomb, Atlanta pediatrician, is in
New York City taking special courses in pediatrics,
tropical diseases and languages, prior to going as a
medical missionary to India. Dr. Lipscomb will head
the pediatrics department in the hospital at the Univer-
sity of Madras, Bellore, India.
OBITUARY
Dr. Barton Brown, aged 82, retired Savannah physi-
cian, died at a local hospital January 28, 1950. Dr.
Brown was born in Williamsport, Pa. in 1867. He
graduated from the University of Pennsylvania School
of Medicine, Philadelphia, in 1891, and for many years
after that served in private practice in Pennsylvania.
In January 1918, he entered the U. S. Army as captain
for World War I duty. He was stationed for a short
time at Fort Oglethorpe and at Fort Sam Houston,
Texas, and then was transferred to Fort Screven, where
he got his introduction to Savannah before being dis-
charged in December 1918. After his return to civilian
life for approximately 16 months, he joined the U. S.
Quarantine Service, a branch of the U. S. Public Health
Service. He came to Savannah in 1921 to assume the
directorship of the United States Quarantine Station.
After being transferred to a number of other places, he
returned to Savannah for the third time for a short
wffiile before his retirement December 1, 1937. He was a
member of the Medical Society of the State of Pennsyl-
vania. He was a Thirty-second Degree Mason, a Shriner,
and a Scottish Rite Mason, being an honorary life
member at Conders Port, Pa. He is survived by his
wife, the former Miss Sara Cohick, of Pennsylvania.
The funeral services and burial were held at Williams-
port, Pa.
* * *
Dr. James Arren McAllister, aged 57, Atlanta, chief
medical officer of the Georgia regional Veterans Admin-
istration office, died unexpectedly in his office of a heart
attack, February 16. 1950. A native of Mt. Vernon, Dr.
McAllister was an honor graduate of Emory University
School of Medicine, Atlanta, in 1914. He was a veteran
of World War I, and had been associated with the
Veterans Administration for the past 20 years. He had
served as chief medical officer for the past three years
and before that was chief of the out-patient clinic at
the VA hospital. He was a member of the Fulton
County Medical Society, the Medical Association of
Georgia, a fellow of the American Medical Association,
and a member of the First Presbyterian Church. His
residence was at 126 East Wesley Road, N. E., Atlanta.
Surviving are his widow, Mrs. Tressie Fitts McAllister,
two sons, Gordon McAllister, Augusta, and James A.
McAllister, Jr., Atlanta, four sisters, two sisters-in-law,
and two grandchildren. Funeral services were held at
the First Presbyterian Church. Dr. William V. Gardner,
pastor, officiated. Members of the Fulton County Medi-
cal Society and employees of the Veterans Administra-
tion acted as honorary escort. Burial was in West View
Cemetery, Atlanta.
* * *
Dr. Lowndes Walton Shaw, aged 58, Savannah urolo-
gist, died unexpectedly of a heart attack at his home at
Isle of Hope, January 26, 1950. A native of Willa-
coochee. Dr. Shaw gradnated from Emory University
School of Medicine, Atlanta, in 1915, and from the
University of Vienna in Austria. He spent practically
his entire medical career in Savannah. He was a member
and past president of the Georgia Medical Society, the
Medical Association of Georgia, and a fellow of the
American Medical Association. Also a member of the
American Urological Association. Dr. Shaw was a
member of Christ Episcopal Church, and Ancient Land-
mark Lodge No. 231 of the Free and Accepted Masons.
Since 1916 he had been on the staff of the United States
Marine Hospital, handling its urologic cases. He was
also on the staffs of St. Joseph’s and the Warren A.
Candler Hospitals. He is survived by his wife the
former Miss Mildred Carr; two sons, Richard and
Julian Shaw, all of Savannah; his mother, Mrs. F. A.
Shaw, Willacoochee, and two brothers. Funeral services
were held at the chapel of Sipple’s Mortuary with the
Rev. F. Bland Tucker, rector of Christ Episcopal Church,
officiating. Burial was in Hillcrest Memorial Park
Cemetery, Savannah.
* * *
Dr. James Simpson Tankersley, aged 90, widely-known
physician of Ellijay and Gilmer County, died in a Canton
hospital, February 11, 1950. A native of Gilmer county.
Dr. Tankersley was graduated from the Atlanta Medical
College which is now Emory University School of Medi-
cine, Atlanta, in 1884. He was one of the oldest gradu-
ates of Emory. Dr. Tankersley was a member of the
Ellijay Baptist Church and a Mason. Last year he
received a Fifty-Year Certificate of Distinction and a
gold lapel button from the Medical Association of
Georgia. Also a 50-year membership pin from the
Ellijay Masonic Lodge. He is survived by a son, James
S. Tankersley, Jr., and one granddaughter, both of Elli-
jay. Funeral services were held at the Ellijay Baptist
Church with the Rev. H. P. Bell and the Rev. A. B.
Couch officiating. Burial was in the City Cemetery,
Ellijay.
NEW BOOKS
Quinidine in Disorders of the Heart. By Harry Gold,
M.D., Professor of Clinical Pharmacology at Cornell Uni-
versity Medical College, Attending-in-Charge of the
Cardiovascular Research LTnit at the Beth Israel Hos-
pital, Attending Cardiologist at the Hospital for Joint
Diseases, Managing Editor of the Cornell Conferences
on Therapy. Cloth. Price, $2. Pp. 115. Paul B. Hoeber,
Inc., Medical Book Department of Harper & Brothers,
49 East 33rd Street, New York 16, N. Y., 1950.
This small book presents full discussion of the use of
quinidine in disorders of the heart. Among other things
it states: “Digitalis is the most effective drug against
auricular tachycardia. Quinidine is the only drug effec-
tive against ventricular tachycardia, and in this condition
there is the possibility that digitalis may do harm.”
140
The Journal of the Medical Association of Georgia
While the author stresses the importance of accurate
diagnosis, at the same time he says “cases of disordered
rhythm in which the differential diagnosis between the
various mechanisms cannot be made do not need to go
without specific therapy which offers a high probability
of success. Quinidine should be tried in these cases.”
* * *
Brucellosis (Undulant Fever) Clinical and Subclinical.
By Harold J. Harris, M.D., F.A.C.P., with the assistance
of Blanche L. Stevenson. R.N. Foreword by Walter M.
Simpson, M.S., MD., F.A.C.P. Second edition. Cloth.
Price $10. Pp. 617, with 111 illustrations, 12 in full
color. Paul B. Hoeber, Inc., Medical Book Department
of Harper & Brothers, 49 East 33rd Street, New York
16. N. Y„ 1950.
In this attractive book an honest effort has been
made to bring up-to-date knowledge of brucellosis, long
a troublesome condition which, unfortunately, is not
diagnosed and treated as often as many wish. This
book should be in every physician’s library.
* * ' *
Diseases of the Foot. By Emil D. W. Hauser, M.S.,
M.D., Associate Professor of Bone and Joint Surgery,
Northwestern University Medical School. New, Second
Edition. 415 pages with 195 figures. Philadelphia and
London : W. B. Saunders Company, 1950. Price $7.00.
Dr. Hauser has written an attractive book. He leads
off with discussion of the anatomy and physiology of
the foot, and then takes up methodically the various
conditions affecting the foot, followed by suggestions for
their correction. This book should be in every physi-
cian's library.
* * *
Cardiovascular Disease. Fundamentals, Differential
Diagnosis, Prognosis and Treatment. By Louis H. Sigler,
M.D., F.A.C.P., Attending Cardiologist' and Chief of
Cardiac Clinic, Coney Island Hospital; Consulting Car-
diologist, Rockaway Beach Hospital; Consulting Car-
diologist, Menorah Home and Hospital for the Aged.
Cloth. Price, $10. Pp. 551, with illustrations. Grune &
Stratton. Inc., Medical Publishers, 381 Fourth Avenue,
New York 16, N. Y., 1949.
Another good book on cardiovascular disease. While
any book which attempts to portray this subject in full
is to face the question, “What are the most essential
things to include?”. Dr. Sigler seems to have used good
judgment in crowding into one average size volume
much valuable information, particularly that dealing
with the clinical aspects of the subjects covered.
* * *
Mitchell-N elson s Textbook of Pediatrics: Edited by
Waldo E. Nelson, M.D., Professor of Pediatrics, Temple
Llniversity School of Medicine; Medical Director, Saint
Christopher’s Hospital for Children, Philadelphia. With
the Collaboration of Sixty-Three Contributors. New, 5th
Edition. 1658 pages with 426 illustrations, 19 in color.
Philadelphia and London: Wr. B. Saunders Company,
1950. Price $12.50.
Textbooks are so often thought of as being cumber-
some; yet when one wishes to search for all available
information on any subject he or she is likely to turn
first to an up-to-date and authoritative textbook. Such
authoritative work is Mitchell-Nelson's book on pedi-
atrics. It is well edited, attractively presented and con-
tains a wealth of material by its more than 63 con-
tributors.
COUNTIES REPORTING FOR 1950
Baldwin County Medical Society
President — Melvin E. Smith, Milledgeville
Vice-President — Wallace M. Gibson, Milledgeville
Secretary-Treasurer — Robert D. Waller, Milledgeville
Delegate — Y. H. Yarbrough. Milledgeville
Alternate Delegate — O. C. Woods, Milledgeville
Censors: Y. H. Yarbrough, R. W. Bradford and John D.
Wiley
Bulloch-Candler-Evans Medical Society
President — Waldo E. Floyd. Statesboro
Vice-President — Curtis G. Hames, Claxton
Secretary-Treasurer — Elizabeth Fletcher, Statesboro
Delegate — Louie IJ. Griffin, Claxton
Alternate Delegate — John Mooney, Jr., Statesboro
Censors: Ben A. Deal, W. E. Simmons and J. H.
Whiteside
Coffee County Medical Society
President — H. G. Joiner, Douglas
Vice-President — H. J. Goodwin, Douglas
Secretary-Treasurer — Sage Harper, Douglas
Delegate — L. H. Shellhouse, Willacoochee
Censor: G. M. Ricketson
Fulton County Medical Society
President — A. O. Linch, Atlanta
President-Elect — Hal M. Davison, Atlanta
Vice-President — Cyrus W. Strickler, Jr., Atlanta
Secretary-Treasurer — A. Worth Hobby, Atlanta
Delegates — A. O. Linch, Stephen T. Brown
Hal M. Davison, Eustace A. Allen, A. Worth Hobby,
William G. Hamm, Jack C. Norris, Cyrus W. Strickler,
Jr., John W. Turner, Major F. Fowler, Shelley C.
Davis, J. D. Martin, Jr., C. Purcell Roberts
Alternate Delegates — A. Park McGinty, Lester Brown,
J. G. McDaniel, Mark Dougherty, David Henry Poer,
Tully T. Blalock, Harry Rogers, George Holloway,
Harold McDonald, J. C. Blalock, H. Walker Jernigan,
Hayward S. Phillips, and W. Perrin Nicolson
Jenkins County Medical Society
President — Austin P. Fortney, Sylvania
Secretary -Treasurer — Cleveland Thompson, Millen
Delegate — H. G. Lee, Millen
Alternate Delegate — William G. Simmons, Sylvania
Randolph-T errell Medical Society
President — Ernest F. Daniel, Jr., Dawson
Vice-President — Robert B. Martin, III, Cuthbert
Secretary-Treasurer — W. G. Elliott, Cuthbert
Delegate — Robert B. Martin, III, Cuthbert
Alternate Delegate — Robert B. Quattlebaum, Fort Gaines
Censors: J. C. Tidmore, A. R. Sims, and F. S. Rogers
South Georgia Medical Society
Berrien-Clinch-Cook-Echols-Lanier and Lowndes Counties
President — J. R. Smith, Hahira
Vice-President — E. Harry Mixson, Valdosta
Secretary-Treasurer — Jesse Parrott, Hahira
Delegate — A. G. Little, Jr., Valdosta
Alternate Delegate — Fred N. Clements, Adel
Censor — James S. Peters, Jr., Nashville
Whitfield County Medical Society
President — Truman W. Whitfield, Dalton
Vice-President — E. A. Rosen, Dalton
Secretary-Treasurer— H. J. Ault, Dalton
Delegate — G. L. Broaddrick, Dalton
Alternate Delegate — Paul L. Bradley, Dalton
Worth County Medical Society
Secretary-Treasurer — Gordon S. Sumner, Sylvester
Delegate — J. L. Tracy, Jr., Sylvester
Alternate Delegate — Henry G. Davis, Jr., Sylvester
VETERANS’ NEWS
Veterans Administration in June opened a new 399-
bed general medical and surgical hospital in Provi-
dence, Rhode Island, bringing the total number of
V-A hospitals to 129.
* * *
About 7,227,000 National Service Life Insurance
policies, held by World War II veterans, were in force
in late Spring, Veterans Administration said. The
policies represented $41.6 billion of insurance protec-
tion.
MACON HOTELS
Macon hotels are: Dempsey, Lanier, Central,
Southland, Colonial, and Milner. Tourist courts
are: Magnolia, and Peach State. The dates of
our annual session are April 18-21. Get your
reservations now.
March, 1950 141
THE WOMAN’S AUXILIARY TO THE MEDICAL ASSOCIATION OF GEORGIA
Mrs. J. Harry Rogers
Atlanta
President 1949-1950
INVITATIONS
WOMAN’S AUXILIARY TO THE BIBB
COUNTY MEDICAL SOCIETY
To the Members of the Woman's Auxiliary:
On behalf of the Woman s Auxiliary to the
Bibb County Medical Society it gives me great
pleasure to extend to every member of the Wom-
an’s Auxiliary to the Medical Association of
Georgia a most cordial invitation to attend the
annual state medical convention, which will be
held in Macon April 18-21. We are looking for-
ward to having you with us at that time and
hope that each of you will make a special effort
to be present.
We will be very happy for all doctors’ wives
who are not members to take part in the con-
vention.
Every doctor’s wife has a job to do today that
is beyond the routine chores of a housewife. An
excellent program has been planned to help each
of us do that job better. Our entertainment com-
mittee is also hard at work planning many good
times for us all.
Each year we enjoy renewing old acquaintances
and making new friends. Make your plans now
to help make the 1950 convention in Macon a
delightful and interesting occasion.
Sincerely,
Mrs. Milford B. Hatcher, President.
Woman’s Auxiliary to the Bibb County
Medical Society
WOMAN’S AUXILIARY TO THE MEDICAL
ASSOCIATION OF GEORGIA
Dear Auxiliary Members:
The twentv-fifth convention of the Woman’s
Auxiliary to the Medical Association of Georgia
will be held in Macon April 18-21. As president
of the Auxiliary I wish to extend a sincere invi-
tation to every member, as well as to those eligi-
ble women who have not yet joined the Auxiliary ,
to attend this most important meeting.
For this is perhaps the most important one
that we have ever held, as we join forces w ith
other similar groups throughout the country in
our fight for our way of life. There will be the
sociability and fellowship that we always find at
our annual meetings, but there will also he that
important place reserved in our convention pro-
gram for the latest information from the Wash-
ington scene.
We need each one of you at this our twenty-
fifth annual convention. Won’t you come?
Mrs. J. Harry Rocers, President,
Woman’s Auxiliary to the Medical
Association of Georgia.
PROGRAM
TWENTY-FIFTH ANNUAL CONVENTION
WOMAN’S AUXILIARY
to the
MEDICAL ASSOCIATION OF GEORGIA
Macon
APRIL 18-21, 1950
OFFICERS AND COMMITTEES
Executive Board
President — Mrs. J. Harry Rogers, Atlanta.
President-Elect — Mrs. Lehman W. Williams, Savannah.
First Vice-President — Mrs. J. R. Shannon Mays, Macon.
Second Vice-President — Mrs. T. A. Peterson, Savannah.
Third Vice-President — Mrs. Harold Smith, Savannah.
Recording Secretary — Mrs. Leo Smith. Waycross.
Corresponding Secretary — Mrs. D. R. Longino, Atlanta.
Treasurer — Mrs. Robert C. Major, Augusta.
Historian — Mrs. Luther H. Wolff, Columbus.
Parliamentarian — Mrs. Eustace A. Allen, Atlanta.
Advisory Committee
Dr. Murdock Equen. Atlanta, Chairman.
Dr. Ralph H. Chaney, Augusta.
Dr. J. Harry Rogers, Atlanta.
Dr. W. G. Elliott, Cuthbert.
Dr. Eustace A. Allen, Atlanta.
Dr. Fullmer Holton, Savannah.
Dr. Thomas Ross, Jr., Macon.
Dr. W. Bruce Schaefer, Toccoa.
Dr. Shelley Davis, Atlanta.
Chairmen of Standing Committees
Organization — Mrs. Lehman H. Williams, Savannah.
Program — Mrs. J. R. Shannon Mays, Macon.
Hygeia — Mrs. T. A. Peterson. Savannah.
Scrapbook — Mrs. Harold M. Smith, Savannah.
142
The Journal of the Medical Association of Georgia
Achievement Award Mrs. Ralph McCord, Rome.
Archives- Mrs. C. W. Roberts, Atlanta.
Budget — Mrs. Ralph H. Chaney, Augusta.
Bulletin — Mrs. William K. Jordan. Macon.
Camellia Garden Mrs. T. C. Clodfelter, Milledgeville.
Doctors’ Day -Mrs. Lloyd Wood. Dalton.
Editorial Mrs. Ben Hill Clifton. Atlanta.
Mrs. .1. Bonar White Exhibits and Scrapbook Awards
Mrs. R. K. Winston, Tifton.
Legislation .Mrs. Marion Estes, Augusta.
Public Relations — Mrs. Shelley C. Davis, Atlanta.
Research in Romance of Medicine — Mrs. Wilbur D.
Hall. Calhoun.
Revisions — Mrs. Lee Howard. Savannah.
Student Loan Fund — Mrs. J. Lon King, Macon.
Airs. James N. Brawner Trophy— Mrs. Sam Anderson.
Atlanta.
District Managers
First District — Mrs. T. A. Peterson, Savannah.
Second District — Mrs. Paul Russell. Albany.
Third District — Mrs. A. R. Sims, Richland.
Fifth District — Mrs. Murdock Equen. Atlanta.
Sixth District — Mrs. J. R. Shannon Mays, Macon.
Seventh District — Mrs. W. I . Hvden, Summerville.
Eighth District — Mrs. T. J. Ferrell. Waycross.
Ninth District — Mrs. C. J. Roper, Jasper.
Presidents of County Auxiliaries
Baldwin — Mrs. E. W. Allen, Milledgeville.
Barrow-Jackson — Mrs. Paul Scoggins, Commerce.
Bibb — Mrs. Milford Hatcher, Macon.
Bulloch-Candler-Evans Mrs. J. L. Nevil, Metter.
Burke-Jenkins-Screven — Mrs. Cleveland Thompson, Mil-
len.
Carroll-Douglas-Haralson — Mrs. W. P. Downey, Talla-
poosa.
Chatham Mrs. Joseph Pacific, Savannah.
Cherokee-Pickens — Mrs. Arthur Hendrix^ Canton.
Cobb — Mrs. W. H. Benson, Marietta.
Coffee — Mrs. Dan A. Jardine, Douglas.
Colquitt— Mrs. Edgar Holmes, Moultrie.
Crisp — Mrs. C. E. McArthur. Cordele.
Dougherty Mrs. David Mann, Albany.
DeKalb— M rs. G. A. Duncan, Decatur.
Dodge-Pulaski-Bleckley (Ocmulgee) — Mrs. James W.
Thomson, Eastman.
Floyd — Mrs. Warren Gilbert, Rome.
Fulton — Mrs. Charles Daniel, College Park.
Gordon — Mrs. J. E. Billings, Calhoun.
Glynn — Mrs. T. H. Johnston, Brunswick.
Gwinnett — Mrs. W. J. Hutchins, Buford.
Habersham Mrs. J. L. Walker, Clarkesville.
Muscogee- -Mrs. James Elkins, Columbus.
Randolph-Terrell — Mrs. A. R. Sims. Richland.
Richmond Mrs. N. M. DeVaughn, Augusta.
Sumter — -Mrs. John H. Robinson, III, Americas.
Stephens — Mrs. Robert Shiflet, Toccoa.
Tift — Mrs. R. E. Jones, Tifton.
Troup— Mrs. William Hutchinson, LaGrange.
Ware — Mrs. W. P. Stoner, Waycross.
Washington — Mrs. J. B. Dillard, Davisboro.
Whitfield — Mrs. Fred Ragland, Dalton.
PAST PRESIDENTS AND CONVENTIONS
Honorary Presidents for Life — Mrs. James N. Brawner,
Atlanta, and Mrs. Eustace A. Allen, Atlanta.
1924 — Augusta — ■( Organization I — Mrs. C. W. Roberts,
Atlanta, Temporary Chairman.
1925— Atlanta — Mrs. James N. Brawner, Atlanta.
1926 — Albany — Mrs. William H. Myers, Savannah.
1927 — Athens — Mrs. C. W. Roberts, Atlanta.
1928 — Savannah — Mrs. Paul Holiday, Athens (Mrs. J. C.
Moore, Gaffney, S. C.)
1929 — Macon — Mrs,- Charles Hinton, Macon.
1930 — Augnsta — Mrs. Marion T. Benson, Atlanta.
1931— Macon — Mrs. Charles Harrold, Macon.
1932 Savannah — Mrs. Ralston Lattimore, Savannah.
1933 -Macon — Mrs. S. T. R. Revell, Louisville.
1934 — Augusta — *Mrs. J. Bonar White, Atlanta.
1935 -Atlanta — Mrs. J. E. Penland, Waycross.
1936 — Savannah — Mrs. Ernest R. Harris, Winder.
1937- Macon Mrs. William R. Dancy, Savannah.
1938 Augusta — Mrs. Ralph Chaney, Augusta.
1939 — Atlanta Mrs. Warren Coleman, Eastman.
1940 Savannah — Mrs. Eustace A. Allen, Atlanta.
1941 — Macon Mrs. 11. G. Banister. Decatur.
1942— \ugusta — Mrs. Lee Howard, Savannah.
1943 — Atlanta Mrs. J. Lon King, Macon.
1944 — Savannah Mrs. Olin S. Gofer, Atlanta.
1946 — Macon — Mrs. W. T. Randolph, Winder.
1947 — Augusta Mrs. W. Bruce Schaefer, Toccoa.
1 ‘>48 — Atlanta — Mrs. W. G. Elliott, Cuthhert.
1949 — Savannah Mrs. Sam Anderson, Atlanta.
•Deceased
WOMAN’S AUXILIARY TO THE BIBB COl NTY
MEDICAL SOCIETY
COMMITTEES
Credentials and Registration
Mrs. R. W. Richardson.
Chairman
Mrs. Thomas Harrold, Jr..
Co-Chairman
Mrs. Harold C. Atkinson
Mrs. John T. DuPree
Mrs. Earl Lewis
Mrs. Allan A. Cole
Mrs. W. A. Newman
Mrs. R. M. Reifler
Mrs. Charles T. Rumble
Mrs. Charles Rey, Jr.
Mrs. W. P. Smith
Mrs. R. E. Roberts
Decorations
Mrs. J. L. King, Chairman Mrs. R. Cullen Goolsby
Mrs. D. T. Henderson
Mrs. J. P. Holmes
Mrs. A. R. Rozar
Mrs. V. H. McMicheal
Mrs. Wr. A. Williams
Mrs. Joe W. Daniel
Mrs. Fred N. Aldrich
Mrs. O. R. Thompson,
Co-Chairman
Mrs. 0. F. Keen
Mrs. James A. Fountain
Mrs. Holloway Bush
Mrs. William L. Barton
Mrs. Charles McLaughlin
Mrs. W. W. Chrisman
Reception
Mrs. William Jordan, Mrs. Leon J. Goodman
Chairman Mrs. Charles C. Harrold
Mrs. J. R. S. Mays, Mrs. L. P. James
Co-Chairman Mrs. Jules Neal
Mrs. J. D. Applewhite Mrs. Cleveland Thompson
Mrs. Wallace L. Bazemore Mrs. William C. Sams
Exhibits
Mrs. Willard Golsan, Mrs. George W. DuPree
Chairman Mrs. Marvin Harris
Mrs. Alvin Siegel.
Co-Chairman
Luncheons
Mrs. T. L. Ross, Jr.,
Chairman
Mrs. Ernest Corn,
Co-Chairman
Mrs. J. C. Anderson
Mrs. Charles H. Richard-
son, Jr.
Mrs. Allan Smith
Mrs. Frank M. Houser
Mrs. Edwin Watson
Mrs. John Paul Jones
Mrs. Edmund A. Brannerc
Mrs. J. W. McFarlane
Mrs. Edgar M. Pope
Mrs. John Moorman
Mrs. Remer Young Clark
Tea
Mrs. Henry Tift, Chairman Mrs. William L. Barton
Mrs. Robert McAllister
Pages
Mrs. J. Emory Clay, Mrs. Edmund A. Brannerr
Chairman Mrs. Charles L. Ridley, Jr.
Mrs. Hall Farmer, Mrs. E. C. McMillan
Co-Chairman
Mrs. George A. Billing-
hurst
Timekeeper
Mrs. J. L). Applewhite Mrs. H. G. Weaver
Publicity
Mrs. W. D. Hazlehurst. Mrs. J. C. Anderson,
Chairman Co-Chairman
Transportation
Mrs. J. Fletcher Hanson
Mrs. R. W. Edenfield
Mrs. Sam N. Rubin
Mrs. D. D. Walker
Mrs. Roland Brown
Mrs. W. Devereaux Jarratt
Mrs. Sam Patton,
Chairman
Mrs. L. D. Porch,
Co-Chairman
Mrs. Sam Work
Mrs. W. C. Boswell
Mrs. Ralph G. New ton
March, 1950
143
Banquet
Mrs. Charles J. Woods, Mrs. William Jordan
Chairman
Mrs. W. W. Baxley,
Co-Chairman
Mrs. C. H. Richardson, Sr.
M rs. C. H. Richardson, Jr,
Mrs. H. G. Weaver
Mrs. Walter Mobley
Mrs. J. R. S. Mays
Mrs. John I. Hall
Mrs. Ben Bashinski
Mrs. Max Mass
Mrs. O. O. Watson
Mrs. Lee Williams
Mrs. Ralph Roberts
Mrs. Wm. Mark Watkins
Mrs. C. C. Hinton
Arrangements
Mrs. A. M. Phillips Mrs. Milford B. Hatcher
PROGRAM
Headquarters, Hotel Dempsey
Registration
Tuesday, April 18: 2 P. M. to 6:30 P. M.
Wednesday, April 19: 9 A. M. to 12:30 P. M., 2 P. M.
to 4 P. M.
Thursday, April 20: 9 A. M. to 12:30 P. M.
Program and Entertainment
Tuesday, April 18: 3 P. M. — Executive Board Meeting.
Tuesday, April 18: 8 P. M. — Report from President of
Woman’s Auxiliary to House of Delegates of Medical
Association of Georgia.
Tuesday, April 18: 9-11 P. M. — Reception at the Sidney
Lanier Cottage, 935 High St., Given by the Bibb
County Medical Society for all members of the Medi-
cal Association, their wives, and guests.
Wednesday, April 19: 10 A. M. to 12:30 P. M. — General
Meeting.
Wednesday, April 19: 1 P. M. — Luncheon at Wesleyan
College honoring Mrs. David B. Allman, president of
the Woman’s Auxiliary to the American Medical Asso-
ciation, and Mrs. J. Harry Rogers, president of the
Woman’s Auxiliary to the Medical Association of
Georgia.
Wednesday, April 19: 4 P. M. to 5:30 P. M. — Tea at
the home of Mrs. Henry H. Tift, 420 Nottingham
Drive. Given by Woman's Auxiliary to the Bibb County
Medical Society.
Wednesday, April 19: 8 P. M. — Public Meeting, Medical
Association of Georgia.
Thursday, April 20: 10 A. M. to 12:30 P. M. — General
Meeting.
Thursday, April 20: 7:30 P. M. — Joint banquet at Idle
Hour Country Club. All members of Medical Associa-
tion and their wives are invited.
Post-convention Board Meeting.
GENERAL MEETING
Hotel Dempsey
Wednesday, April 19, 10:00 A. M.
Call to Order by the President, Mrs. J. Harry Rogers,
Atlanta.
Invocation
The Rev. Tracy Lamar, Macon, Rector St. James
Episcopal Church.
Pledge of Loyalty
Mrs. Sam Anderson, Atlanta.
Address of W elcome
Mrs. Milford B. Hatcher, Macon, President Woman's
Auxiliary to the Bibb County Medical Society.
Response to Address of Welcome
Mrs. W. H. Benson, Marietta.
Introduction Officers and Distinguished Guests
Mrs. J. Lon King, Macon.
Roll Call of Districts and Counties
Mrs. Leo Smith, Waycross, Secretary
Address “Our Present Situation”
Dr. Enoch Callaway, LaGrange, President Medical
Association of Georgia
Address “Public Relations”
Mr. Ed Bridges, Public Relations Director, Medical
Association of Georgia
Rules Governing Convention Procedure
Mrs. Eustace A. Allen, Atlanta, Parliamentarian.
Report from Executive Committee
Mrs. J. Harry Rogers, Atlanta, President.
Introduction of Pages
Mrs. J. Emory Clay, Macon.
Address
Mrs. David B. Allman, Atlantic City, N. J., President
Woman’s Auxiliary to the American Medical Association.
Memorial Service
Mrs. Ernest R. Harris, Winder, chairman: Mrs. C. II.
Richardson, Macon, co-chairman.
Reports District Managers and County Presidents
Reports of Registration Committee
Mrs. Rhea W. Richardson, Macon.
Reports of Entertainment Committee
Mrs. A. M. Phillips, Macon, General Chairman.
Report Convention Womans Auxiliary to American
Medical Association.
Mrs. Allen Bunce, Atlanta.
Business
Reading of Minutes
Adjournment
GENERAL MEETING
Hotel Dempsey
Thursday, April 20, 1950, 10:00 A. M.
Call to Order by the President, Mrs. J. Harry Rogers,
Atlanta.
Invocation
Dr. William E. Denham, Pastor First Baptist Church.
Pledge of Loyalty
Mrs. W. G. Elliott, Cuthbert.
Response
Mrs. Robert E. Jones, Tifton.
Address
Dr. A. M. Phillips, Macon, President-Elect of the
Medical Association of Georgia.
Report of Advisory Committee to W omans Auxiliary oj
the Medical Association of Georgia
Dr. Murdock Equen, Atlanta, chairman.
Address
Mrs. W. Bruce Schaefer, Toccoa, Chairman Legislation,
Woman’s Auxiliary to the American Medical Association.
Address
Mrs. R. C. Haynes, Marshall, Mo., President Woman’s
Auxiliary to Southern Medical Association.
Report Convention W omans Auxiliary to Southern
Medical Association
Mrs. John W. Turner, Atlanta
Reports of Officers
Reports of Auditing Committee
Reports oj Resolutions Committee
Reports of Awards Committee
Mrs. Sam Anderson, Atlanta; Mrs. Ralph McCord,
Rome; Mrs. Richard Winston. Tifton.
Report of Courtesy Committee
Business
Report of Nominating Committee
Election of Officers
Installation of Officers
Mrs. Ralph H. Chaney, Augusta
Presentation President’s Pin to Retiring President
Mrs. Joseph Yampolsky, Atlanta.
Announcements by the President
Mrs. L. W. Williams.
Adjournment.
POST CONVENTION BOARD MEETING
Mrs. L. W. Williams, Savannah.
RULES TO GOVERN THE CONVENTION
1. To gain recognition, a delegate is requested
to rise, address the chair, give her name and the
name of her auxiliary.
2. No delegate shall speak more than twice on
the same subject, and is limited to two minutes
each time.
3. Reports shall not be read from Auxiliaries
which are not represented by delegates but shall
be filed with the secretary.
144
The Journal of the Medical Association of Georcia
4. All original motions on resolutions shall be
made by submitting two copies; one to the Reso-
lutions Committee, and one to the Recording
Secretary.
5. Reports of delegates and district managers
are limited to two minutes.
6. No one is entitled to vote before she is
registered.
7. All persons appearing on the program must
be seated near the platform when the session
opens.
8. Badges must be worn by members of the
voting body during all general sessions of the
convention.
9. Delegates’ privileges are not transferable.
Whispering conversations greatly retard the
business of the meeting; order must be main-
tained at all times. Please be prompt. Meetings
will begin promptly at the time announced.
Reports must conform to the time allotted.
PLEDGE
”1 pledge my loyalty and devotion to the
“Woman’s Auxiliary to the Medical Associa-
tion of Georgia. I will support its activities,
protect its reputation, and ever sustain its high
ideals.
COLLECT -
“Keep us, 0 God, from pettiness; let us be
large in thought, word and deed. Let us be done
with fault-finding, and leave off self-seeking. May
we put away pretense, and meet each other face
to face, without self-pity and without prejudice.
May we never be hasty in judgment, and al-
ways generous. Let us take time for all things;
make us to grow calm, serene, gentle.
Teach us to put into action our better impulses,
straightforward and unafraid. Grant that we may
realize it is the little things that create differences;
hut in the big things of life we are one.
And may we strive to teach and to know the
great, common Woman's heart of us all. and 0,
Lord God, let us not forget to be kind.”
TREAT BLOOD CLOT IN BRAIN BY BLOCKING
NERVE PATHWAY
Doctors have devised a promising treatment for a clot
in a blood vessel of the brain, according to a report in
the January 7 Journal of the American Medical Asso-
ciation.
Until recently treatment of the condition, acute
cerebral thrombosis and embolism, was confined to gen-
eral measures such as administering intravenous fluid
or giving whisky.
The new technic, known as stellate ganglion block,
is reported bv Drs. Edwin W. A vines and Seymour M.
Perry of the College of Medical Evangelists and Liniver-
sity of Southern California School of Medicine, Los
Angeles.
It involves blocking certain nerve pathways to ves-
sels which supply the brain. This is done by injecting
procaine hydrochloride, a pain-killing drug, in nerve
pathways at the back of the neck. The procedure tends
to increase the blood supply to the part of the brain
that has been affected by the clot.
Of the 44 patients treated, 28 showed improvement in
15 minutes to an hour after the first injection was given.
The doctors noted increased alertness, gieater ability to
move, improved speech and better comprehension.
Improvement occurred in nine of 10 cases who received
the treatment in the first six hours after the onset of
symptoms, the doctors say.
REPORT NEW SURGERY TO SAVE CHILDREN
FROM FATAL DISEASE OF PANCREAS
A new surgical procedure to save the lives of children
afflicted with a hitherto uniformly fatal disease of the
pancreas has been devised by three New Orleans doctors.
The operation, splanchnicectomy, involves cutting cer-
tain nerves just below the diaphragm. It is performed
in conjunction with blocking of nerves in the same area
by injection of procaine hydrochloride, a pain-killing
drug.
The doctors are William B. Ayers, Daniel Stowens and
Alton Ochsner of Tulane University School of Medicine
and the Ochsner Clinic. They report the procedure in
the January 7 Journal of the American Medical Associa-
tion.
The disease, characterized by formation of fibrous
material in the pancreas, was first recognized in 1938,
according to the doctors. Babies suffering from the
disease characteristically develop pneumonia or other
respiratory conditions at an early age. Nutritive diffi-
culties in babies also are characteristic.
A 17-month-old girl, identified only as G. G., had pneu-
monia at five months of age and during the following
year had two severe infections of the upper part of the
respiratory tract, the doctors say. She grew slowly and
had a persistent cough.
After the operation and nerve block were performed,
her appetite and general appearance improved and her
difficulty in breathing disappeared. She was discharged
from the hospital free of symptoms.
Three other children with the disease on whom the
doctors performed the surgery and nerve block responded
in a similar manner. A fifth child died of heart failure
during the surgery.
ATTRIBUTE BALDNESS IN WOMEN TO METAI.
CURLERS, TIGHT BRAIDS
Women who consistently use metal curlers on their
hair or wear it in tight braids may develop bald spots
above the ears, according to three Los Angeles doctors.
Drs. Samuel Ayres Jr., Samuel Ayres III and Joseph
T. Mirovich report five cases of such baldness in the
December 1949 Archives of Dermatology and Syphilology,
published by the American Medical Association.
Three of the women had been using metal curlers and
two had been wearing their hair pulled away from the
ears and braided tightly.
VETERANS’ NEWS
Less than one-fourth of the World War II veterans
holding National Service Life Insurance have converted
their policies from trem insurance to one or more of the
half-dozen available permanent plans, Veterans Ad-
ministration disclosed.
He * *
More than 202,000 World War II veterans by June 1
had either exhausted their entitlement to G.I. Bill
training, or had completed their Public Law 16 training
and were declared rehabilitated. Veterans Administra-
tion said.
* * *
The number of World War II veterans training on-
the-job under the G. I. Bill and Public Law 16 dropped
to 403.135 on June 1 — a 45 per cent decrease from the
720,510 peak reached in January, 1947.
* * *
World War II veterans between 25 and 34 years of
age had a median income of $2,401 in 1947, compared
with $2,585 for non-veterans in the same age group,
according to a Census Bureau study.
The Medical Association of Georgia will hold its
1950 annual session in Macon, April 18-21.
THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX — No. 4 Atlanta, Georgia, April, 1950 No. 4
NECK DISSECTIONS
Milford B. Hatcher, M.D.
Macon
Neck dissections, like all surgery, may
be simple or they may be more difficult de-
pending upon the type and nature of the
lesion and the location. In all surgery it is
essential to have a working knowledge of
anatomy, but in the field of neck surgery it
is imperative to have mastered the anatomy
of that region. It is also a basic require-
ment to be familiar with the embryologic
development of the structures in the head
and neck. In this paper no attempt will be
made to discuss either the anatomy or the
embryology. The approach will be made
from the clinical viewpoint, and from that
phase one asks the question, When is a neck
dissection indicated? A dissection is indi-
cated when there is a tumefaction either pal-
pable or plainly visible or when other signs
and symptoms demonstrate an abnormal
process amenable to surgery unless there
are distinct contraindications, which will
be discussed later.
Please allow me to beg here that one not
take neck dissections too lightly or feel that
they can be shelled out in a haphazard or
matter-of-fact manner. True, some are very
simple; however, some that appear simple
may run into difficult situations if precau-
tions are not taken. They should not be
considered an office procedure.
In this paper I will not attempt to discuss
neck dissections for conditions such as cer-
Read before the Medical Association of Georgia in annual
session. Savannah, May 13, 1949.
vical rib, scalenus anticus syndrome, or eso-
phageal diverticulum.
To aid in having an accurate preopera-
tive diagnosis, swellings in the neck have
been divided into two main classifications:
(1) those in the midline, and (2) those in
the lateral positions. Midline swellings may
be divided into: (a) thyroglossal duct cyst
or sinus; (b) lingual goiter (removal of
which often causes myxedema if normal thy-
roid tissue is not present; so when one re-
moves a lingual goiter it is necessary to ex-
plore the thyroid area to be sure the normal
thyroid is present) ; (c) sebaceous cyst or
cyst of the isthmus of the thyroid, and (d)
ranula.
Swellings of the lateral portions of the
neck can be divided into the following clas-
sifications: (a) salivary; (b) hygroma;
(c) branchial cleft cyst (or sinus); (d)
dermoid; (e) venous hemangioma ; (f) thy-
roid enlargement (hyperthyroidism includ-
ed); (g) neurofibroma; (h) adenoma or
tumor of the parathyroids; (i) Hodgkin’s
disease; (j) lymphosarcoma; (k) leukemic
adenitis; (1) sarcoid; (m) tuberculous ade-
nitis; (n) carotid body tumors; (o) so-
called lateral “aberrant” thyroid; (p) epi-
dermoid carcinomas (lympho-epithelioma
or transitional-cell carcinomas) ; and (q)
cervical metastasis. Generally speaking, we
might state that all midline tumors and A
through parathyroid tumors require only
careful surgical dissection; Hodgkin’s dis-
ease through tuberculous adenitis are medi-
cal problems from a treatment standpoint
and are mentioned here only to be used
from a differential point of view before
any surgery is done except biopsy. Later in
116
The Journal of the Medical Association of Georgia
the paper I will discuss the lateral “aber-
rant” thyroid.
Carotid body tumors deserve special men-
tion due to the fact that the actual treatment
of them depends upon the findings at op-
eration; that is, whether the carotids are in-
volved and whether the frozen section dem-
onstrates benign or malignant changes. The
general concensus of opinion appears to he
that if they are too difficult to remove and
show only benign changes that it is best to
leave them and not attempt a resection which
would necessitate ligation of the common
carotid vessels.
The epidermoid carcinomas of the mouth
and pharynx are a group of highly ana-
plastic, radio-sensitive malignancies which
is characterized by an inconspicuous pri-
mary lesion with massive involvement of
the regional and distant lymph nodes with
the formation of visceral metastases. Irra-
diation is the therapy of choice.
The last on our list, cervical metastasis,
is the one which will be discussed most in
detail in this paper. Treatment of the pri-
mary cancerous lesion of the head and neck
has advanced so much that death due to
metastasis is now of the greatest concern.
Adequate follow-up and proper considera-
tion of the metastatic involvement cannot be
too strongly stressed. With the exception of
the thyroid and melanomas, most cancers of
the head and neck confine their metastatic
activity to the lymphatic pathways. Because
of this preponderance of lymphatic metas-
tasis, most of the head and neck metastasis
is confined above the clavicle until late.
Braund and Martin1 in a review of autopsies
of patients who died of head and neck can-
cers found only 23 per cent of the metastases
were found below the clavicle. Slaughter2
states that the spread is generally unilateral
unless late, and the cervical nodes are
blocked on one side, causing a reverse of
lymphatic flow; or else the primary lesion
extends across the midline. Although clin-
ically it may not be apparent, a group of
nodes rather than one node is usually in-
volved when the metastatic lesion is detect-
ed. This was apparently what made Brown
et al state that block surgical excision of the
lymphatic tissues in the neck would prob-
ably cure more patients with metastatic car-
cinoma ending in this area than any other
procedure at the present time.
It must be admitted that the advisability
of when to do neck dissections can be a de-
batable question, and there are excellent
opinions on both sides: Blair, Brown, and
Byars4 advocate neck dissections as soon as
possible on patients with intraoral cancer,
whether the neck nodes are palpable or not.
Kennedy'' concurs with this and even feels
that a suprahyoid dissection should be done
at the time the lip lesion is excised. Martinb
does not support this view and has even
shown that cure rates in patients without
demonstrable metastases are approximately
the same whether or not neck dissection is
done. The problem then arises as to when
to do neck dissections for cancer. The fol-
lowing generalizations are given:
Indications : (1) The primary lesion is
controlled; (2) The primary lesion is limit-
ed to one side of the oral cavity; (3) The
primary lesion is shown to be of highly
differentiated cells; (4) Cervical metastases
are present and limited to one group of
nodes or nodes in two contiguous sets of
triangles; (5) Nodes are movable and dis-
crete; (6) Opposite side of neck is free of
metastasis; (7) No distant metastasis is
present; and (8) The patient is in good
general condition.
Contraindications: (1) The primary le-
sion is uncontrolled; (2) The primary
lesion extends to or beyond the midline of
the oral cavity; (3) The primary lesion is
shown to be of undifferentiated cell type;
(4) No metastatic nodes are present; (5)
The involved nodes are fixed or matted to-
gether; (6) Contralateral or bilateral cer-
April, 1950
147
vical metastases are present; (7) Distant
metastases are present; and (8) The patient
is in poor general condition.
After the decision has been made to do
a neck dissection, the question arises as to
when is the optimum time. Here again only
generalized facts can be stated. The primary
lesion should he under control, and several
weeks should elapse before the primary
treatment and the neck dissection are per-
formed, on the theoretical grounds that this
interval would allow cells loose in the reg-
ional lymphatics time to reach the regional
nodes. Ideally, it would be good if we could
do a complete excision and dissection in
continuity as in breast cancer, but it cannot
often be done in neck surgery. This is prac-
tically impossible. Occasionally this is nec-
essary and done when we perform a “Com-
mando procedure”, such as removing a sec-
tion of the jaw combined with a radical
neck.
For the most part we use two types of
neck dissections, the supraomohyoid dis-
section and the radical or complete neck
dissection. The supraomohyoid dissection
is used generally: (1) when only one node
is detected high in the neck; (2) when one
side has had a radical and a gland is felt
high on the other side; or (3) when the
lesion extends slightly across the midline,
seen at times in a lip lesion. It is my feel-
ing that when a single dissection is done a
radical procedure is the one of choice. Gen-
erally speaking, it is a formidable proced-
ure, but actually the mortality is low,' given
by some between 1 and 4 per cent, and the
resultant defect in appearance and function
is small.
Dissection is done through a Y-shaped
incision with the long limb over the anterior
border of the sternomastoid muscle and the
short limb toward the hyoid bone. The
block excised contains the subcutaneous tis-
sue and fascia, the platysma, the sternomas-
toid, internal jugular vein, submaxillary
gland, tip of the partotid gland, and the en-
closed lymphatics and other tissues. The
dissection extends internally down to the an-
terior scalene, levator scapuli, trapezius,
and the myohyoid muscles. The carotid
arteries, vagus nerve, hypoglossal nerve,
phrenic, and spinal accessory nerves should
he saved by careful dissection, except in
certain cases in which the metastasis has
extended to involve these structures.
The area dissected is further bordered by
the trapezius muscle inferiorly across the
top of the clavicle and manubrium of the
sternum and anteriorly to the thyroid, above
along the ribbon muscles to the hyoid, across
the midline to the opposite point of the chin.
The skin flaps are closed with drainage, and
a light pressure dressing of mechanic’s waste
is applied.
There is one condition necessitating a
radical neck dissection which requires spe-
cial consideration; that is, malignancy of
the thyroid, as this tends to metastasize both
by veins and lymphatics. The dissection of
the submaxillary triangle may be omitted,
but the entire thyroid on the affected side
with the isthmus and a subtotal thyroidec-
tomy on the opposite side should be includ-
ed. Contrary to neck dissections for epider-
moid carcinoma, radical thyroidectomy
should be followed by x-ray irradiation to
the thyroid area and neck. ,
I wish to call to your attention the so-
called lateral “aberrant” thyroid tumors,
which tend to occur in a younger age group
than does cancer in general or than does thy-
roid disease. The presenting finding is usu-
ally a swelling or nodule in the lateral side
of the neck, and the disease often recurs
locally unless complete eradication is per-
formed by surgery. The concensus of opin-
ion at the present time appears to be that if
the mass along with the lobe of the thyroid
on that side is removed that the condition
will be cured and that in the majority of
148
The Journal of the Medical Association of Georgia
cases there is a metastasis from the lobe
of the thyroid on that side of the cervical
glands. In a large percent of these cases
the “mother tumor” is beyond clinical rec-
ognition hut has to he picked up by very
careful microscopic examination. As these
tumors are slow-growing anyhow, follow-up
examinations must be made over decades
rather than years.
We are all interested in what disability
or disturbance of function to expect after
carrying out the above-mentioned radical
procedures. Surprisingly, they are small.
Probably the most common one is a slight
weakness of the lower lip due to injury of
the lowest branch of the facial nerve and a
shoulder drop due to injury or severence of
the eleventh nerve. Accidents to the recur-
rent laryngeal, vagus, phrenic, hypoglossal,
and lingual nerves do occur but should for
the most part be avoided. Clinically, re-
moval of the sternomastoid, omohyoid, and
ribbon muscles has little functional effect.
Summary
Neck dissections may be simple or more
difficult depending upon the type and nature
of the lesion and the location. For diagno-
sis, lesions are divided into two main groups,
midline and lateral. From a treatment angle
dissections are classified as simple dissec-
tion, diagnostic (biopsy), and radical. Spe-
cial consideration should be given to dis-
sections for carotid body tumors, lateral
“aberrant” thyroid tumors, and thyroid
malignancies. The indications and contra-
indications for neck dissections due to can-
cer are given. The disability or disturbance
of function and appearance is surprisingly
small.
bibliography
1. Braund, Ralph R., and Martin, Hayes E. : Distant Metas-
tasis in Cancer of the Upper Respiratory and Alimentary
Tracts, Surg., Gynec_ & Obst. 73: 63-71 (July) 1941.
2. Cole, W. H. : Slaughter. D. P., and Rossiter, L. : Potential
Dangers of the Non-toxic Nodular Goiter, J.A.M.A. 127 : 14
(April 7) 1945.
3. Brown, J. B., and McDowell, F. : Neck Dissections for
Metastatic Carcinoma, Surg., Gynec. & Obst. 79: 115 (Aug.)
1944.
4. Blair, Vilray P. ; Brown, J. B., and Byars, L. T. : Our
Responsibility Toward Oral Cancer, Ann. Surg. 106: 568-576
(Oct.) 1937.
5. Kennedy, R. H. : Epithelioma of the Lower Lip, Ann.
Surg. 106: 577-583 (Oct.) 1937.
6. Martin, Hayes E. : The Treatment of Cervical Metastatic
Cancer, Ann. Surg. 114: 972-986 (Dec.) 1941.
7. Taylor, G. W.: Evaluation of Regional Lymph Node Dis-
section in the Treatment of Carcinoma, New England J.
Med. 226: 367 (March 5 » 1942.
PILONIDAL CYST AND SINUS
A Simple, Ambulatory Surgical Treatment
Needham B. Bateman, M.D.
William H. Bateman, M.D.
Gregory W. Bateman, M.D.
and
Joseph D. Woddail, M.D.
Atlanta
For the sake of brevity reference will not
be made to the etiology, incidence, path-
ology, symptoms and diagnosis of this con-
dition inasmuch as excellent descriptions
and discussions of these phases are abun-
dantly available in the current literature.
Treatment for this condition is surgical
and must include the care of the acutely in-
fected or abscessed pilonidal cyst or sinus
and the chronically infected or quiescent
lesion. In years gone by, especially before
the availability of the sulfa drugs and peni-
cillin, the abscessed sinus or cyst would be
incised and drains inserted. A period of
varying length passed during which the
patient had repeated dressings, hospital or
office care, and usually did not engage in
his regular occupation to the fullest extent.
Both the patient and the doctor were waiting
and working for the time that the necessary
surgery could be done to effect a cure. Not
infrequently the area would abscess re-
peatedly before the surgeon could bring
about sufficient improvement to justify com-
plete excision. This delay and treatment
was a great handicap to the patient, as well
as disturbing to the employer, and undesir-
able to the attending physician.
Therefore it becomes apparent that a
simple operation that can be used in the
case of pilonidal disease, regardless of its
Read before the Medical Association of Georgia in annual
session, Savannah, May 13, 1949.
state of infection, would be most desirable
to all concerned. On reviewing the litera-
ture and the results of over 800 personal
cases it becomes evident that really only
two methods of treatment exist; namely,
(1) surgical removal and suturing or closed
method; (2) surgical removal and packing
or open method. Of course numerous sur-
geons have recommended and used modifica-
tions of these two methods with varying sta-
tistical results. The advocates of the closed
methods have claimed anywhere from 45 to
92 per cent healing by primary intention.
They also list recurrences varying from 12
to 37 per cent. These surgeons claim shorter
hospitalization and more comfortable scars
for the closed method. On the other hand,
advocates of the open method claim to have
reduced recurrences to as low as 3 per cent.
In a few words, an uncomplicated operation
suitable for any case of pilonidal sinus or
cyst that will enable the operator to (1) re-
duce recurrences to a minimum; (2) return
the patient to ambulation and employment
in the shortest possible time; (3) give the
patient a comfortable scar when healed and
(4) involve very little if any discomfort to
the patient, is the operation to be desired.
Such an operative procedure is to be herein
described.
If the patient does not have an abscess or
is not acutely infected he is given a prelim-
inary examination to rule out the presence
of any disease or condition that will inhibit
or retard natural healing. If he shows any
of the gross signs of inadequate nutrition
these are called to his attention. He is then
given a balanced diet list along with instruc-
tions to correct any nutritional defects, as
well as advised to secure necessary dental
repair and obtain adequate sleep, and exer-
cise. He is also given multiple vitamin cap-
sules in the maximum dose. If possible a
period of six to twelve weeks is allowed to
enable the patient to reach the peak of nor-
mal nutrition. As these patients feel better,
and it is explained to them that all of these
things are being done to increase their com-
fort and shorten their healing time follow-
ing operation, it is remarkable how fully
they cooperate. On the other hand if the
patient does have abscess or is acutely in-
flamed, or for some other reason cannot wait
for the usual preparation, operation is ad-
vised immediately. In the case of abscess
the top of the abscessed cavity as well as the
top of any ramifying portions of the sinus
are excised leaving the posterior wall of the
abscessed cavity or sinus. Since the cyst
lining is epithelial and exposure to the sur-
face causes it to lose its secretory function
it is well to preserve this tissue when it is
found practical to do so. This is a modifi-
cation of the marsupialization operation as
performed by Buie and others. However,
less than 10 per cent of the patients seen
in private practice suffering from pilonidal
disease are such that any part of the cyst
wall can be safely left in. Therefore the
entire cyst or sinus is excised in over 90
per cent of the cases. Dye is not used since
it only makes more difficult the identifica-
tion of the tissue to be removed. The skin
edges are sutured with continuous silk or
cotton, kept taut so as to control skin and
subscutaneous bleeding, and other bleeders
are ligated with plain catgut. The cavity is
packed loosely with fine mesh gauze, the
gauze sprinkled generously with sulfa crys-
tals, and a large dressing is applied with
adhesive. The patient is allowed out of bed
in three to six hours depending on the type
of anesthetic he has had. General diet and
multiple vitamin therapy are resumed as
soon as tolerated. At the end of 72 hours
Sitz baths are started. If possible the patient
is allowed to sit in plain hot water for
V2 hour three to four times daily. If the
patient experiences much pain, as is some-
times the case where there was an abscess
150
The Journal of the Medical Association of Georgia
or acute infection, heat is applied between
baths with an infra-red lamp and wet dress-
ing of tyrothricin, 1:5000, is kept in place
throughout the night until the infection is
completely controlled. The patient is al-
lowed to leave the hospital between the
fourth and sixth postoperative days. He
continues his treatment at home, using a
simple T binder made from two or three
inch gauze bandage to hold his dressing in
place. He may resume light duty in five to
eight days postoperatively, and is usually
healed completely and ready for his usual
work in 15 to 20 days postoperatively.
Until completely healed he comes to the
office twice each week in order that his
progress may be checked.
T he end result leaves very little scar as
you will see from the postoperative photos
on the slides to follow. This is due mainly
to three things; namely, (1) the removal
of only the minimal amount of tissue and
skin; (2) sharp dissection and keeping tis-
sue damage to a minimum; and (3) proper
nutritional state of the patient. The granu-
lating incision having been kept healthy
the skin edges grow out to meet thereby re-
ducing the width of the strip of scar tissue
on the surface when it is healed.
Conclusions
1. This simple procedure is suited to all
cases of pilonidal disease, both acutely in-
fected or abscessed and quiescent.
2. It reduces recurrences to a minimum.
3. Hospital care is greatly shortened, and
the patient is ambulatory.
4. There is little discomfort to the pa-
tient, and postoperative care is simplified.
5. A comfortable scar results.
6. Loss of time from work is markedly
reduced.
7. The patient’s general health is bene-
fitted by the preoperative and postoperative
treatment he receives.
8. This procedure is easily carried out
by any surgeon even if he sees compara-
tively few such cases.
REFERENCES
1. Ziegler, Hrolfe R. ; Murphy, David R.. Jr., and Meek,
Edwin M.: Pilonidal Cyst and Sinus, Surgery 20: 690-103
(July-Dee.) 1946.
2. Emery, Fredric R. : The Surgical Treatment of Pilonidal
Cyst and Sinuses. J. Kansas M. Soc. 209: 218-219, 1948.
3. Behrend, Albert: The Surgical Treatment of Chronic
Infected Pilonidal Sinus, S. Clin. North America, 10: 1507
(Nov.) 1946.
4. Rosser, Curtis, and Kerr, Jack G. : Pilonidal Disease —
Present Status of Management, J.A.M.A. 133-13-1003 (April)
1947.
5. Roddenberry, S. A., and Rizzuto, M. P. : Observations on
the Effects of Tyrothricin in Postoperative Pilonidal Cyst
Wounds. Ann. Int. Med. 27: 106-110 (July) 1947.
6. Buie, L. A.: Jeep Disease (Pilonidal Disease of Mechan-
ized Warfare) South. M. J. 37 : 103-109, 1944.
GASTRO INTESTINAL ALLERGY
IN CHILDREN
Harold W. Muecke, M.D.
W ay cross
The purpose of this discussion is to con-
sider some of the gastro-intestinal allergic
manifestations in children and to suggest
their relationship and similarity to certain
symptoms which occur in adults and which
are not generally considered as having an
allergic basis. In this brief discussion no
attempt will be made to consider extra-
gastro-intestinal allergic signs and symp-
toms, such as angioneurotic edema, urti-
caria, eczema, migraine, allergic rhinitis,
asthma, and so forth, any one of which may
result from the ingestion of food to which
the individual is over-sensitive; but only
evidences of local allergic irritation to the
gastro-intestinal tract will be taken up.
Gastric Manifestations
Not infrequently one sees infants who be-
gin to vomit as soon as they take food
(breast milk) . Others may take breast milk
well and begin to vomit when cow’s milk is
begun. Still others do well on milk and
begin to vomit only when other articles of
food are added to their diet, such as eggs,
orange juice, chocolate, nuts, and so forth.
In other words, one may encounter allergic
vomiting at any stage of childhood, depend-
ing upon when the exciting substance which
Read before the Medical Association of Georgia in annual
session. Savannah, May 13, 1949.
April, 1950
is responsible for the symptoms of vomiting
becomes a part of the diet. I do not mean to
give the impression that vomiting is a very
common symptom of allergy, or that allergy
figures very prominently as a cause when
we consider all the vomiting that occurs in
children. Just as allergy produces many
symptoms other than vomiting, so vomiting
has many causes other than allergy. The
point is that when allergy is the cause of
vomiting, the vomiting tends to he of a per-
sistent nature and no relief is obtained
unless the causative factor is recognized
and removed completely or unless chance
removes the cause for us, which not infre-
quently happens.
The earliest type of allergic vomiting
which we see is that in small infants which
begins when the infant first takes food, or
soon after. In these infants hypertrophic
stenosis of the pylorus is nearly always
thought to he the cause of the vomiting.
And, of course, probably in the majority of
instances of persistent vomiting at this pe-
riod, it is the cause. However, I have seen
a number of infants with early persistent
vomiting whose condition had been diag-
nosed hypertrophic stenosis of the pylorus
but whose symptoms were relieved only
when it was found that they were sensitive
to milk and when the cause of the trouble
was removed. I also know of five infants
who were operated on in various hospitals
for hypertrophic stenosis of the pylorus, but
were found to have no hypertrophy. Later
their symptoms were relieved when the
a Her gic nature of the condition was discov-
ered and the causative factor was removed.
A few months further up the scale of in-
fancy we not infrequently encounter vomit-
ing when new articles of food are added to
the diet. This of course does not necessarily
mean that the child is over-sensitive to the
new food unless the vomiting occurs each
time the food is given, and even then one
looks for additional evidence to prove aller-
gy is the cause. A family history of allergy
in the mother, in the father, or in both is
usually present when the infant presents this
particular symptom of allergy. A positive
skin test to an extract of the food is usually
present. This, however, is not always so,
just as in adults. Other allergic manifesta-
tions in the patient such as urticaria or
eczema should be sought for, but such skin
manifestations do not usually occur coinci-
dentally with the gastro-intestinal manifes-
tations of allergy. In older children one
may get a history of previous skin manifes-
tations. Finally, strong supporting evidence
of the true nature of the condition is ob-
tained if there is a cessation of symptoms
upon eliminating the suspected food from
the diet, and if there is a recurrence of
symptoms when the food is again added to
the diet. Unfortunately, the situation not
infrequently is complicated by the fact that
there is in the diet more than one food to
which the child is sensitive.
It is usually later on in childhood that
we meet the familiar condition called cyclic
or recurrent vomiting. Attacks of cyclic or
recurrent vomiting may not always be due
to allergy, but I have had occasion in the
case of several children to prove their aller-
gic basis. For example, one 10-year-old girl
had had a number of attacks of cyclic vom-
iting. She was found to be skin sensitive to
milk. As long as milk and milk products
were left out of the diet there was no trou-
ble. Another child had attacks once a year
when he went to the circus. The attacks were
attributed to excitement and exhaustion, but
on further questioning it was found that he
ate peanuts only during his visit to the cir-
cus, and when tested to peanuts he was found
to he sensitive. The parents doubted the
validity of our suggestion that peanuts were
responsible for his trouble and somewhat
later gave him peanuts. A severe attack
followed. By accident the experiment was
repeated several times with the same results.
152
The Journal of the Medical Association of Georcia
There is further evidence and support of
the allergic nature of cyclic vomiting in that
a number of the adults who suffer with mi-
graine give a history of cyclic vomiting
during childhood. This, of course, presumes
that migraine is an allergic manifestation.
Intestinal M ani festations
Again, early in infancy one sees children
who do not vomit, but who have severe in-
testinal symptoms, such as colic, frequent
bowel movements containing mucus, and
the passage of a great deal of gas by bowel.
The frequent movements are not watery as
in diarrhea, but are soft, are apt to be small,
and nearly always contain mucus. The colic
mentioned here is genuine colic and not
mere hunger pains which so frequently are
called colic. This type of manifestation is
similar to much of the mucous colitis of
adults. In children, however, one seldom
sees the spastic type of colitis. These chil-
dren gain weight well and develop well if
given an adequate amount of food, but al-
most run the family crazy until relief from
their pain is obtained by finding the cause
of their trouble and removing it. As op-
posed to other children who may tempor-
arily have similar symptoms due to other
causes, these small infants are not ill but
are merely very uncomfortable. The aller-
gic nature of this condition is readily sus-
pected if one has had previous experience
with such infants, but proof of the diagnosis
is to be obtained only by more or less the
same methods as those indicated above in
connection with vomiting. Symptoms like
these may occur during any stage of child-
hood and even in adults. For example, a
small child who had suffered for two months
with the above-mentioned symptoms was
found to be sensitive to milk and was com-
pletely relieved when he was placed on a
dried milk preparation which of course had
been heated. Various fresh milk prepara-
tions had been tried with no benefit. The
probable explanation of the relief which
these children often get when placed on a
milk preparation which has been subjected
to prolonged heating is that there are two
factors in milk to which they may become
sensitive and one is apparently heat labile.
This is the explanation offered in 1932 by
Lewis and Hayden and which has stood the
test of time. Another older child (12 years
of age) passed a great deal of gas, had soft
bowel movements containing much mucus,
and had colicky pains in the abdomen. He
was found to be sensitive to chocolate and
on repeated occasions later his symptoms re-
curred following the ingestion of chocolate.
Still another patient (an adult) who had
complained of marked abdominal pain for
three years, and for a year had had typical
severe mucous colitis symptoms, was found
to he sensitive to milk and on removal of
the milk and all milk products from his diet
all symptoms disappeared and his weight
rapidly rose from 130 to 200 pounds. He
was six feet two inches tall, very much under
weight and had made milk and various milk
drinks a constant part of his diet for the
purpose of improving his physical condi-
tion. Probably because of the constant pres-
ence of milk in his diet he had become sus-
picious of the bad effects of almost every-
thing he ate. On two occasions later the un-
intentional addition of milk products (fro-
zen custard and Swiss cheese) to his diet
resulted in the recurrence of a marked de-
degree of his previous symptoms.
There is another group of individuals
whose symptoms probably come from intes-
tinal irritation, in whom abdominal discom-
fort is the chief complaint. Their symptoms
in general are similar to those of the group
described above except that the bowel move-
ments as a rule are not frequent. Some of
these individuals are indeed constipated.
The members of this group are usually old-
er children and adults. The symptoms in
certain cases have been repeatedly produced
April, 1950
by giving to the patients food to which they
are sensitive. In some instances there is dull
pain, and in others sharp cramp-like pain.
For example, one boy who had had attacks
of cyclic vomiting for several years began
to have abdominal discomfort later which
prevented his sleeping and caused him trou-
ble during most of the day from time-to-
time. These latter symptoms had continued
for three or four years when we first saw
the boy and found him to be sensitive to
chocolate and tomatoes. These two articles
of food were removed from his diet follow-
ing which there was complete relief from
discomfort and a gain of 10 pounds in
weight during the next month. While I have
had no opportunity to prove the presence of
spasm of the intestine in these cases, its
occurrence is suggested by the fact that re-
lief of symptoms sometimes results from
the administration of atropine. There is
much reason also to believe that the entero-
spasm, which is sometimes the only finding
when the abdomen is explored surgically
for appendicitis or intestinal obstruction, is
of this nature. In some cases the severe pain
followed some time later by vomiting might
quite naturally suggest intestinal obstruc-
tion. Relief has been obtained in just this
type of patient from the administration of
atropine. I recognize the danger of assum-
ing that symptoms like these have an aller-
gic basis, and of course one should never
make tins assumption except as a last resort
because of the great danger of missing other
abdominal conditions with like symptoms
which produce more serious consequences if
the surgeon does not intervene. However,
repeated attacks of this type not localized
to the appendix region, associated with eat-
ing of certain foods and occurring in a pa-
tient with a personal or family history of
allergy, should always be suggestive of an
allergic etiology. In many instances the
confirmation of positive skin tests may be
obtained.
After one finds the food or foods which
are responsible for the allergic symptoms,
treatment consists of removing the offending
foods from the diet, or of modifying the
food so that it will not cause symptoms, or
of modifying the patient’s response to the
food. For example, if a patient is found to
be sensitive to chocolate it is not difficult to
eliminate chocolate from the diet. Elimina-
tion of the offending food, if this is possible,
is the most simple method of treatment and
produces the most clear-cut results. How-
ever, if a small infant whose sole article of
diet is milk is sensitive to that milk, then
elimination is difficult. In this case it has
been found that cow’s milk that has been
subjected to varying degrees of heat, such
as dried milk or evaporated milk, may be
taken without producing symptoms, when
fresh milk cannot be tolerated. One of the
factors in cow’s milk to which children
often become sensitive can be completely or
partially destroyed by heat. If this modifi-
cation of milk does not result in relief of
symptoms it then becomes necessary, if the
symptoms are severe enough, to change to
some other food, such as goat’s milk or in
some instances to soy bean preparations.
In older children where there is sensitive-
ness to several foods, and elimination would
unduly restrict the diet, the patient’s re-
sponse to these foods usually can be modi-
fied through a process of what one may call
desensitization. Patients themselves have a
tendency to carry out this desensitization
through repeatedly taking the foods to which
they are sensitive, provided they do not take
enough to produce severe symptoms. This
is what the layman calls “out-growing” the
condition. Desensitization to a food can be
carried out through starting the patient on
infinitesimally small amounts of the food
by mouth and by gradually increasing the
amount or by the injection of extracts made
from the particular food or foods to which
154
The Journal of the Medical Association of Georgia
the individual is sensitive. One must go
slowly enough to avoid the production of
symptoms if possible. This requires a great
deal of patience, but we have successfully
desensitized a number of infants to eggs in
this manner. The subcutaneous injection is
more rapid, but one should begin with an
amount sufficiently small so as to be sure
that no demonstrable reaction occurs. We
often begin with as weak a dilution as
1:1,000.000. or even less if the sensitive-
ness is severe. In this way we have success-
fully desensitized a number of children to
foods to which they are sensitive, or at least
have made it possible for them to take these
foods without discomfort — foods, the inges-
tion of which previously produced severe
symptoms.
The above methods not infrequently are
attended by discouraging results. Failures
in many instances may be due to lack of
patience, or may be explained by the fact
that treatment has not included all the foods
which are contributing to the symptoms.
I am well aware of the fact that all of this
is quite familiar to those working especially
in the field of allergy, but the discussion
seemed justified because of the fact that we
continue to see large numbers of patients be-
longing to this group whose symptoms have
received abundant unsuccessful treatment
without any thought having been given to
allergy as the probable etiologic factor.
HEALTHGRAM
The family is engaged in a variety of activities asso-
ciated with homemaking. housekeeping, and child care
with which we are so familiar that we often fail to
realize their significance. If there is to be any effective
health care and preventive medicine, as distinguished
from treatment of the sick, it cannot be provided by
doctors, nurses, or other professionals — however much
their knowledge and skills may be needed by the family.
Health care and preventive medicine are carried out in
the daily activities of housekeeping and homemaking.
Through marketing, cooking and the serving of meals,
basic nutritional needs must be met, and through house-
cleaning, laundering, dishwashing, and similar sanita-
tion, the necessary defense against infections and con-
tamination must be maintained. Through provision of
rest, care of minor ills, and all the cherishing functions
within the home, individual members are protected and
restored, so that they can live in health and carry on
their daily activities. Lawrence K. Frank, The Survey,
Dec., 1949.
NEWCASTLE VIRUS DISEASE
Report of Four Probable Cases
Edwin R. Watson, M.D.,
and
Marvin M. Harris, Ph.D.
Macon
Great interest in Newcastle virus disease
of chickens was stimulated by the report of
Howitt. Bishop, and Kissling1 in 1948. show-
ing neutralizing antibodies against New-
castle disease virus in high titer in the sera
of 14 children in Tennessee. Neutralizing
antibodies were also found in high titer in
the sera of 8 adults who had a mild central
nervous system disurbance. Antibodies in
high titer were also found in 6 laboratory
workers who experienced an acute influenza-
like infection. To quote Howitt1 et al:
‘‘Although no virus has been isolated, it
seems probable from the evidence presented
that the Newcastle disease virus of fowls
is the agent responsible for many of the
atypical central nervous system infections
that have been reported in man during the
past few years, and that, as in the fowl, the
manifestations are neurological in young
individuals and influenza-like in the adult".
REPORT OF CASES
Case 1. E. G., colored male 7 years of age, was ad-
mitted to the Macon Hospital 11-6-48 in a comatose
condition. For two weeks prior to admission, patient had
a cold and slight cough, with non-tender swelling of
the head in the parotid area on the right side. Patient
experienced a severe convulsion just prior to admission
to hospital. Three other convulsions occurred the after-
noon of admission. There was no fever. There was no
past history of convulsions. Family history was negative.
Physical examination showed a normally developed 7
year old male. Skin normal. Temperature 98.6°F.
Blood pressure 140/100 (after convulsions). No stiffness
of neck, and pupils reacted normally. Ears normal.
Tonsils hypertrophied. There were a few scattered rales
throughout both lung fields. Heart, abdomen, and ex-
tremities normal. Chest x-ray showed accentuated bron-
chiovascular markings bilaterally. Patient was very irri-
table and appeared irrational. I rine was normal. Kahn
and tuberculin tests were negative. Five days later white
blood cell count was 8.800 with 58 per cent lymphocytes.
Spinal fluid had a cell count of one lymphocyte. Smear
and culture of spinal fluid were negative. Blood collected
11-9-48, (approximately 3 weeks after onset of illness)
showed no neutralizing antibodies against the viruses of
eastern and western equine encephalomyelitis. Neu-
tralization index of 2190 was obtained against Newcastle
Read before the Medical Association of Georgia in annual
session, Savannah, May 13, 1949.
April, 1950
155
disease virus. Two months later the neutralization index
against Newcastle disease virus was 1520.
Patient became rational 2 days after admission and
was discharged as well 7 days following admission. Re-
peated spinal laps during this period yielded negative
spinal fluid findings. Impression at time of admission:
mumps, encephalitis and possible early pneumonia. Final
diagnosis: Newcastle virus disease. Patient had no con-
tact with chickens as far as could be determined.
Case 2. F. A. M., white male, aged 6, was admitted to
the Macon Hospital 12-31-48 with fever 103°F. and
moderate stiffness of neck. Patient was apparently well
until the day before when he developed a severe head-
ache and vomited several limes during the day with
development of fever 1 103°F.J . Physical examination
revealed a well developed child who was febrile but did
not appear critically ill. Only positive finding was
moderate stiffness of neck. White blood cell count was
9,400 with 83 per cent neutrophiles. Urine was normal.
Spinal fluid had a cell count of 70 with 86 per cent
neutrophiles. Total protein was 40 mg. Smear and cul-
ture of spinal fluid were negative. Day after admission
patient's temperature reached 104°F. X-ray of chest
showed moderate accentuation of the bronchiovascular
markings in the roots of both lungs. Blood collected
1-3-49 (5 days after onset) gave a neutralization index
of 317 for Newcastle disease virus. Eight days after onset
index was 1480 for Newcastle disease virus. This speci-
men of blood gave a negative complement fixation test
for mumps, and negative neutralization tests for eastern
equine encephalitis and lymphocytic choriomeningitis.
Clinical impression on admission was “virus meningitis”.
Final diagnosis: Newcastle virus disease. Patient was
discharged as improved 5 days after admission. This pa-
tient had possible contact with chickens prior to becom-
ing ill.
Case 3. T. J., colored male, aged 16 years, was ad-
mitted to the Macon Hospital 1-28-49, in a semicomatose
condition. The day before while playing basketball he
became faint, and was “light-headed” with “foaming at
the mouth”. He remained semicomatose for 48 hours
after admission. Physical examination showed a well-
developed 16 year old colored male, semicomatose with
weakness in the right arm. Blood pressure was 150/90.
Temperature 101 “F. There were no other physical
abnormalities except for poor to absent reflexes. White
blood cell count was 11.400 with 80 per cent neutro-
philes. Urine negative. Blood Kahn negative. Spinal
fluid 1-28-49 (on admission) showed 109 cells with 62
per cent lymphocytes, total protein and sugar were
normal. Smear of spinal fluid was negative. On 1-29-48
spinal fluid had 97 cells with 83 per cent lymphocytes.
Colloidal gold test negative. On 2-2-49, spinal fluid had
56 cells with 94 per cent lymphocytes. Smear and cul-
ture of spinal fluid were negative. On 2-7-49 (10 days
after admission) spinal fluid showed 36 cells, all lym-
phocytes. Spinal fluid Kahn was negative, with total
protein and sugar normal. Patient’s temperature reached
103.6° F. the night of admission and gradually came down
to normal on the fifth day. Blood collected 1-31-49 (7
days after onset) gave a negative neutralization index
for eastern equine encephalitis and a positive neutraliza-
tion index of 21,900 for Newcastle disease virus. Three
weeks after onset, neutralization index for Newcastle dis-
ease virus was 10,000. Six weeks after onset, the index
for Newcastle’s was 813. Working diagnosis on admis-
sion was cerebrovascular accident which was later
changed to lymphocytic choriomeningitis. Final diag-
nosis: Newcastle virus disease. Subsequent history
elicited after discharge showed patient had been in con-
tact with chickens.
Case 4. T. M., white male, 7 years of age, was admitted
to the Macon Hospital 3-6-49 with chief complaint of
headache the day before, followed by vomiting and
fever 102°F. Reflexes were hyperactive and initial im-
pression was meningitis. Physical examination revealed
a well developed child who was febrile but did not
appear acutely ill. On admission white blood cell count
was 16.750 with 84 per cent neutrophiles. Urine was
negative except for 1-f- acetone. On 3-8-49. the white
blood cell count had dropped to 8.250 with 44 per cent
neutrophiles and 56 per cent lymphocytes. On admis-
sion, spinal fluid showed 822 cells with 75 per cent
lymphocytes, 60 mg. of protein, normal sugar. Smear
and culture of spinal fluid were negative. Tentative
diagnosis at this time was lymphocytic choriomeningitis.
Blood collected 3-9-49 (4th day of illness) gave a
neutralization index of 132 for Newcastle disease virus
and a 4-)- complement fixation test for mumps titer
1-4. Blood collected 3-14-49 (9 days after onset) gave a
neutralization index of 1480 for Newcastle disease virus,
and a 4+ complement fixation test for mumps — titer
1-32. Patient's temperature on admission was 102° F.
and reached 103° F. two days later and gradually came
down to normal after 8 days’ hospitalization. Patient was
discharged improved.
This child had possibly been in contact with neigh-
bor’s chickens. The child had no history or signs of
mumps. Since a low titer (4+ 1-4) complement fixation
test for mumps was obtained on the fourth day of illne-s
and this titer rose on the 9th day ( 4— (— 1-32) it is pos-
sible that we are dealing here with a case of mumps
encephalitis which gave cross-neutralization tests for
Newcastle disease virus. On the other hand, since the
neutralization index rose from 132 on the fourth day to
1480 on the 9th day, a marked rise in titer in 5 days*
we feel that this is a case of Newcastle virus disease
in which complement-fixing antibodies for mumps from
a previous unrecognized mild mumps infection were
restimulated by the Newcastle disease virus — an anam-
nestic reaction. Final diagnosis was therefore made as
Newcastle virus disease.
Summary
Four cases are presented in which anti-
bodies were present in the blood in high
titer for Newcastle disease virus. Two cases
could be classed as severe since they were
admitted to the hospital in a semicomatose
condition. The other two cases were mild
in nature with chief complaint of headache,
vomiting, and fever, with some stiffness of
the neck in one case. All four cases showed
some meningeal irritation or meningitic-like
symptoms and all cases recovered rapidly
without sequelae. Three of the four cases
had contact with chickens. Although the
virus of Newcastle’s disease was not iso-
lated from any of the cases, the high blood
titer of antibodies for Newcastle disease
virus would seem to point to the fact that
these cases had been in contact with the
virus. Newcastle virus disease should be
included as one of the possible diagnoses in
all cases in which neurotropic virus infec-
tion is suspected.
Acknowledgment: It is a pleasure to acknowledge our
indebtedness to Miss Beatrice Howitt, bacteriologist in
charge of the U.S.P.H.S. Virus Laboratory, Montgomery,
Alabama, who performed the virus tests.
Note: For virus studies of the blood, 20 cc. or more of
156
The Journal of the Medical Association of Georgia
sterile clotted blood should be submitted for examina-
tion.
Addendum: Vfter this paper was prepared and just
prior to this presentation, we received a communication
from Miss Howitt to the effect that there is a heat-labile
factor that may be responsible for the positive neutraliza-
tion tests against Newcastle disease virus which probably
has no real connection with this virus. Research, which
is still in progress, seems to indicate lhat there is another
virus, as yet unidentified and unrelated to Newcastle's,
which may be the real etiologic agent in such cases as
presented. These results bring out some of the difficul-
ties and problems in virus research today. Steady
progress, however, is being made and the virus or viruses
responsible for such cases as here presented will un-
doubtedly be identified in the near future.
REFERENCE
Howitt, Beatrice F., Bishop, Lindsay K., M.D., and Kissling.
Robert E., D.V.M., “Presence of Neutralizing Antibodies of
Newcastle disease virus in Human Sera”, Amer. Jour. Pub.
Health, Sept. 1948, Vol. 38, No. 9, Pp. 1263-1272.
MASKED HYPOTHYROIDISM AS A
BASIS FOR SYMPTOMS
W. Edward Storey, M.D.
Columbus
It is obvious that the readiness with which
one recognizes any diseased state depends
upon the constancy with which he' hears it in
mind. Every physician has experienced de-
lay in arriving at a correct diagnosis lie-
cause he failed to remember it while weigh-
ing the several possibilities in a given situa-
tion. When the features of the case under
consideration are largely subjective and
common to various ill-defined disorders, the
lesson is difficult and the error likely to re-
cur. Nowhere is this better illustrated than
in thyroid dysfunction, especially under-
function in the milder grades.
It is doubtful whether any interested phy-
sician would fail to recognize a well devel-
oped case of myxedema or Gull’s disease.
The history of progressively reduced physi-
cal, mental and emotional vitality culminat-
ing in constant lethargy, the increasing body
weight, obstinate constipation, and marked
preference for warmth all point to the cor-
rect diagnosis. These and the puffed facies,
the thickened tongue and speech, the pallor,
the dry, brittle hair and one hardly needs a
From the Medical Service, Columbus City Hospital, Co-
lumbus.
Read before the Centennial Session of the Medical Asso-
ciation of Georgia, Savannah, May 13, 1949.
test of metabolism except for confirmation.
Unfortunately, however, for the sharpening
of one’s diagnostic acumen, this patient is
uncommon to say the least. It is the indi-
vidual whose complaints and findings are
less well manifested or who may even make
an entirely different impression who is like-
ly to escape recognition and to come even-
tually to be regarded as an inadequate per-
sonality. Indeed, many patients exhibit a
degree of physical and emotional agitation
whi ch suggest at once thyroid overactivity.
In such cases the report of lowered basal
metabolic rate may be received with sus-
picion or accepted with reluctance because
it is so contrary to that which had been
anticipated.
For present purposes, the effect of the
thyroid gland upon the body may be com-
pared to the effect of the damper upon a
stove. Efficient utilization of fuel for pro-
duction of heat depends upon proper ad-
justment. Over or under adjustment results
in excessive or deficient consumption of fuel
with corresponding change in output of
heat. It is the latter state with which one
may compare the several degrees of hypo-
thyroidism. The reduced supply of thyroid
catalysts reduces the rate of cellular chemi-
cal reactions, and is reflected in a lowered
rate of oxygen consumption as determined
by basal metabolic test. Such a reduced
rate of cellular oxidation is evident, sooner
or later, in reduced functional efficiency of
the tissues of the several organs and thus is
the basic cause of the multiple and scattered
clinical symptoms and signs. Tissues whose
optimal function is more delicately bal-
anced with oxidation will be affected first
and most. Others, not so dependent, will
be deranged later and less. Here the pa-
tient’s individual physiologic variations and
requirements must play a very large part in
the initial or predominating organ manifes-
tation and account for the diversity of chief
complaints. Therefore, for present clarity,
April, 1950
hypothyroidism may be regarded as a quan-
titatively variable state ranging from clini-
cally imperceptible changes through obvi-
ous illness, to disability and, if unrecog-
nized and untreated, to death. The clinical
features of the more advanced degrees of
this state are sufficiently uniform as to
deserve a name, myxedema. It is these fea-
tures of myxedema, sketched above, which
the average physician usually has in mind
when be thinks of hypothyroidism. There-
fore, when bis patient lacks them, he is
likelv to be misled into ruling out this diag-
nosis. Yet, from the present analysis, it
would appear that hypothyroidism may fre-
quently be the basis for a wide variety of
symptoms, even certain ones which suggest
the opposite state, namely hyperthyroidism.
Moreover, underfunction it seems must
reach the myxedematous level before the
usually expected features of that state be-
come apparent. Prior to attainment of that
low level, the diversity of symptoms is con-
siderable and only a small portion of cases
present features which arouse suspicion to-
ward hypothyroidism.
In 1000 patients, painstakingly studied,
various degrees of hypothyroidism occurred
89 times and this is 8.9 per cent of the total,
a substantial figure. It is entirely probable
that even more patients, among this total,
had thyroid underfunction but at least this
many were discovered. From this group, 50
cases were selected for the present analysis.
Only cases were chosen who bad two com-
parable basal metabolic tests done on sep-
arate days. In each case, total serum choles-
terol was determined.
The only medication given during the
period covered in this study was desiccated
whole thyroid substance orally (Armour’s).
Following establishment of diagnosis, the
usual plan was to prescribe 4 grains of thy-
roid daily, taken as one dose before break-
fast. At 10 to 14 days later basal rate was
157
redetermined and, if satisfactory, thyroid
dosage was reduced to a daily maintenance
level of 2 grains. In a few instances, a dose
of 6 grains was found necessary to achieve
satisfactory symptomatic and metabolic im-
provement and several patients required 3
or 4 grains daily for maintenance. As fur-
ther evidence that diagnosis and therapy
were correct, a few patients, who improved
satisfactorily, became careless in regard to
the daily maintenance dose. After a few
weeks most of the former symptoms began
to recur. Redetermination of basal rate
showed recession and resumption of a prop-
er dose again effected a good result.
So, if these patients may be accepted as
true examples of hypothyroidism, it is
profitable to analyze the symptoms which
brought them to the physician. Complaints
were always multiple, sometimes remark-
ably so, and occasionally it was difficult to
decide which predominated. Notwithstand-
ing this, they could be divided into 3 general
groups which are convenient for present
purposes:
1. The first group included 13 patients, or
about a fourth of the total, whose complaints
suggested, in some degree, myxedema. The com-
mon denominator among these complaints might
be stated as an unaccounted-for reduction in
physical, mental, and emotional vitality. The
particular variant of this might vary from patient
to patient as, for example: loss of strength, easy
fatigue, difficulty concentrating, loss of interest
in work or home, episodes of acute exhaustion,
failing memory or indifference to husband or
wife. There were other voluntary complaints
such as flatulence, constipation, increased nerv-
ous irritability or ill-defined pains, but these
were usually subsidiary in the patients’ own ap-
praisal and, where these were consistent with
myxedema, they were hardly ever of such severe
degree as found in that condition. Sometimes
direct interrogation elicited an acknowledgment
of dry skin or hair, preference for warmth, or
a clumsiness of gait, but the answers were un-
certain and therefore of doubtful significance.
Among this group the physical findings, except
for body weight, were seldom striking. Infre-
quently a mild simple hypochromia or a lowered
blood pressure or, perhaps, a less moist skin was
found, but these features are so common to other
ailments that interpretation was inconclusive.
158
The Journal of the Medical Association of Georgia
The impressive mongoloid facies of myxedema,
the brawny, non-pitting tissues, sparse hair and
eyebrows, cool, dry, branny, reptilian skin, thick-
ened tongue and blubbering speech, the compla-
cent attitudes and slow movements, the enlarged,
globular heart with a distant, one-tone tick and
the electrocardiographic features were all en-
tirely lacking in these cases. Therefore, if one
approached these patients mindful of Gull's de-
scription. he must surely pass them up as too
dissimilar. \et they all were proven to be cases
of hypothyroidism.
2. The second group included 18 patients, or
just over a third of the total. Almost invariably
these patients were given a metabolic test because
the examiner thought he was being smart enough
to sense an overactive thyroid gland. Here the
symptomatic common denominator might be ex-
pressed as increased nervous tension. Again there
were multiple features which overlapped, to some
extent, with the other groups, but basically the
general impression was just opposite to that of
the first group. There were speed, agitation,
overperformance, as contrasted to sloth, depres-
sion and underperformance. Individual variants
included excessive drive manifested as a com-
pulsion to constant activity, general restlessness,
an unwarranted anxiety and concern over trivial
or improbable matters, insomnia arid physical
tiredness yet inability to relax and rest, emo-
tionalism and emotional storms, paroxysmal
tachycardia, excessive appetite, and menstrual
dysfunction. In regard to menstrual disorders,
some of these patients, who were women in their
middle years with recent variations in menstrual
pattern, presented an impression which differed
in no important way from usual menopausal syn-
drome. Indeed, that diagnosis might justifiably
have been made from a symptomatic viewpoint
and estrogenic therapy used. Had they not re-
sponded well they would have remained, to some
degree, puzzles. Actually their response to thy-
roid was excellent, including regulation of men-
struation which thus far, over some months, has
remained so. Undoubtedly they will eventually
experience a cessation of menstruation, but as
yet it is too early.
Subsidiary complaints included occasionally a
sense of fullness in the region of the thyroid
gland and sometimes so-called choking spells.
In a few, the thyroid isthmus and/or lobes were
palpably or visibly enlarged to a slight degree.
In others a complaint of dryness or ill-defined
impediment to swallowing accompanied such
fullness of the gland. No bruit was heard in any
case. Most patients were of normal weight and
some were below the standard for age and height,
though none admitted progressive loss. Tachy-
cardia as a persistent feature was lacking and
none acknowdedged inappropriate sweating. Fre-
quently the undue drive alternated with periods
of simple physical exhaustion. Here again, flatu-
lence and constipation were about as common as
in the first group; there was no episodic diarrhea.
Notwithstanding the absence of flush and sweat, a
bounding heart, stare, tremor, thinness, or a full
gland and bruit, the possibility of masked hyper-
thyroidism made one keen to see the report of
basal metabolic test. It was these cases in which
the report, when rendered, was accepted with
some misgiving until sufficient experience was
accumulated to make it clear that thev were in-
deed instances of true hypothyroidism.
3. This group was composed of the remaining
19 patients. Their chief complaints were not
readily suggestive of any kind of thvroid dys-
function. Most of them came as diagnostic
problems and, in several instances, they had
first consulted one or more specialists who they
had believed were indicated for their particular
complaints. After varying periods, they were
either referred by such specialists for general
physical survey or, of their own accord, they
sought it.
Examples illustrating this circuitous approach
were 9 cases of headache. As may be imagined,
nearly all of them had been seen by one or more
specialists and usually they had purchased
glasses, sometimes several pairs. They had been
suspected of nasal, aural or dental disease, and
had been x-rayed and treated locally and sys-
temically for various suspected disorders of these
parts. Some of these headaches were regarded
as migrainous in nature, others as allergic or
psychogenic. Sometimes other features of a case,
such as flatulence or constipation, were blamed
and treatment directed to the stomach or bowel.
In one case, serious disease of the central nervous
system was suspected and lumbar puncture done.
The dynamics, chemistry and cytologv of this
fluid were all normal.
These headaches were as likely to be in one
area as another, though most were diffuse and
all were bilateral. They had recurred with in-
creasing frequency and duration over a period of
several years. Notwithstanding attention by com-
petent physicians they seemed to conform to no
recognized clinical pattern and thus no clear
idea had been developed regarding their nature.
No papilledema or objective neurologic signs
were found in any case. If one interrogated
these patients with hypothyriodism in mind,
some one or more corroborative features could
be elicited, but of course that is now hindsight
which is always easier than foresight. In retro-
spect, it is now obvious that, after careful history
and physical examination were completed, the
earlier basal metabolic rate and serum cholesterol
were determined, the more delay, suffering and
expense were spared.
The next most frequent complaint was scat-
tered muscular aches and soreness. These pa-
tients had suspected themselves of being rheu-
matic and sometimes it had seemed so to their
April, 1950
159
physicians because the matter is indeed often one
of opinion and not always subject to proof. More-
over, their ages made it seem reasonable. Some-
times they thought the discomfort was worse
during weather change or with the advent of
fresh infection such as a cold. Most often such
aches involved the neck, shoulders, back, hips and
thighs, and occasionally the calf. Interestingly,
it was symmetric in distribution and degree and
there was a striking lack of articular or periarti-
cular involvement. No rubor, calor or tumor was
acknowledged. Again, if sought for, corrobora-
tive signs warranting a suspicion of hypothy-
roidism were sometimes to be found in the forms
of rounded bodily contours, sallow complexion or
a history of constipation or reduced perspiration.
Otherw ise, they were easy to overlook or to attrib-
ute to other causes. Where x-rays had been made
they were either free of defects or showed nothing
conclusive. Proof that these pains were not rheu-
matic but, instead, due to hypothyroidism was
evident in their complete abolition after a suit-
able period of thyroid therapy. A further sub-
stantiating fact in this connection was the ten-
dency to accentuation of such pains shortly after
commencing thyroid and then rapid clearance, a
common experience when such pains are a part
of the better known syndrome of myxedema.
The remaining patients among this group, a
residual of some 7 cases, had chief complaints
suggesting a variety of non-thyroid disorders.
Among them were recurrent skin eruption, flatu-
lent dyspepsia, vertigo, and paroxysmal auricular
tachycardia with ventricular premature beats,
and a very severe emotional disorder. Had exam-
inations been less painstaking and less complete
there might be large room for doubt concerning
the relation of these complaints to hypothyroid-
ism. As they were, however, it is stated with
confidence that the evidence for thyroid under-
function was adequate and the evidence for other
causes lacking. Perhaps the relation was not
always a direct one in that some of the above-
mentioned states, whatever their basic etiology,
are known frequently to be provoked and aggra-
vated by increased nervous tension. Therefore,
since in group 2 such tension is seen to be a fre-
quent accompaniment of hypothyroidism, it is
believed to have served as the more immediate
basis which itself was present because of the
underfunctioning thyroid. Evidence supporting
this viewT is seen in the satisfactory symptomatic
result only after thyroid. When sedatives and
other measures directed to the tension alone had
been used, symptoms persisted.
W hile each of these cases presents its own
intriguing details, time will not permit their full
analysis. Instead, one case involving serious
emotional disorder will be sketched because it
illustrates so well the practical importance of this
subject. A 24-year-old white female had been
gradually adding a few pounds each year for
several years. Six months earlier she had be-
come unduly concerned over the welfare of her
husband and only child. She began to fancy all
manner of tragic situations involving them and
often she couldn't sleep at night for contemplat-
ing these. This led to periods of physical de-
pletion during which she was depressed, less com-
municative and apathetic. She became increas-
ingly incapacitated for her ordinary duties and
actually neglected her family in her anxiety or
depression over them. She felt unsure if not
suspicious of other relatives and, in general,
alarmed everybody by her unwarranted behavior.
For several years her husband had noted enlarge-
ment of the thyroid gland. The preoccupation led
to anorexia and she began to lose a few pounds.
He took her to a surgeon who declared she had
hyperthyroidism and did a subtotal thyroidec-
tomy. In retrospect, both she and her husband
emphatically deny that she was given a test of
metabolism at any time before or after operation.
1 hey were told that the operation was necessarv
to reduce the effects of a “toxic condition of the
thyroid gland ’. Operation did nothing to benefit
her; instead all features became increased. After
several weeks the surgeon advised psychiatric
consultation which had to be sought in another
city. Admittedly, the psychiatrist was at a disad-
vantage with but a single interview upon which
to base his impressions, but he suspected a
manic-depressive psychosis. The prognosis was
guarded and therefore assumed by the husband
to be discouraging. He brought her home in
an attitude of resignation and soon began to suffer
himself with insomnia, flatulence, fatigue and
emotionalism. It was during an interview refer-
able to his own symptoms that discussion of his
wife came up. Since she was not currently under
the care of anyone he expressed the desire to
have some local physician familiar with her his-
tory in case of need.
When first seen, some 2 months following
operation, she was preoccupied with the thoughts
described and emotional over her own reduced
health, but she was entirely oriented and had
satisfactory insight. Physically, she was still
overweight, allowing for some recent loss, and
there was rather dry hair and skin, a pulse of
66 and embryocardial heart tones. Menstruation
had been excessive in amount and duration for a
year. There was nothing else to suggest hypo-
thyroidism. All else was essentially normal.
Basal rate was minus 34 and minus 31 per cent
and total serum cholesterol was 390 mg. per cent.
A month after starting thyroid she was less ob-
sessed but not enthusiastic over her progress.
She had lost about 6 pounds, most of it soon
after starting thyroid and notwithstanding im-
proved appetite and unrestricted diet. After two
months of therapy she could laugh at the ab-
surdity of her former fears and since then has
continued well except when smaller daily main-
160
The Journal of the Medical Association of Georgia
tenance doses were tried. When hasal rate was
found to be drifting below minus 15 per cent,
mild depression and reminiscences of the bad
days then menaced her. Surely there must he
other similar cases about and a most satisfying
reward awaits the physician who is mindful of
hypothyroidism.
The three general groups outlined above
take account only of the chief or predomi-
nating complaints ol these 50 patients and,
as stated, complaints were always multiple.
A tabulation of the frequency with which
all complaints occurred, in some degree or
other, shows that, among this total group,
increased nervous irritability was named 33
times, reduced physical drive 25 times,
overweight or weight-gain 24 times, head-
aches 21 times, constipation 19 times, scat-
tered muscular pains 15 times and easy
fatigability 10 times. In addition to those
named in the three groups there were, with
varying frequency, undue sensitivity to cold,
dry throat, thyroid fullness, complaints re-
ferable to the hair, unwarranted anxiety,
insomnia, reduced sexual libido, failing
memory, difficulty concentrating, and flatu-
lent dyspepsia.
In summary, then, it is justified to make
the following general observations.
1. Whereas myxedema is characterized
by a fairly consistent group of complaints
and physical findings, the lesser degrees of
hypothyroidism are not. On the contrary,
complaints are widely varied, inconsistent
from case to case, and, in many instances,
least suggestive of thyroid dysfunction if
myxedema is to be followed as the general
pattern.
2. Many cases of mild to moderate hypo-
thyroidism present complaints, but seldom,
if ever, physical features, which are defi-
nitely suggestive of thyroid over-function.
The common denominator among these cases
is increased nervous tension which may be
manifested in a variety of ways. If the me-
tabolic test has been reliably performed, it
should decide the question. An elevated
serum cholesterol further assures the mat-
ter. In nearly every such instance the doc-
tor will be justified in letting the laboratory
reports overrule his clinical impression.
3. There are no important or consistent
physical findings in mild to moderate hypo-
thyroidism except insofar as the physical
features of myxedema may be incompletely
developed. Taken by themselves, such fea-
tures are often in contradiction to the pa-
tient's complaints or are easily overlooked.
4. Almost any patient who presents mul-
tiple somatic complaints which are unsup-
ported by comparable physical or labora-
tory findings may have mild to moderate
hypothyroidism and deserves a metabolic
test. The latter, however, should be done
with care and interpreted with judgment.
5. Masked or inapparent hypothyroidism
of mild to moderate degree is demonstrated,
by the present 50 cases, to occur with great-
er frequency than may he generally recog-
nized and to serve as a basis for multiple
symptoms, some of which can be disabling.
This basis is easily correctible by simple
oral medication.
1308 Third Avenue
Columbus, Georgia
DISCUSSION
DR. HAL M. DAVISON (Atlantal: Dr. Muecke has
presented clearly and convincingly a subject which,
while already important, will assume more importance
in medicine of the future. Allergic reactions as a whole
are increasing in frequency, and we pay far too little
attention to food allergy. As Dr. Muecke stated, we
often overlook allergic reactions in our patients because
we do not even consider the possibility of their being
present.
Infants may become sensitized to foods in utero be-
cause of the passage of unchanged food protein through
the placenta from the mother's blood, and also may
become sensitized to unchanged food protein present in
breast milk, and therefore may show an allergic reaction
following the first ingestion of a food.
Other children inherit the ability to become sensitive
to foods, and develop sensitivity to certain foods after
eating them for a time. Apparently, an infant is more
apt to become sensitive to foods while suffering from
entero-colitis. It is believed that the altered state of the
intestinal mucosa facilitates the passage of unchanged
foods into the blood.
Bronfenbrenner, of St. Louis, has shown that guinea
pigs in a state of scurvy are readily sensitized to egg
white by ingestion. Pottenger, of Monrovia, California,
has produced allergic manifestations in cats by feeding
them cooked foods only. Proper feeding of all foods for
four generations was necessary to eradicate the allergy
April, 1950
161
in the offspring of these cats.
There seems to be no doubt that the allergic state
affects the nutrition of our patients, and that various
states of malnutrition facilitate the production of sensi-
tivity in experimental animals, and probably in our
patients. It is more than likely that the production of
the allergic state in an infant depends more on the state
of nutrition of the pregnant mother than upon any other
one thing.
Skin testing for food sensitivity may be done at any
age, and direct testing of the patient is more accurate
than that done by passive transfer. Tests should be
made not only with extracts of the foods that are being
eaten by the infant, but also by extracts of other foods
that may be used to supplement the diet.
As Dr. Mueeke stated, however, the best proof of food
sensitivity is the fact that symptoms are relieved by
removing a food from the diet, and reproduced at will
by reintroducing the food into the diet. Some of our
patients may be mildly sensitive to some foods and may
be able to eat them every second, third or fourth day
without manifesting symptoms. Some allergic patients
become sensitized easily to foods they eat every day. For
both of these reasons it may be advisable to feed our
patients in a cyclic manner, using three to four separate
diets.
It is appropriate to conclude this discussion with a
quotation of part of the last sentence of Dr. Muecke’s
paper: "‘We continue to see large numbers of patients
belonging to this group whose symptoms have received
abundant unsuccessful treatment without any thought
having been given to allergy as the probable etiologic
factor.”
DR. WILLIAM R. DANCY (Savannah): From time
to time we have heard that many people are sensitive to
fish foods, and that certain conditions promote this
urticarial reaction.
Having had a lot of experience along this line, because
I have lived on the coast, I would like to say that there
are many people who are sensitive to crabs, to fish, to
shrimp and to oysters. It does not mean that if they
are sensitive to one of these they are sensitive to all.
I he fact is that they may be sensitive to one and not
to the others.
Dr. Davison has brought out the secret of treating these
cases (which in our hands has been very successful);
namely, that of changing the diet and eliminating the
sensitive food from time to time and giving the sensitive
food in small quantities, gradually increasing the amount
of this food up to the stage of reaction. We have cured
many cases that are sensitive particularly to shrimp and
crabs.
Another feature that I want to bring out (and we hear
it particularly inland ) is never to eat fish food along
with milk. If the fish food is fresh you can take milk —
sour, sterilized, fresh, raw, or any way you wish — clabber,
buttermilk, or anything else — and you will not have
any trouble with the fish food. However, if the fish food
is at all decomposed you will have trouble.
I am not sensitive to fish foods, but last year in
Atlanta we went to an Emory dinner and the piece de
resistance was a cocktail of shrimp. It didn’t state the
age of the shrimp, but I had to eat one of the shrimp
because I had it in my mouth. It was definitely spoiled,
and that night I had an urticarial rash. That was not
due to the fact that I had had enough ice cream to
affect the shrimp, because the small amount which I
ate was hardly sufficient to taste.
I want to bring out the point that milk does not have
any ill effect, or has no ill effect to my knowledge,
when drunk at the time fresh fish foods are eaten.
DR. CHARLES RICHARDSON, SR. (Macon): In
regard to emphasizing the point that Dr. Hatcher brought
out in his paper, this is a very important thing; namely,
that practically all lateral aberrant tumors of the thyroid
are papillary carcinoma. For many years we did not
know that, and now, when we find them, we not only
remove the tumors but we remove the same side of the
thyroid gland. Practically always you find a primary
tumor in the tip of the upper pole. If you don't find it,
it should be removed anyway. If you care to you can
follow this procedure with irradiation, but it isn't entirely
necessary because these tumors are of low malignancy
and complete removal usually does away with them.
DR. C. H. RICHARDSON, JR. (Macon): Hypothy-
roidism is a disease generally seen by the internist and
Dr. Storey has brought us a very stimulating presenta-
tion from his experience. However, there are two occa-
sions when the surgeon also may be called upon to
recognize this condition.
One is the patient with goiter, who is also nervous
and fatigued, and is a little overweight and in whom
hyperthyroidism is suspected. Only a careful examina-
tion and a low basal metabolic rate will show that hypo-
thyroidism is the true cause of symptoms and that sub-
total thyroidectomy, while perhaps still indicated for
the goiter, will not alone relieve these.
The second instance is hypothyroidism arising after
subtotal thyroidectomy for hyperplastic goiter. We have
seen this in perhaps 10 to 15 per cent of cases and
peculiarly it has occurred only in the diffuse toxic
goiter, not the nodular or nontoxic, regardless of the
operative technic. After a period of 8 to 12 weeks the
symptoms become pronounced and generalized swelling
may occur as well as the other symptoms described by
Dr. Storey. Two cases developed bilateral effusion of the
knee joint which disappeared only on thyroid medication.
Headache has been seen as well as insomnia and in-
creased irritability and as the appetite is reduced gain in
weight is not always noted. Fortunately, in the post-
operative cases the patient seems to adjust in a few
months and rarely needs to continue thyroid therapy.
Dr. Storey has outlined the need for adequate thyroid
medication. I would like to ask if hypothyroidism, like
hyperthyroidism, is a cyclic disorder with changing need
for therapy dosage or is it a permanent progressive
disease?
This is an excellent paper and Dr. Storey is to be
highly commended.
DR. A. H. LETTON (Atlanta) : I want to say just a
word or two about Dr. Storey’s very interesting paper
on hypothyroidism, and to second what Dr. Richardson
has just said, and to thank him for pointing out the
difference between myxedema and hypothyroidism.
As we tried to point out yesterday, certainly everyone
who has hypothyroidism does not have myxedema. If
you will look back into the Greek meaning of the word
“myxa", it means “mucus”, and “aidema means “swell-
ing"’. Thus, by definition, it is a mucus type of swelling
of the tissues and does occasionally appear in some in-
stances of hypothyroidism, but not in all.
We have noted some three instances in which we have
had people who have had hyperthyroidism with high
basal metabolic rates and yet had myxedema. In each
instance removing the goiter has cured their myxedema.
The moral of this is that you can't depend on myxe-
dema as an indication of the action of the thyroid gland
with any degree of accuracy.
I believe it is most important for us to realize that
there are many instances of masked hypothyroidism
which can easily go undiagnosed and we should all be
alert for such. We should thank Dr. Storey for bringing
this excellent message to us.
DR. A. M. PHILLIPS (Macon) : First of all. I want
to congratulate the essayists of the last series of papers
on the presenations we have just heard. They were kind
enough to send me copies of their presentations. I read
them over very carefully and enjoyed them. However,
since my work is limited to rectal conditions, I feel that
I can discuss only the paper presented by Dr. Bateman,
of Atlanta, “Surgical Treatment of Pilonidal Cyst — A
Simple Ambulatory Method.”
As we all know, pilonidal cysts have ccme more to
162
The Journal of the Medical Association of Georgia
the front in t lie past ten years. A pilonidal cyst is some-
times referred to as “jeep disease ", due to the fact that
so many of these pilonidal cysts have been found in the
past few years in service men and the pre-existing cyst,
which is congenital, had in some way or other been
bruised and later become infected.
As far as the treatment of pilonidal cyst is concerned,
there are two methods. Each of these has its own advo-
cates; namely, the open method and the closed method.
The success of either method depends upon complete
eradication of the cyst and all of its ramifications.
As far as the preliminary treatment mentioned by
Dr. Bateman is concerned, we all realize that whether it
is a pilonidal cyst or any other surgical condition we
may consider elective, the general welfare of the patient
certainly should be considered, and all means at our
disposal should be used in getting the patient in the
best physical condition before operation.
Probably I have not gone as far in this direction as
has Dr. Bateman. Be that as it may, it does behoove us
all to have the general welfare of our patient in mind.
As to the two types of treatment; namely, the closed
and the open methods, to a great extent I have used the
open method. My results have been made much more
satisfactory, and the hospital time is certainly no
longer than with the closed method. The loss of time
from work is no greater than with the closed method,
and as a rule the patient is back on the job in eight
or ten days. I do not mean that recovery has been
complete, but he has recovered sufficiently to resume
his usual occupation.
When I say “his” occupation you might think I am
intimating that all of these cysts are found in male
individuals. Twenty years ago I read an article in
which that statement was made that it was a disease
of males. 1 have since found a considerable number
of women and girls with pilonidal cysts. However, 1
would say the percentage is certainly less than 5 per
cent.
There is one thing 1 would like to bring to your
attention. It is purely and simply a personal observa-
tion, and I would like anyone in the audience who has
found a true pilonidal cyst in a colored individual to
tell me about it. 1 have seen a good many colored
patients with rectal complaints (we usually class this
as a rectal condition), but there is usually no connection
between the cyst and the rectum unless there is a
fistulous tract which is abscessed and has broken through
into the rectum. It has been my personal observation
that pilonidal cyst does not occur in colored individuals,
and I would like to know if anyone has seen it in a
colored individual.
The operative technic which Dr. Bateman has used,
as illustrated here, is very nice. You find very few
cases where you can use this modification of the mar-
supialization. It is fine when you have a firm base
and can suture the edges of the skin to the bed. That
is probably done more in operations for fistula than in a
pilonidal cyst operation.
His idea of bringing the edge of the skin down and
suturing it around does do away with a lot of the cauli-
flower-like appearance of the open wound, which comes
about after a few days’ time, and the healing time is
shortened thereby.
DR. MARION C. PRUITT (Atlanta): I would like
to answer the question that Dr. Phillips asked about
the occurrence of pilonidal cyst in the colored race.
\es, they do occur in the colored race.
In a series of my own experience of operative cases,
between 700 and 800 cases, two were in the colored
race. One was in a Negro girl.
The case in the Negro girl you will find reported in
my book on “.Modern Proctology.’’ This case was seen
at Grady Hospital and had been treated for a long
period of time with various types of escharotics, and
had been followed by a great deal of keloid conditions
which made a very extensive and ugly condition to
treat by any method at that time.
THE SURGICAL PLAN OF THE MEDICAL
ASSOCIATION OF GEORGIA
(A) Objectives and Principles
The Medical Association of Georgia (herein-
after sometimes referred to as the “Association” I
establishes as its objectives:
(1) To increase the extent to which volun-
tary insurance against the cost of medical care
is made available to the people of the State of
Georgia;
( 2 1 To increase the effectiveness of such
insurance through the voluntary cooperation of
its members;
(3) To make such insurance available at
the lowest practicable cost under competitive
conditions; and
(4) To safeguard the physician-patient rela-
tionship deemed necessary by the Association
to maintain and improve the high standards of
medical care in the State of Georgia.
In order to attain such objectives the Asso-
ciation hereby sponsors a program of prepaid
non-occupational surgical insurance on the fol-
lowing principles:
(1) The attached Master Schedule of Surgical
Indemnities shall serve as a standard for use
in connection with this plan; such schedule is
subject to change by the Association as condi-
tions and experience warrant.
(2) The Association shall make a determined
effort to obtain the consent of its members to
participate in the plan. Participation shall mean
the doctor’s agreement with the Association to
accept for a minimum of one calendar year the
amounts in the Indemnity Schedule as full pay-
ment for the procedures listed therein for per-
sons coming within the defined income group
and their dependents insured under policies
endorsed by the Association, as hereinafter set
forth; provided such persons authorize that the
benefits be paid by the insurance carrier direct
to the physician.
(3) The Association shall make a determined
effort to interest all insurance companies and
insuring agencies licensed to do business in
the State of Georgia in underwriting this plan.
(4) Persons who shall receive surgical ser-
vice for the indemnity fee listed in the Master
Schedule of Surgical Indemnities include (a)
individuals without dependents whose incomes
do not exceed $2,400 per annum, and (b) indi-
viduals with dependents whose incomes do not
exceed $3,600 per annum. Persons whose in-
comes exceed such limits shall have such in-
demnity fee applied towards the physician's
total bill with such persons liable for any addi-
tional fee charged by the physician. These in-
come limits are subject to change by the Asso-
ciation from time to time as warranted by
conditions and experience.
(5) Each insurance company or insuring
agency desiring to have its policies approved
under this program shall submit to the Associa-
April, 1950
tion the policy form or forms it plans to offer
with the endorsement of the Association; such
policy forms may include coverages in excess
of that required by the Association for endorse-
ment.
(6) The Association shall review the policy
forms and. if it finds that the Indemnity Sched-
ules and other provisions in such policies, except
as hereinafter noted, meet the minimum stand-
ards of coverage and believes that the promo-
tion and sale of such policies will contribute
toward the attainment of the objectives of its
program, the Association shall forthwith grant
its consent to the use by the company of the
statement "The Benefits in this Policy are Ac-
cepted and Approved by the Medical Associa-
tion of Georgia,” or such similar statement as
i;ray be approved by the Association, on such
policy forms and in its advertising and promo-
tional literature to be used in connection there-
with; for the sake of simplicity, some of the
less frequent types of procedures may be
omitted from the printed fee schedule in such
policy forms, with the understanding that the
attached Indemnity Schedule shall govern for
unprinted procedures.
(7) All advertisements and promotional litera-
ture involving the Association’s name shall be
submitted to the Association before publication.
(8) The Association shall be under no obliga-
tion whatsoever to review the premium rate or
rates of those policies submitted for its approval
under this program, since it is the desire of
the Association to permit such rates to seek their
natural levels through competition; however, the
Association may request any company to furnish
it with the rates at which the policies are to be
or are being offered to the public and the com-
pany shall comply with such request within a
reasonable time.
(9) The Association may request experience
and enrollment figures from any insurance com-
pany and the company shall comply therewith
in reasonable time, but such statistics shall not
be made public in any manner which will identi-
fy any of the statistics with any one insurance
company without that company’s consent.
(10) An insurance company whose policies
are approved under this plan shall not inter-
fere with the insured’s free choice of a physician.
(11) The Association shall not interfere with
an insurance company’s rights and obligations
under the terms of the policy form endorsed by
the Association provided, however, that pay-
ments made by the insurance company under
such policy for procedures not listed in the
attached Indemnity Schedule shall be subject
to review by the Association.
1 12 i The Association may at any time, upon
thirty days’ prior written notice to an insur-
ance company, withdraw its consent to the use
of its endorsement on any policy form and in
advertising and promotional literature in con-
163
nection therewith. In the event of such with-
drawal (a) the company shall cease forthwith
to use such endorsement on all new policies on
such forms and in advertising and promotional
literature in connection therewith; (b) the
Association endorsement of all outstanding poli-
cies of said company on said form shall never-
theless continue until the next following anni-
versary date of issue of such policies; and
(c) the company shall have no cause of action
against the Association except upon proof of
malice.
(13) An insurance company whose policies
are approved under this plan may at any time,
upon thirty days’ prior written notice to the
Association cease to issue its policies with the
Association endorsement. Thereafter, such com-
pany shall not use the endorsement of the
Association on any new policies issued or in
advertising or promotional literature in con-
nection therewith. In such event the Associa-
tion's endorsement of all outstanding policies
of said company shall nevertheless continue until
the next following anniversary date of issue
of such policies.
(14) An insurance company whose policies
are approved under this program shall not be
prevented thereby from issuing policies which
are not endorsed by the Association so long as
such policies and advertising and promotional
literature in connection therewith do not use
the name of the Association.
(15) A Committee of the Association shall
confer with the insurance companies on prob-
lems which arise in connection with this pro-
gram, for the purpose of taking appropriate
action upon administrative matters, complaints
of persons insured and/or participating doctors,
and, if so authorized, to act in the name of the
Association to carry out these principles.
(16) An insurance company authorized to
sell the Georgia Surgical Plan may, at its dis-
cretion, offer additional allied coverages, to wit:
(1) hospitalization, (2) accident and health,
(3) medical. This provision shall apply to
groups averaging 25 persons or less during the
previous fiscal employment year. It is further
provided that in these instances it shall be made
clear in the policy to the insured that the addi-
tional plans are not a part of the Georgia Surgi-
cal Plan sponsored by the Medical Association
of Georgia.
(B) Master Schedule of Surgical Indemnities
— Including Usual Pre- and Post-
Operative Care
I. Multiple Procedures
When more than one operation is performed
at one time, payment will be made for each in
accordance with this Schedule, subject to a maxi-
mum total of $175. Furthermore, the maximum
total with respect to all operations due to the
same or related cause which are performed dur-
ing a continuous period of disability shall be
164
The Journal of the Medical Association of Georgia
$175. For this purpose all procedures per-
formed through the same incision shall be con-
sidered one operation, and operations that are
not separated by three months shall he deemed
to have been performed during "a continuous
period of disability.”
II. I nlisted Procedures
In addition to the procedures listed in this
Schedeule. amounts shall be payable for any
other operations. The maximum amounts for
such procedures shall be determined in amounts
consistent with those listed.
(C) Participating Physician of the Medical
Association of Georgia
1 hereby subscribe as a participating physician
under the program sponsored by the Medical
Association of Georgia for surgical insurance
as accepted and approved by the Medical Asso-
ciation of Georgia.
In consideration of my being listed as such
“Participating Physician," I hereby agree that
my charges for the services included in the
Master Schedule of Surgical Indemnities and
rendered to the insured or his dependents, shall
not exceed the amount specified therein, provided
the insured is ( a I an individual without de-
pendents whose income does not exceed $2,400
per annum or lb I an individual with dependents
whose income does not exceed $3,600 per annum.
I understand that persons whose incomes
exceed such limits shall have such indemnity
applied towards my total bill with such persons
liable for any additional fee charged by me.
I understand that nothing in this agreement
is intended to affect the relationship between the
physician and his patient nor to restrict the
physician in the exercise of his right to refuse
to treat any patient for appropriate professional
reasons.
I further agree to abide by the rulings of the
Association s Committee which will function un-
der this program for the express purpose of
facilitating any administrative problems that
may arise.
I agree not to withdraw my consent as a
participating physician prior to .
._, M.D.
Address:
Date:
PROPOSED
SCHEDULE OF SURGICAL BENEFITS
General Surgery
Maximum
Operation Payment
Infection and Trauma
Abscess incision and drainage, Furuncles
excepted $ 5.00
Deep cervical abscess 25.00
Carbuncle 25.00
Ulcer, surface excision 10.00
Tendon, repair, one primary 25.00
each additional 10.00
Maximum . 100.00
Septic finger I tendon sheath involve-
ment) 15.00
Septic hand I tendon sheath and com-
partments ) .... 75.00
Lacerations, extensive, including
debridement 25.00
Cysts
Cyst, sebaceous, removal 10.00
Pilonidal cyst or sinus 50.00
Thyroglossal cyst, removal 100.00
Branchial cyst, removal 100.00
T umors
Tumors, benign external, removal 10.00
Tumors, benign, removal deep 25.00
Parotid tumor, removal 75.00
Epithelioma of face, surgical removal 25.00
Cancer of tongue, (resection or removal) 100.00
Same with neck dissection 150.00
Cancer of lip I local operation) 35.00
Same with neck dissection 125.00
Biopsy
Biopsy, superficial 5.00
Biopsy, bone or bone marrow 15.00
Biopsy, needle aspiration 5.00
Glands
Glands, superficial, removal 10.00
Dissection glands of neck, deep chain 100.00
Radical Axilla or groin .. 100.00
Thyroid
Thyroidectomy, subtotal 125.00
Thyroidectomy, two-stage, subtotal I with
or without ligation ) , complete pro-
cedure 150.00
Parathyroidectomy 150.00
Breasts
Breast abscess, drainage 25.00
Breast cyst or abscess, aspiration 10.00
Breast tumor, benign removal 35.00
Breast, radical removal, including axil-
lary dissection 150.00
Breast, simple removal 75.00
Miscellaneous
Ligation, saphenous vein low, including
retrograde injection, if done 25.00
Bilateral 50.00
Ligation, saphenous vein, high, and com-
bined including retrograde injection 30.00
Bilateral 50.00
Toe nail, ingrown, removal radical __ 20.00
Stone, submaxillary or parotid duct 25.00
Removal of submaxillary salivary gland 50.00
Injection, varicose veins complete pro-
cedure 25.00
Injection without ligation, each 3.00
Maximum 30.00
Endoscopy
( When preliminary and related to surgical
service only)
Bronchoscopy, diagnostic, preceding
surgery 25.00
April, 1950
165
Operative 50.00
Cystoscopy
Observation (preceding surgery) 15.00
Ureteral catheterization 20.00
Operative 35.00
Gastroscopy 15.00
Laryngoscopy
Diagnosis (by Laryngoscope) ... 10.00
Operative 25.00
Sigmoidoscopy and biopsy 10.00
Esophagoscopy „ 25.00
Special Surgery
Thoracic Surgery
Pneumolysis 75.00
Pleura, paracentesis . 10.00
Empyema, closed drainage ... 25.00
Empyema, rib section _ 75.00
Phrenic nerve, crushing _ 25.00
Thoracoplasty (First stage or partial) . 75.00
(complete) 150.00
Lobectomy 150.00
Aneurysmorraphy ... 150.00
Induction of artificial pneumothorax . 25.00
Refills ... . 5.00
Abdominal Surgery
Abdomen, paracentesis 10.00
Herniotomy, single, inguinal, femoral or
umbilical 100.00
Herniotomy, bilateral, inguinal or
femoral 1 125.00
Herniotomy, hiatus or diaphragmatic . 150.00
Herniotomy, ventral or incisional 100.00
Esophageal diverticulum . 125.00
Gastrotomy or gastrostomy . 100.00
Gastrectomy 175.00
Gastro-enterostomy 125.00
Peptic ulcer, perforated, closure ... . 100.00
Peptic ulcer, subtotal gastrectomy 150.00
Pyloric stenosis (Ramstedt’s in infant).. 100.00
Intestines, anastomosis 125.00
Intestines, (small) resection 125.00
Laparotomy 75.00
Colon, resection 175.00
Colostomy 75.00
Appendectomy 100.00
Diverticulum, intestinal (Meckel’s) . 100.00
Common Duct with or without cholecys-
tectomy 175.00
Appendiceal, abscess, drainage . 100.00
Subdiaphragmatic abscess 100.00
Cholecystectomy 125.00
Common duct, resection or reconstruc-
tion 150.00
Cholecystotomy 100.00
Cholecystoduodenostomy 125.00
Pancreas, drainage 100.00
Splenectomy 150.00
Proctology
Hemorrhoids, injection, each $3.00,
maximum 30.00
Hemorrhoids, external 25.00
Hemorrhoid, thrombosis, incision 5.00
Complete hemorrhoidectomy in hospital „ 85.00
Complete hemorrhoidectomy in office 35.00
Fistulectomy, single, excision of tract 50.00
Multiple, excision of tracts 85.00
Fissurectomy 10.00
Polypectomy .... 25.00
Abscess, ischio-rectal or peri-rectal drain-
age - 25.00
Carcinoma of rectum, resection 175.00
Prolapsed rectum, repair 100.00
Urology
Circumcision, infant not requiring
anesthesia 5.00
Circumcision, excepting the above 15.00
Ureterotomy 50.00
Prostatic abscess 35.00
Prostatectomy, perineal 125.00
Prostatectomy suprapubic — one stage
including vasectomy if required 125.00
Prostatectomy, suprapubic- — two stage
including vasectomy 150.00
Prostatectomy, transurethral 125.00
Punch operation with suprapubic
drainage 120.00
Perineoplasty with urethral repair 75.00
Hydrocele, radical operation 50.00
Litholapaxy 50.00
Epididymectomy .. ... ... .... 50.00
Vasectomy (when not preliminary to
prostatectomy) 15.00
Vesiculectomy 100.00
Varicocelectomy 25.00
Orchidectomy simple 50.00
With gland dissection . 100.00
Cystotomy or Cystostomy 75.00
Cystostomy with fulguration 100.00
Cystectomy 150.00
Ureter transplantation, single .... 100.00
Bilateral 150.00
Bladder tumor, diverticula, etc (resec-
tion) open operation 125.00
Uretero-lithotomy __ 100.00
Nephrotomy 125.00
Nephrostomy 125.00
Nephrectomy 125.00
Nephropexy 100.00
Plastic on pelvis and ureter 125.00
Heminephrectomy 125.00
Excision and suture of urinary fistula
(suprapubic) 50.00
(vaginal) 100.00
Penis amputation 75.00
Same with groin dissection 150.00
Plastic Hypo and epispadias 125.00
Meatotomy 5.00
Caruncle excision 15.00
Caruncle fulguration 15.00
Neuro-Surgery
Skull
Simple fracture (non-operable) with
brain injury 35.00
Depressed 75.00
Compound 150.00
Brain Tumors 175.00
166
The Journal of the Medical Association of Georgia
Brain Injuries; operable type
Extradural hematoma - 150.00
Subdural hematoma 150.00
Exploratory Trephination, One Side 50.00
Two Sides 75.00
Intracortical clot 150.00
Arterio-venous fistula, intracranial __ . 150.00
Spinal Cord
Section of anterior or posterior roots 150.00
Decompressive laminectomy _ 150.00
Removal of or exploration for an extrud-
ed nucleus, pulpous or ruptured inter-
vertebral disc 150.00
Peripheral Nerve
Suture, decompression, or transplantation
of single nerve 25.00
Each additional 10.00
Maximum 100.00
Pneumoencephalogram 25.00
Ventriculogram 40.00
Spinal cord tumors . 150.00
Operation for pain associated with malig-
nancy or similar unbeatable disease
requiring intraspinal nerve sections or
cordotomy 150.00
Miscellaneous
Section of sensory root for 5th nerve
neuralgia 150.00
Section of vestibular nerve for Meniere’s
disease or aural vertigo __ 150.00
Operation for scalenus anticus syndrome 50.00
Craniotomy for brain abscess 150.00
Craniotomy for conditions not listed
herewith 150.00
Bilateral orbital decompression __ 150.00
Choroidectomy for hydrocephalus 150.00
Excision of meningocele 75.00
Lumbar puncture (with fracture or oper-
ative work only) ( diagnostic excluded) 5.00
Sympathetic System
Unilateral lumbar sympathectomy ___ 100.00
Bilateral lumbar sympathectomy 150.00
Resection of pre-sacral plexus 150.00
Bilateral, thoraco lumbar sympathectomy 150.00
Obstetrics
Pregnancy, delivery (does not cover pre-
natal and postnatal home and office
care ) 50.00
Miscarriage (curettage) 25.00
Caesarean section, vaginal 100.00
Caesarean section, abdominal 100.00
Pregnancy, ectopic 100.00
Gynecology
Bartholin's gland, incision ... 5.00
Bartholin's gland, excision 25.00
Labial tumors and cysts, removal 20.00
Atresia of vagina, plastic 50.00
Fistula, recto-vaginal 100.00
Fistula, vesico-vaginal 100.00
Cul-de-sac, drainage 35.00
Cauterization, each 3.00
Maximum 12.00
Dilation and curettage with or without
cauterization 25.00
Uterine polyp removal with dilatation
and curettage 25.00
Cervical polyp removal 5.00
Trachelorrhaphy .. 35.00
Cervix amputation 50.00
Oophorectomy or resection of ovaries . 100.00
Hysterectomy 150.00
Myomectomy 100.00
Uterine flexions, etc., correction (plus
surgery of tubes and ovaries) 100.00
Same with vaginal plastic work ... 125.00
Salpingectomy 100.00
Salpingoophorectomy 100.00
Cystocele 50.00
Rectocele 50.00
Combined cystocele and rectocele 75.00
Prolapsed operations (interposition,
Manchester) 120.00
Vulvectomy 75.00
With groin dissection 150.00
Ophthalmology
Foreign body, removal, within anterior
or posterior chamber 90.00
Cornea, paracentesis 20.00
Conjunctival suture 15.00
Conjunctival flap for corneal ulcer, etc. 25.00
Chalazion (excision) simple 10.00
Multiple 25.00
Lacrimal sac, removal 60.00
Entropion or ectropion, Ziegler’s punc-
ture 30.00
Entropion or ectropion, plastic operation 50.00
Entropion or ectropion, plastic operation
grafts or flaps ... 60.00
Symblepharon, release 35.00
Pterygium 35.00
Corneal Ulcer cauterization 5.00
Corneal Ulcer, delimiting keratotomy.. _ 30.00
Tarsorrhaphy, orbicularis paralysis 30.00
Ptosis, (single) 60.00
Strabismus, one or more muscles 75.00
Cataract, needling 50.00
Cataract, removal ... 120.00
Iridectomy 75.00
Removal foreign body of cornea 3.00
Glaucoma, filtration operation 120.00
Enucleation or evisceration 90.00
Enucleation with implant 140.00
Tumor, exenteration of orbit 120.00
Dacryocystorhinostomy 90.00
Detached Retina 150.00
Otolocy
Aural Polyp 10.00
Paracentesis tympani __ 10.00
Mastoidectomy, acute single 120.00
Mastoidectomy, acute bilateral 125.00
Mastoidectomy, radical single 175.00
Fenestration for otosclerosis 175.00
Nose and Throat
Nasal polyps, removal 10.00
Antrum, Caldwell-Luc 60.00
Ethmoidectomy 40.00
April, 1950
167
Frontal sinus, radical 120.00
Turbinectomy 10.00
Submucous resection 60.00
Palatorrhapy 100.00
Tonsillectomy and adenoidectomy
Under 15 30.00
Over 15 40.00
Laryngectomy 175.00
Tracheotomy 50.00
Malignant disease, accessory sinuses
Radical Operation, one sinus ... 120.00
Multiple 175.00
Malignant disease, tonsil and pharynx
radical operation 120.00
Antrum puncture and irrigation 5.00
Antrum window 50.00
Orthopedic
Spinal fusion 175.00
Cartilage of condyle of femur, removal of 90.00
Bone plate, removal of 30.00
Talipes 60.00
Semilunar cartilage, removal from joint 90.00
Tenotomy, simple, open ._ 30.00
Closed 15.00
Claw foot, except bone surgery — see foot
stabilization 60.00
Coccyx, excision of 30.00
Arthrotomy, any major joint 90.00
Hallux valgus, single radical operation 60.00
Hallux valgus, bilateral radical operation 90.00
Exostosectomy 30.00
Osteomyelitis, sequestrum removal 30.00
Foot stabilization 175.00
Hammer toe, operation for 40.00
Arthrodesis of knee, hip, shoulder or
elbow 175.00
Torticollis, operation for 90.00
Arthroplasty, any major joint .. ... 175.00
Hip joint, resection 175.00
Any other major joint, resection _ 120.00
Any joint, resection of, fingers or toes 30.00
Amputations
Shoulder, disarticulation 150.00
Upper arm 60.00
Forearm 60.00
Hand 60.00
Finger, single 15.00
Each additional 10.00
Hip 150.00
Thigh 90.00
Knee __ 90.00
Leg 90.00
Toe 15.00
Each additional 10.00
Foot .1 60.00
Elbow 90.00
Scapulo thoracic amputation 175.00
Dislocations — Closed
Carpal bone, one 30.00
Each additional 10.00
Clavicle 30.00
Elbow 30.00
Finger, one 5.00
Each additional 5.00
Hip __ 40.00
Knee 40.00
Mandible 10.00
Metacarpal bone, one 15.00
Each additional 5.00
Metatarsal bone, one 15.00
Each additional 5.00
Patella 15.00
Rib ..... 10.00
Shoulder 30.00
Tarsal bone, one 30.00
Each additional 10.00
Thumb 10.00
Toe, one 5.00
Each additional 5.00
Vertebra, one or more 120.00
Simple Fractures — Closed
Lower jaw 30.00
Carpal bone, one 30.00
Each additional 10.00
Clavicle 30.00
Coccyx 10.00
Femur 90.00
Tibia or fibula or both 60.00
Pott’s or Cotton’s Fracture 90.00
Finger, one 10.00
Each additional 5.00
Humerus 60.00
Metacarpal bone, one 15.00
Each additional 10.00
Metatarsal bone, one ... 15.00
Each additional 10.00
Patella, closed 30.00
Nasal bone or bones, reduced 30.00
Pelvis 90.00
Radius or Ulna, or both 30.00
Rib, one or more ... ....... .... . 10.00
Sacrum 40.00
Scapula 30.00
Skull .. 40.00
Sternum 30.00
Tarsal bone, one (exclude os calcis and
astragalus) 30.00
Each additional 10.00
Toe, one 10.00
Each additional 5.00
Vertebra, one or more 120.00
Os Calcis or Astragalus, or both 60.00
Open Reductions and Compound Frac-
tures— For compound fractures the
maximum amount will be one and one-
half times, and for fractures or disloca-
tions requiring an open operation will be
twice the amount shown for the corre-
sponding simple fracture or dislocations,
but in no case more than 175.00
Unlisted Procedures
In addition to the procedures listed in this
Schedule, amounts shall be payable for any
other operations. The maximum amounts for
168
The Journal of the Medical Association of Georgia
such procedures shall be determined by the
Insurance Company in amounts consistent with
those listed.
W. S. Dorough, M.D.. Chairman,
Prepayment Medical Care Plans
Committee, 478 Peachtree St.,
N. E., Atlanta.
THE PAPANICOLAOU SMEAR:
IN RETROSPECT AND FUTURE
When Dr. Papanicolaou first described his re-
sults with the exfoliated cell method for the rapid
diagnosis of cancer, he almost caused a sensation
in pathologic circles in the United States. The
report largely concerned the diagnosis of cervical
cancer and uterine malignancy; however, the
process is applicable to finding cancerous cells
from almost any site in the body, especially the
lung, prostate, kidney and bladder.
After hearing Dr. Papanicolaou make a report
in Chicago, we came away deeply impressed, and
went on record as so stating, with a declaration
that he was “an honest man and a master path-
ologist who had been working on this problem
for twenty-five years." Later another statement
was made in which we wondered where this
method of diagnosis was going to lead us. Per-
haps, we thought, we might eventually make the
diagnosis of cancer on the morphology of single
cells, which is not impossible at all.
However, since October 1948, much water has
poured over the dam. Numerous pathologists
here and abroad, and in many different clinics,
have thoroughlv tried the smear method of diag-
nosis. Asa whole the results have been good and
encouraging ones. Now comes a report in the
January issue of the journal of the American
Medical Association, 28th instant, by Drs. Nei-
burgs and Pund of Augusta, Georgia, which to
my mind is one of the most comprehensive pub-
lished to date. The medical profession has confi-
dence in these men, as they also most certainly do
in Dr. Papanicolaou. We have known them for
some time past, especially Dr. Pund with whom
we served in World War I. He is one of Amer-
ica s outstanding pathologists.
The report by Neiburgs and Pund will allow
us to come to some concrete decision as to the
best use of Papanicolaous technic in the future.
Briefly we gain these impressions from the article.
They made a study for three years, making rou-
tine reports and smears on 10,000 women. Posi-
tive smears were found in 3.3 per cent. Histologic
review of a large number of the women showed
that 76 per cent had cancer, and that 3 per cent
had borderline lesions. Twenty one per cent were
false positives. Cancer, however, was discovered
in 2.5 per cent of the entire group, wfith 40 per
cent classified as having preinvasive types. We
might here add that some outstanding clinics
and pathologists do not recognize such an entity
as preinvasive malignancy.
An interesting statement may he well worth
quoting from the paper: “From the evidence re-
ported, it is apparent that this method should not
be recommended as a diagnostic procedure. Its
interpretation is difficult and unreliable for any
one who has not been trained for at least one
year with sufficient amount of material; further-
more, in view of the small number of cases de-
tected the cost of diagnosis would be prohibitive
if applied in this manner.” Neiburgs and Pund
also stated that it cost $120 to $150 to detect a
case of preinvasive cancer.
Such conclusions from outstanding men with
such a large amount of material are very stimu-
lating. It is verv difficult for a person to clearly
define his reactions to a highly technical process
like the Papanicolaou smear. Often-times one
will examine such a slide and will be amazed
w ith the simplicity and clarity and the easy diag-
nosis of cancer. A slide then later comes to the
desk made from a young woman with little if
any clinical disturbance, and one finds cells that
make one apprehensive, and others that are prob-
ably not important. The pathologist therefore
finds himself in a quandary. Somehow^ this situ-
ation might be compared to a fine salad made by
a great chef, and notes the flavor and composi-
tion to be intriguing and almost perfect, yet
leaves a somewhat disagreeable taste in one’s
mouth. It is therefore not entirely satisfactory,
and leaves something to be desired. In this com-
parison the technic and the interpretation of the
smear falls short of the information sought, espe-
cially so when compared to the information one
may get from a properly cut and stained biopsy
from a lesion at hand.
Therefore, we have come to the conclusion
that Papanicolaou’s smear method of cancer
diagnosis should best be used as a screening test
for cancer. It should be examined only by
trained cytologists. The routine application of
the test in doctors’ offices and small clinics should
be discouraged. The method cannot possibly
replace the biopsy.
If in the future we find reason to alter our
opinions as expressed above, we shall gladly do
so.
Jack C. Norris, M.D.
HEALTHGRAMS
Tuberculosis rates are. it is agreed, among the most
important indices of the state of the public health. The
Right Hon. Walter Elliot, F.R.C.P., M.P., British Medical
Jour., August 6, 1949.
In the entire United States about 270.000 mental
patients are coming back into the community each year.
The spread of the disease from those who may have con-
tracted tuberculosis while in mental hospitals therefore
becomes a community problem which we cannot afford
to ignore. Pub. Health Rep., Jan. 7, 1949.
April, 1950
169
PRESIDENT’S PAGE
NEW OPPORTUNITIES
AND RESPONSIBILITIES
The rapid extension of prepaid medical and
hospital insurance in the State in the past few
years will he augmented, now that satisfactory
legislation for nonprofit plans has been enacted.
The participants in these plans will naturally
seek more medical and surgical attention than
they did before. The quality of service rendered
them will be a major factor in making voluntary
health insurance a success and thereby acting
as a definite factor in defeating plans to socialize
medicine. We will have both the opportunity
and the responsibility of rendering better medical
service to a greater number of our people than
in the past.
The opportunity to admit more patients to
hospitals for diagnosis and treatment should be
reflected in a higher rate of accurate diagnosis
and cure, and a lessened period of disability in
many cases. The ability of many people to have
necessary elective surgery performed should not
only increase their enjoyment of life, but also in
many cases increase the scope of their employ-
ability and thereby increase their earning power.
By centralizing a considerable proportion of his
patients in one place, the doctor will be spared
the time-wasting travel from one home to an-
other and can devote more personal attention to
each patient. However, there is a responsibility
to see that use of hospitalization is not abused.
Patients should be sent to hospitals when better
care and service can be rendered them than they
can receive at home. The ownership of an insur-
ance policy should not influence the doctor to
admit a patient to a hospital because it will be
more convenient for him. Voluntary prepayment
insurance can be destroyed by abuse and overuse
in the same way that compulsory medical care
in Great Britain has been reduced to a low
degree of quality. Care should be taken that
being free from the financial responsibility for-
merly faced when surgical procedures were con-
templated, the patient even though he seeks ill
advised surgery w ill not receive it. This is far
from being a hypothetical danger.
With large numbers of our patients covered
by various forms of health insurance, we should
not forget our responsibility to the unemployed
or otherwise indigent patient. Careful study at
the present time will show that a small percentage
of the medical profession is taking care of a
large majority of these patients. In many locali-
ties they are very inadequately cared for. This
situation casts a reflection on the entire medical
profession. It is the profession’s responsibility
to see that this condition is promptly and satis-
factorily corrected.
All municipal and county hospitals should pro-
vide adequate space, facilities and nonprofes-
sional personnel for outpatient clinics. The hos-
pital boards and authorities should demand that
every member of the staff devote the prorata
amount of time necessary to make these clinics
render the proper and needed service to the
community’s indigent sick. Where public funds
maintain hospitals for his private patients a
doctor should be more than willing to devote a
small part of his time to the care of those mem-
bers of the community unable to provide medical
attention for themselves.
Every member of the medical profession should
take the time and trouble to carefully and con-
scientiously consider all phases of the health and
medical problems which confront him today. He
should carefully and definitely decide what he
considers essential for good medical practice.
We are facing new conditions, new opportunities
and new responsibilities. Our ability to properly
understand and meet these new conditions can-
not fail to have a profound influence on our
future. The free practice of medicine is definitely
on trial. It is in our power to make the verdict
favorable.
Enoch Callaway, M.D.
170
The Journal of the Medical Association of Georgia
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
April, 1950
SURVEY OF PHYSICIANS’ INCOMES
Late in April the Bureau of Medical Economic
Research of the American Medical Association
and the Office of Business Economics of the U. S.
Department of Commerce will jointly conduct a
survey of physicians’ incomes.
The Bureau has been authorized bv the A.M.A.
Board of Trustees to cooperate in this survey,
which the Department of Commerce had planned
to conduct alone. It will be the first full-scale
survey by the department of physicians’ incomes
since 1941.
An analysis of the results will be published
by the Department of Commerce next fall in its
monthly publication, “Survey of Current Busi-
ness." Its August 1949 and January 1950 issues
had published similar analyses of surveys of in-
comes of dentists and lawyers, respectively, made
jointly with the American Denial Association
and the American Bar Association.
There is evidence that the national average in
some surveys have been too high because physi-
cians who do not have bookkeepers to fill out
questionnaires do not reply in sufficient numbers.
Accordingly, the Bureau emphasizes the impor-
tance of all doctors, especially those with a rela-
tively small practice, filling out the question-
naires.
Accurate postwar data on physicians’ incomes
is badly needed in order to develop better esti-
mates of how much the American people pay to
physicians.
Every physician can be assured that the sur-
vey has no relation whatever to the operations
of the U. S. Bureau of Internal Revenue. There
is no way by which the Department of Commerce
could have obtained the needed information
from the Bureau of Internal Revenue; hence, the
questionnaire survey.
There will be two questionnaire forms. The
Bureau of Medical Economic Research helped to
design these. A short form will request income
data for 1949 only. A long form questionnaire
will cover the years 1945 through 1949. All
are to be returned unsigned in franked envel-
opes.
The punch card files of the Bureau of Medical
Economic Research contain the names of about
200,000 physicians. The survey will cover 125,-
000 of these, or 62V2 per cent of the total. Selec-
tion will be by a formula which eliminates any
partiality.
A short form will be sent once only to every
other name in the file. Of the remaining 100.000
names, every fourth will be selected. To these
will go 10,000 short forms and 15.000 long
forms, with this distinction — the return franked
envelopes will carry a code number which will
identify the physician to the Bureau of Medical
Economic Research alone. All of the addressing
will be done in the headquarters of the A.M.A.
The sole purpose of the code number is to
enable the Bureau of Medical Economic Research
to address a follow-up letter to those not replying
to the first request. Physicians need have no
suspicion about the code number because when
the reply is received, the questionnaire will be
separated immediately from the envelope and
the identity will be lost.
Physicians will he doing the medical profes-
sion a service by filling out the forms and return-
ing them as soon as possible.
STATEMENT BY JAMES E. PAULLIN, M.D.,
ON H.R. 6000 -SUBMITTED TO THE
SENATE COMMITTEE ON FINANCE
February 28. 1950
To identify myself. I am James Edgar Paullin
M.D.. of Atlanta. Georgia, a duly licensed physi-
cian engaged in the active practice of medicine
in Atlanta for the past 40 years. At the same
time I have been a part-time teacher in the
Medical Department of Emory University. I am
a member in good standing of our local, state,
and national medical societies, and during my
years in practice, at one time or another, I have
held offices of responsibility in these organiza-
tions. I desire to appear before your Committee
as a member of the medical profession opposing
in particular that part of H.R. 6000, Section 107,
which relates to the inclusion among its pro-
visions of total and permanent disability insur-
ance benefits.
In reading the amendments which have been
offered to the Social Security Act under H.R.
6000 I was amazed at the recommendations for
increased appropriations in money which are
requested to be given as benefits under the vari-
ous titles of the bill, as well as to increase the
numbers concerned. So far as I could tell, the
requests for money to support this program were
increased tremendously, none were eliminated,
and none were decreased. Naturally the question
arose in my mind as to how all of these benefits
could be undertaken without increasing the tax
burden on the productivity of our citizens to
meet the increasing demands for assistance, and
why our citizens are willing to allow L ncle Sam
to assume responsibility for their support, edu-
cation, health, housing, and retirement without
the necessity of any effort on their part to pro-
duce income from which these taxes are to be
paid. I have not given all provisions of the Act
careful study, and if I had I would not be com-
April, 1950
171
petent to offer valid testimony concerning them.
However, 1 do have experience and observations
concerning total and permanent disability, which
is Section 107 in H.R. 6000. and which will in-
volve the expenditure of millions upon millions
of dollars as a part of the Social Security pro-
gram.
I do not believe that anyone would oppose
rendering assistance to those in dire distress or
who are in great need and who are not finan-
cially able to help themselves, either because of
sickness, injury, or disease. However, the actual
need must be established, with a primary interest
centered on a program which would rehabilitate
the person or persons disabled in an effort to
make them self-supporting members of society.
This must be the chief purpose for which contri-
butions are made for aiding this group of our
citizens. To those of us who have been in the
active practice of medicine for any considerable
number of years, we are aware that there are
many psychological factors demanding consid-
eration in any discussion of the determination
of the presence or absence of disability.
First, if a tax is levied for the purpose of fur-
nishing total and permanent disability insurance
for an individual, and if the individual pays for
it for a certain length of time, he develops the
feeling that he has a right, under certain circum-
stances, to demand the benefits which he has
purchased. In other words, there is an honest
psychological approach on the part of the person
with disability insurance to demand support even
though he is conscious that he is not totally and
permanently disabled. If there is written into
the law a clear statement defining disability,
either total or permanent, and if the insured
does not completely qualify for these benefits,
if he sees or hears of some one with no more
disability than he has drawing benefits for dis-
ability, he makes an earnest effort to affect total
disability in order to collect his pay check.
The second psychological effect of disability
is that the patient who claims disability benefits
makes an effort to satisfy his own conscience as
to the justice of his demands, and he develops
subjective symptoms of disease which no one
can demonstrate as non-existent. Particularly
is this true with certain types of individuals who
are, to some extent, emotionally unstable. Such
a condition occurs in a higher percentage among
women than among men. We as physicians know
that disappointments, frustrations, emotional in-
stability, ill-adjusted family life, and various
other situational and environmental difficulties
w ill cause in some people a reaction of defeatism ,
with the development of more subjective com-
plaints, which tbe patient cannot adequately de-
scribe, if given an opportunity, in an all day
rehearsal of his ailments, and which, if they
were the result of disease, would prove fatal be-
fore the narrative could be finished.
Third, if a person is insured by the Federal
Government against disability and can draw a
nice pay check each month for his disability,
in a complaining individual as above described,
the stage is set for the making of a complete,
permanent, 14-carat invalid who is totally dis-
abled, and who will resist with vehemence any
and all efforts toward rehabilitation.
Within the past 20 years I think all of us have
become conscious that the present trend of so-
ciety is leading to a steady and gradual weaken-
ing, and even disintegration, of our moral and
spiritual consciousness, and with it, unfortu-
nately, the deliberate surrendering of individual
initiative, ambition, and a desire to succeed in
any undertaking, for a paltry mess of pottage
served by a paternalistic government. The de-
velopment of this type of philosophy, among an
otherwise healthy citizenship, weakens the very
foundation of that type of citizen who has made
this government possible, and will greatly in-
crease the demands for government benefits
which, in times of stress and strain, will be
greatly increased and force our people into a
moral state of indolence, and our national econ-
omy into a state of bankruptcy.
I ask those of you who visit among your con-
stituents to observe the tremendous increase in
the members of our population who are looking
for a position and not for a job, a position they
consider ornamental to a business without the
assumption of any tremendous amount of re-
sponsibility, and which could be used to enhance
the business because of their supposedly striking
qualifications and their ability to drawr a nice pay
check. Those who seek a job are people who are
willing to work, who glory in the accomplish-
ment of a task, and who are happy to be pro-
ductive. These are few in number. Evidence of
this belief can be obtained by spending a few
hours visiting any of the employment agencies.
Fourth, physicians have little sympathy with
this point of view since they not only work “when
willing and able, but also without a contract. ”
They go on call both day and night, irrespective
of a national emergency, to render service to the
rich, to the poor, and to all of our citizens,
regardless of race, creed, or religion. They are
conscious of demands which are made upon
them, and which will be increasingly made if
the provisions of this Act are passed, for certifi-
cation as to presence of total and permanent
disability which does not exist. It takes a physi-
cian of considerable stamina to be able to resist
some of these appeals. And sometimes they wfill
not do so.
Some 20 or 25 years ago many large insurance
companies issued policies on a great number of
people, covering them for total and permanent
disability. During prosperous times the insur-
ance companies made money on this type of con-
tract. When the sailing became a little rough, a
172
The Journal of the Medical Association of Georgia
great many physicians will recall, considerable
numbers of patients so insured demanded to be
classed as permanently and totally disabled so
they could retire from business and receive a
tax-free income which was sufficient for them to
enjoy the art of living without any of the respon-
sibilities, restrictions, or obligations connected
with the honorable profession of work. I am not
referring in this statement to those patients who
obviously suffered a disability which prevented
them from working. But I am referring to that
large group which developed only subjective
complaints, such as nervous disorders, head-
aches, backaches, rheumatism, angina pectoris,
and other disorders which could not in the slight-
est degree be detected by physical or other exam-
inations. These people, many of them, had per-
suaded themselves that they were sick and dis-
abled. Many of them could not do the slightest
thing, if such was called work, but much could
be done under the name of pleasure, such as
fishing, skeet shooting, piloting a boat, bird
hunting, ten-cent poker, and other pleasures
which would perhaps require no physical exer-
cise but which might increase their blood pres-
sure, and be indulged in without damaging their
chances of living provided no work was involved.
The depression, which came along in the
thirties, also caused many people m a different
financial bracket, insured under a group policy,
to seek the security of a permanent and total
disability. All of this illustrates the point that
when the field is made fertile for the develop-
ment of dependency on some agency or carrier
other than the patients’ own efforts, they nat-
urally seek the course of least resistence and
demand help from other sources. The experience
of life insurance companies, if studied, would be
most interesting because I do not believe that
the underwriters have been at all successful in
removing from their payroll any of those who
are collecting for total and permanent disability,
except by death, and the mortality is quite low
for the disease causing the disability.
It is my belief that unemployment (which is
liable to increase in this country) from a psycho-
logical standpoint will cause the development of
a great many subjective symptoms which could
be classed as rendering a patient totally and
permanently disabled. It is true that with stimuli
such as this, and others, it is almost next to im-
possible to determine total disability in a patient
who has made up his mind and is determined to
prove that he is totally disabled in order to obtain
a life income from the Federal Government.
A great number of women are employed, some
18,000.000, many of whom probably would
qualify for benefits under the proposed program.
It is realized by those who are engaged in the
practice of medicine that this would be a most
difficult group to properly evaluate their claims
for disability.
There are other pitfalls which could be brought
lo your attention, hut I believe the idea has been
developed from a practical standpoint sufficiently
to warn the Congress of what a disastrous step
it will be to our national economy to write into
the Social Security Act any such program as
that recommended in H.R. 6000. Section 107, for
total and permanent disability. Social Security
funds should necessarily be limited in amount;
they represent taxes which are drained from the
producers of the nation. Unless there is some
limitation on the fantastic demands for funds,
our national economic health will be thrown tre-
mendously out of balance and a fatal condition
of shock develop from which there is no recovery.
Since it has been very clearly shown that cash
disability benefits diminish the incentive to-
wards rehabilitation, self-reliance, and self-main
tenance, which is extremely undesirable, it seems
to me that the emphasis, and any consideration
which is given to this program, should be fo-
cused on rehabilitation. This cannot be done
successfully in my opinion under Federal control.
All of the states, insofar as I know, have agencies
which are capable of handling individuals who
claim disability, such as the State Welfare Agen-
cies. These agencies are on the ground. They
know of the individual who applies for assistance.
They have an opportunity to investigate their
worthiness, and they have facilities for rehabili-
tation. They are also capable of finding work
for him or her, and determining whether treat-
ment at home, in an institution, or in other
places is the most desirable. Please let them
handle it.
I therefore respectfully request that this part
of the program, Section 107, be eliminated in
the Social Security amendment to H. R. 6000
since its adoption, in my opinion, will lead to
the development of a considerable number of
malingering and semi-invalid individuals among
many of our worthwhile citizens. It would mean
a further encroachment upon States’ Rights, and
the building up of Federal payrolls which would
be used for political influence in the handling of
claims. It matters not what safeguards are taken
to write into the law those who would be eligible
for insurance, all of us know that after a short
space of time no attention is paid to this law,
just as is happening in other phases of the Social
Security program and in the treatment of vet-
erans in VA hospitals. It is common knowledge
that veterans with non-service-connected disabili-
ties who are perfectly able to pay for hospital
care and medical service are being treated at con-
siderable public expense when the law specifies
under what conditions they should be benefi-
ciaries of this service. The same could, in my
opinion, happen with those drawing compensa-
tion for total and permanent disability benefits.
April, 1950
1 75
FIND 50.000 IN LOS ANGELES AREA
HAVE BEEN INFECTED WITH Q FEVER
M ore than 50.000 persons in the Los Angeles
area probably have been infected during recent
years with the microbe that causes Q fever,
according to a report in the March 25 Journal of
the American Medical Association.
The study was made by Dr. Joseph A. Bell,
medical director of the Laboratory of Infectious
Diseases, Microbiological Institute, National In-
stitutes of Health. Bethesda, Md.; Dr. Robert J.
Huebner, senior surgeon, U. S. Public Health
Service, Bethesda; and M. Dorthy Beck, senior
epidemiologist of the California State Depart-
ment of Public Health, Berkeley, Calif.
The disease which was found to occur in the
metropolitan area of Los Angeles in 1947, is com-
monly characterized by headache, high fever,
severe sweats, and pneumonia-like changes in
the lungs which can be seen on x-ray films,
according to the report. Infection with the mi-
crobe occasionally produces no recognizable ill-
ness, often a mild to moderate illness of about
one week's duration and not uncommonly a
severe illness for three or more weeks. Nine
deaths from Q fever have been reported.
Nearly 10,000 persons in Los Angeles and
the surrounding area were given a laboratory
test which indicates whether recent infection w'ith
the Q fever microbe has been present. The per-
centage of positive results from the test in the
first three groups (persons applying for routine
premarital examinations, persons drinking raw
milk and those working in aircraft manufacturing
plants) was 1.36 per cent.
“If this percentage is applied to the total
population, it indicates that more than 50,000
persons in Los Angeles have been infected during
the past several years,” the report says.
Each of the other 12 groups was selected so
as to have a disproportionately large number
of persons who had some type of association w ith
livestock or their raw products. The percentage
of positive reactions in these groups varies from
nearly 4 per cent in packing plants to 23 per
cent in dairy workers.
In all of the various groups, persons who had
used raw milk at any time since 1941 had a
higher percentage of positive reactions than
those who had not. These consistent differences
still obtained after allowance was made for the
influence of other factors.
“It appears that a sizable proportion of these
(50,000 ) infections caused many persons to have
an acute illness with fever for two or more days
which was not heretofore recognized as Q fe-
ver,” the report says.
“The most frequent and by far the most im-
portant sources of human infection were local
dairy cows, their very young calves and some
of their raw products, particularly raw milk
and hides.
“The persons most apt to have been infected
were those who had used raw milk in their house-
holds, those whose residence had been located
near a dairy or livestock yard, and those who
had worked in industries handling live or re-
cently killed local dairy cows and young calves
(employees of dairies, meat-packing, fat-render-
ing and hide plants and creameries).”
An analysis of 300 cases found in Los Angeles
showed that human cases are rarely if ever direct
sources of infection for other persons and that
insects play little if any role in the spread of
the disease to human beings, the researchers
point out.
FIND BLOOD TEST FOR CANCER NOT
SL'ITABLE FOR DIAGNOSIS AT PRESENT
The Huggins-Miller-Jensen blood test for can-
cer does not appear suitable at present as a diag-
nostic test, in the opinion of two researchers
from the Department of Experimental Pathology,
Quincy (Mass.) City Hospital.
The test, based on albumin disturbance in
cancer patients, was first reported about a year
ago by Dr. Charles B. Huggins of the University
of Chicago.
The diagnostic value of the procedure followed
by Dr. Huggins and his co-workers was tested
by Dr. Otakar J. Poliak and Adeline Leonard,
B. S. Their report on test results from blood
serums from 80 patients with proved malignant
growth and on control serums from 170 patients
appears in the March 25 Journal of the American
Medical Association.
In seven of the 80 patients w-ith proved malig-
nant growth, the test failed to indicate the pres-
ence of cancer, the researchers say. In 23 of the
170 persons in whom malignant growth was ex-
cluded on the basis of clinical signs and labora-
tory and x-ray study, the test indicated malig-
nancy. The total number of false reactions in the
series of 250 persons was 30 (12 per cent).
“At the present time, this reaction is not suit-
able as a diagnostic test,” the researchers point
out. “Further investigation might bring about
the development of a reaction the result of which
would show better correlation with disease.’4
CITES DESIRABILITY OF BREAST
FEEDING OF BABIES
Most mothers can give their babies the nutri-
tional and emotional benefits of breast feeding,
a doctor who made a study of methods of breast
feeding reports.
Various demonstrations have proved convinc-
ingly that almost any mother who wants to can
breast feed her baby as long as she and her
doctor desire, says Dr. Frank Howard Richard-
son of Asheville, N. C., and the Children’s Clinic,
Black Mountain, N. C., in the March 25 Journal
of the American Medical Association.
174
The Journal of the Medical Association of Georcia
Breast feeding has been shown to reduce mor-
tality and sickness percentages, enhance im-
munity to gastrointestinal and respiratory dis-
eases and contribute emotional benefits claimed
by psychologists for mother and baby alike, l)r.
Richardson points out.
FIND ETHYL ALCOHOL UNSATISFACTORY
DISINFECTANT FOR WOUNDS
Ethyl alcohol, the ordinary alcohol of com-
merce and pharmacy, should not be used as a
disinfectant in wounds or on raw surfaces of
injured areas, according to a Salt Lake City
doctor who made a study of the substance.
The antibacterial action of ethyl alcohol is
neutralized by proteins present in the wound,
says Dr. Philip B. Price of the University of
Utah College of Medicine. Dr. Price’s report
appears in the March issue of Archives of Sur-
gery, published by the American Medical Asso-
ciation.
Further, the alcohol is painful, injures wound
tissues and delays wound healing. Dr. Price
points out.
Simple solutions of ethyl alcohol are not satis-
factory agents for cold sterilization of surgical
instruments. Dr. Price also found.
Seventy per cent alcohol (by weight) in water,
however, is still believed to be the “solution of
choice” for disinfection of the skin, he says. On
healthy skin, this solution is powerfully destruc-
tive to germs and harmless to the body.
MEDICINE’S ROLE IN CIVIL DEFENSE
TO BE DISCUSSED
The role of medicine in a nationwide civil
defense program will be discussed at the semi-
annual meeting of the Council on National Emer-
gency Medical Service of the American Medical
Association. May 6.
The meeting, to be held in the A.M.A. head-
quarters, 535 North Dearborn Street, Chicago,
will be attended by representatives of state and
territorial medical associations, according to Dr.
Robert M. Hall, Chicago, council secretary.
A tentative agenda calls for discussions, with
recognized authorities, of various civil defense
aspects of atomic, chemical and psychological
warfare, and the presentation of experiences of
states and communities that already have devel-
oped programs to cope with disasters of all types.
Among states which have progressed in that
direction is Maine. Its program and that of
others will be discussed in roundtable forums.
Also to be considered are the Atomic Energy
Commission’^ program for the indoctrination of
the entire physician population in the medical
aspects of atomic warfare and the implementa-
tion of this program by the various medical
societies.
The civil defense problems facing both urban
and rural areas will be outlined.
NO PREVENTIVE OF GRAY HAIR,
SAYS MEDICAL AUTHORITY
An agent which will prevent the graying of
hair of human beings is as yet unknown, says a
medical consultant in the March 25 Journal of
the American Medical Association.
“Sometime ago it was suggested that both pan-
tothenic acid and para-aminobenzoic acid might
prove to be anticanitic (opposed to graying of
hair) agents because they seemingly prevented
the graying of hair in laboratory rats,” he writes.
"However, they have had no such effect on hu-
mans.”
ELECTRON MICROSCOPE PROVING
BIG AID IN MEDICAL RESEARCH
Solutions to some of the vexing problems be-
fore medical researchers may be reached through
the use of the electron microscope, in the edi-
torial opinion of the March 25 Journal of the
American Medical Association.
“Where future research with these microscopes
will lead remains to be seen, but there is assur-
ance that if the future findings are as exciting
as those of the past few years thev will be
astounding,” says the editorial.
It points out that there is need for precision tech-
niques in the field of microscopic exploration. The
electron microscope, which because of its size appears
to be built upside down, is being used in the study of
plant and animal viruses and of bacteriophages, an
ultramicroscopic bacteria-destroying agent.
“The importance of studying the virus (or viruses)
responsible for anterior poliomyelitis (inflammation of
the gray substance of the spinal cord), influenza viruses,
viruses of the pox group and other disease-producing
organisms cannot be stressed too strongly,” says the
editorial.
“One important aspect of the observations made with
the electron microscope is the different way in which
bacteria and viruses may behave in their living and dying
processes. When these variations are better understood
it may be possible to explain some of the peculiar differ-
ences that arise in clinical problems.”
The electron microscope in spite of its cost is becom-
ing more familiar to researchers in the medical, biologic
and industrial fields. Electrons are accelerated electric-
ally between a filament and a condenser to a high speed
or energy. The microscope is a high vacuum instrument
to prevent a collision of these electrons with air mole-
cules. Specimens required for electron microscopy are
much thinner than those used in the conventional
optical microscopes.
Although the use of the instrument is not limited to
bacteriology and virology, its more apparent usefulness
for those concerned with health problems lies in these
fields, says the editorial.
U. S. RANKS WITH LEADING NATIONS
IN PREVENTING INFANT DEATHS
Rapid strides in improving and applying medi-
cal technics of caring for babies have made the
United States practically equal to any other
nation in the world in preventing infant deaths,
an American Medical Association study shows.
The study, which was recently completed by
Frank G. Dickinson, Ph.D., and Everett L. Wel-
ker, Ph.D., Chicago, of the A.M.A. Bureau of
April, 1950
175
Medical Economic Kesearch, and published as
Bulletin 73, is summarized in the April 1 Journal
of the Association.
One reason for the marked improvement in
this country’s infant death rate is that in recent
years the two diseases which are the major causes
of deaths of babies over one month and under
one year — pneumonia and infant diarrhea — have
largely been conquered in most sections of the
United States, according to Dr. Dickinson.
This medical advance has brought about a re-
duction in deaths of babies from six months to a
year of age, he said. During 1946, the latest
year for which specific information is available,
the United States had the world's lowest infant
death rate for this age group.
The difference between the infant death rates
of this country and New Zealand, the leader, for
the first month of life is largely a statistical
illusion, the study shows. Differences between
the definitions and rules of the two countries re-
garding stillbirths and early infant deaths explain
two thirds of the difference between the current
total infant death rates of the two countries.
Also, the United States includes in its compu-
tation of infant death rates the infant deaths
among all racial groups, a fact which helped to
give Arizona, New Mexico and Texas, where
numbers of American Indians and persons of
Spanish-American (Mexican) descent are found,
the highest total infant death rates for 1948 in
the nation. New Zealand excludes infant deaths
among its native Maoris.
The decline in infant deaths in the United
States during the last 15 years has been very
great. Since the middle 1930’s, the infant death
rate for the United States declined from 56 in
1935 to 32 in 1947, while the rate for New Zea-
land declined from 32 to 25, Dr. Dickinson said.
TOWARD EFFECTIVE CANCER CONTROL
Nowhere in the world do voluntary health
agencies flourish in such abundance as they do
in the United States. They are an expression of
the charitableness of our people toward those
less fortunate, and they are testimony to the
democratic spirit of Americans in organizing and
working cooperatively for the common good.
The American Cancer Society, a venerable
member of the family of health agencies, should
be thoroughly known to all doctors for its serv-
ices are many. Through its national office in
New \ork, its 61 chartered divisions and 2,613
county branches, it conducts a broad-based year-
round effort to control cancer, one of the fore-
most medical problems confronting us.
The control of cancer eventually will come
through an understanding of cancer’s causes,
means of prevention and effective treatment meth-
ods; this knowledge waits on research. The So-
ciety has recognized the importance of intensified
investigative efforts in the field of growth and
spends 25 per cent of its income in the support
of such stuflies and in the training of young
scientists to carry them forward. During the
present year this support amounts to $3,500,000.
The total research expenditure for the past five
years is $13,153,560.
A substantial measure of control over cancer
can be achieved today with the knowledge already
at hand. The disparity between cancer's cura-
bility and the cures being achieved is striking.
For example, cancer of the breast is curable in
80 per cent of patients who are treated when the
disease is confined to the breast; yet the country-
wide cure rate is less than 35 per cent. When
cancer of the rectum is confined to the mucosa,
cure rates of 70 per cent have been reported: yet
the overall rate of cure is about 1 1 per cent.
Similar differences hold for most forms of the
disease. In order to achieve a larger measure of
cures, the American Cancer Society engages in an
intensive educational and publicity campaign,
based on knowledge of cancer’s early signs and
symptoms (the Danger Signals), and the value
of periodic physical examinations.
April is the month when the American Cancer
Society makes its annual appeal to the public for
support of its programs. As more and more of
our people live longer, the incidence of cancer
increases. As the problem becomes more wide-
spread, so must the effort to control the disease
be intensified. The Society is dedicated to the
principle that through education and research an
effective measure of cancer control may be
achieved at this time.
Improved services to patients with cancer are
provided by support of cancer clinics, organized
programs of cancer detection and information
services; these efforts are augmented by a corps
of volunteers who provide loan closets, trans-
portation services, recreational activities and
dressings.
Of immediate interest to doctors is the profes-
sional education program. During the past year,
three monographs of a series dealing with cancer
by anatomic site have been distributed to prac-
ticing physicians throughout the country. The
series will be continued this year, with distribu-
tion at three-month intervals.
The professional journal Cancer, which first
appeared in May, 1948, has been well received
by clinicians and investigators interested in the
problems of abnormal growth. A series of motion
pictures for professional audiences, treating the
problems of early diagnosis of cancer by ana-
tomic site, has been outlined. Two of the films
have been released, the first concerned with the
general problem of the early diagnosis of cancer
and the second concerned specifically with the
early diagnosis of cancer of the breast. A third,
covering cancer of the gastro-intestinal tract, is in
preparation and will be released this year.
176
The Journal of the Medical Association of Georgia
A new publication of the Society will appear
this year, and will he distributed bi-monthly to
practicing physicians throughout the country.
Topics of interest to the general practitioner will
he presented in digest form, together with brief
abstracts of significant papers appearing in the
literature. Clarity, brevity and general interest
will be stressed. It is the Society’s hope that this
digest will be accepted by the busy physician
for whom it is planned.
The library of the Society publishes monthly a
bibliography of the current cancer literature
which is available on request to physicians, re-
search workers and libraries. The library will
prepare, on request, bibliographies on any topic
related to the field of cancer. A package lending
library has been established which will supply
reprints, on a loan basis, to any physician or
investigator requesting the service.
Charles S. Cameron, M.D.
Medical and Scientific Director
American Cancer Societv.
USE AUREOMYCIN AGAINST INFLUENZAL
MENINGITIS
Favorable results from treating seven patients
for influenzal meningitis with aureomycin are
reported by a group of doctors from the Uni-
versity of Maryland School of Medicine, Balti-
more.
The disease is an infection of the membranes
which envelop the brain and spinal cord and is
not caused by the microbe responsible for ordi-
nary influenza.
“Aureomycin therapy was followed by fall of
temperature to normal levels within 96 hours
after the initial dose,” Drs. Miles E. Drake, J.
Edmund Bradley, Jerome Imburg, Fred R. Mc-
Crumb, Jr., and Theodore E. Woodward write in
the February 18 Journal of the American Medi-
cal Association.
“On the third day of treatment, abatement of
such symptoms as mental dullness and convul-
sions was definite,” the doctors say. “On the
fifth day, the acute phase of illness had com-
pletely disappeared. The patients were plainly
convalescent, with increased strength and return
of appetite.”
Former treatments for the disease, including
administration of sulfa drugs and streptomycin,
possess “clearly defined disadvantages,” the doc-
tors point out, adding:
“Clinical trial of aureomycin in these cases
has led us to believe that it may represent a
highly effective method of therapy in this type
of infection.”
ST. VITUS’ DANCE
Chorea, or popularly called St. Vitus’ Dance, is a
condition marked chiefly by lack of coordination through-
out the body generally, resulting in jerky, purposeless
movements and causing the victim very often to harm
himself if not closely watched, the Educational Com-
mittee of the Illinois State Medical Society observes in
a Health Talk.
A disease of the nervous system, the condition was
once known as the "Dancing Mania.” Its name "St.
Vitus' Dance” comes from the patron saint of the suffer-
ers of the disease, said to arise from a legend of the
fourteenth century. In 1686, Sydenham, an English phy-
sician, described the condition; hence the name Syden-
ham’s chorea.
Generally believed to be caused by a germ of the
streptococcus type, chorea is defiitely related to rheu-
matic fever. In both the heart may be affected. It
chiefly attacks the age group five to fifteen, and girls
more often than boys.
Apparently the causative agent gets in the brain and
nervous system, accounting for the characteristic symp-
toms of nervousness and a “fidgety” lack of muscle con-
trol. Inability to coordinate is also manifested by
stumbling, jerking, a shaking inability to button clothes
or pick up objects because of the shaking of the arms
and hands.
The strange jerky movements are apparently all dif-
ferent in character, since no two seem to be alike. The
twitching will range from a slight tremor to almost
violent movements. When the facial muscles are affected,
the distortions are indeed a pathetic sight.
It is difficult to say when the disease starts. There
may be dizziness, headache, vomiting and even a slight
fever before the jerky, purposeless movements appear.
Weakness, awkwardness, listlessness, restlessness, in-
ability to pay attention are other signs.
Rest in bed is important for the child with chorea. He
should be watched very carefully, since very often he
can harm himself by the spasmodic movements, particu-
larly if he throws himself out of bed as frequently
occurs, or striking his head, a leg or arm against the
bedpost or a wall.
The attitude to the victim of chorea should be soothing
and comforting, since there is a tendency to emotional
imbalance. The patient is aware of his spasmodic
“threshing about.” He becomes oversensitive and irri-
table.
The sufferer should be supervised closely by a physi-
cian who, very often, can prescribe certain medicines
that will tend to make the purposeless movements less
violent, obviating the chances of producing physical
harm.
Convalescence generally requires from two to six
months. The diet should be nourishing and contain
ample fluids. After care should include adequate diet,
controlled exercise and play. These coupled with proper
relaxation and rest should prevent any permanent dam-
age to the victim of St. Vitus' Dance.
THUMBSUCKING
A parent who attempts to break his child of thumb-
sucking by scolding, or even coaxing, is not using good
judgment. Either practice can be harmful because it
denotes a lack of everyday common sense in rearing a
child, the Educational Committee of the Illinois State
Medical Society advises in a Health Talk.
A child’s first automatic sense of comfort is through
sucking. Whether breast or bottle fed, sucking satis-
fies his hunger, and it isn’t long before he discovers that
the thumb is a handy gadget for his mouth and thus is
established the thumbsucking habit. Very often the
habit suggests that the baby is not getting enough
sucking — perhaps he has been taken away too soon from
the breast or the bottle, or again he has been put on a
nursing schedule that allows too few nursing periods.
In any event, the child derives comfort from his sucking,
an important factor in why he does it.
As the child grows older, he usually resorts to sucking
his thumb to fill an emotional need. Feeling unwanted
and alone may be responsible, so he seeks to satisfy
himself. Unhappiness, fear and insecurity are emo-
tional problems that loom high on a child’s horizon.
It is generally conceded that up to the first few years,
thumbsucking may be considered normal with the habit
April, 1950
177
acting as a sort of pacifier or comforter. A child's
curiosity is an ever present wonder. The more he ex-
plores the new things about him, the more his mind
is taken from himself. Usually by the time he reaches
the wonders of his five to six years of age world, the
thumbsucking habit is forgotten.
If the practice continues beyond this age, however,
definite steps for correction should be undertaken by
consulting with your physician. In the very young child,
it is unlikely that much pressure will be exerted against
the roof of the mouth or on the jaws. However, as the
child grows older, it is possible to exert greater pressure
which, in many cases, may result in some structural
defects of the jaws. And then again, in an older child
the habit suggests an emotional need, a gap that should
be filled to insure normal mental growth.
Thumbsucking is often associated with going to sleep.
Parents dislike seeing their children grow up too soon,
yet many will berate them for being afraid of the dark
or being left alone in the room. They scold these young-
sters for not being “grown up,” and for having baby
fears. Instead of threatening, why not concede a little,
so that the child understands you are trying to help
overcome these fears?
Shaming, threatening, scolding and conversely bribing
and coaxing are all methods used in the correction of
thumbsucking. Unfortunately, the application of bitter
solutions, splints and other restraints are also tried.
Wise parents will understand that thumksucking is a
normal practice for the very young and that the child
w ill stop it unconsciously as he grows older. They will
understand too that, in addition to food and clothing, a
good share of affection and love are essential to meet
the youngster’s emotional needs.
Notice when your child sucks his thumb, don't call
attention to it, but try to understand the circumstances
surrounding the action. Then try to attract his interest
by creating new and happy situations and satisfactions.
WHAT IS NEUROLOGY?
Many persons are confused by the terms neurology
and psychiatry and yet in understanding the definitions
a great distinction is noted between the two fields of
medicine, the- Educational Committee of the Illinois State
Medical Society observes in a Health Talk.
Neurology covers the physical diseases that affect the
entire nervous system which includes the brain, its con-
necting spinal cord, located in the spine itself, and the
many nerves extending from the spinal cord to various
parts of the body.
Psychiatry deals with the emotional or mental dis-
turbances of the mind, stirred up in the brain and
related to the mind itself through thoughts, attitudes and
behavior patterns.
Thus the nervous system is a complex structure of
wiring that may be compared to a telephone system.
The brain is the central office where all communications
are received and sent. In other words, if we touch some-
thing, see an object, whether unconsciously or de-
liberately, a group of nerves goes into action on a mes-
sage from the brain. Certain sections of the brain are
charged with different responsibilities, so that actually
to reach for the object a group of nerves directs the
muscles necessary to bring up the arm and hand to
pick up the object. In the same manner, your eyes
notice a person or an object falling toward you. They
in turn send the message to the central office in the
brain. Again the relay is started, the nerves to the muscles
and up come the arms to ward off the falling object.
When an infection, injury, disease or growth affects
any part of the nervous system, one result is noticed and
that is an interference in the telephone system, causing a
blocking in the service. Thus if a certain part of the
brain is affected, the result may be hemiplegia or
paralysis of one side of the body. If, however, another
part of the brain is affected, or a part of the connecting
link — the spinal cord — the person may lose the use of
both legs, a condition known as paraplegia. If the back
part of the brain is affected, called the cerebellum, a
condition develops known as ataxia and is evidenced by
lack of muscular coordination. The victim will walk in
a weaving fashion, much like a person does who is
intoxicated.
These are some conditions that occur when the brain
is affected. In the same manner when the nerves or
wiring system are attacked, again interference in the
telephone service is noted. If one nerve is affected, we
may have neuritis, or if many nerves are involved, the
result may be multiple or polyneuritis.
Nutritional deficiencies may be the cause, or the tak-
ing of medicines either advertised or perhaps recom-
mended by a friend. Thus self-diagnosis or self-medica-
tion may lead to the development of some form of
neuritis, which will affect the telephone wires in various
parts of the body. As a result, the individual may lose
the use of his hands or feet, known as wrist and foot
drop, respectively.
When the nervous system is functioning normally, the
reflexes are normal. Many different tests are performed
to determine whether an interference in the nervous
system is present. For example, a tapping at a certain
place beneath the knee will cause the foot to jerk invol-
untarily, which is the normal reflex action. In certain
conditions where the wire system is disturbed the
patient will not feel the stick of a pin.
And so in neurology the physical changes of the ner-
vous system are studied and by a series of tests it is
possible to check the patient’s sensibility, thus estab-
lishing the area or site involved.
COUNTIES REPORTING FOR 1950
Bartow County Medical Society
President — Charles L. Ellis, Kingston
Vice-President — H. B. Bradford, Cartersville
Secretary-Treasurer — A. L. Horton, Cartersville
Censors — S. M. Howell, Wm. B. Quillian, Jr., and H. B.
Bradford
* * *
Ben Hill County Medical Society
President — Francis W/ard, Fitzgerald
Vice-President — G. K. Cornwell. Fitzgerald
Secretary-Treasurer — W. P. Coffee, Fitzgerald
Delegate — Roy Johnson, Jr., Fitzgerald
Alternate Delegate — D. B. Ware, Fitzgerald
Censors — G. W. Willis, W. D. Willcox and J. E. Smith
* * *
Bibb County Medical Society
President — C. H. Richardson, Jr., Macon
President-Elect — Robert W. Edenfield, Macon
Vice-President — John I. Hall, Macon
Secretary-Treasurer — Henry H. Tift, Macon
Delegate — J. D. Applewhite, Macon
Delegate — J. B. Kay, Byron
Alternate Delegate — C. N. Wasden, Macon
Alternate Delegate — W. W. Baxley, Macon
Censor — W. W. Baxley, Macon
* * *
Blue Ridge Medical Society
Fannin-Gilmer-Union Counties
President — Courtney C. Brooks, Blue Ridge
Vice-President — James F. O'Daniel, Ellijay
Secretary-Treasurer — Thomas J. Hicks, McCaysville
Delegate — Thomas J. Hicks, McCaysville
Alternate Delegate — James F. O'Daniel, Ellijay
Censors — Ed W. Watkins, James F. O'Daniel and
Thomas J. Hicks
* * *
Chattooga County Medical Society
President — John J. Allen, Trion
Vice-President — Wm. T. Gist, Summerville
Secretary-Treasurer — -Hugh A. Goodwin, Summerville
Delegate — G. H. Little, Trion
* * *
Cherokee-Pickens Medical Society
President — E. A. Roper, Jasper
Vice-President — Charles R. Andrews, Jr., Canton
Secretary-Treasurer — A. M. Hendrix, Canton
Delegate — C. J. Roper, Jasper
Censors — Grady N. Coker, T. J. Vansant, and Ben K.
Looper
The Journal of the Medical Association of Georgia
Clarke County Medical Society
President — J. B. Neighbors, Jr., Athens
Vice-President — Linton Gerdine, Athens
Secretary-Treasurer -William H. Bonner, Athens
Delegate -Marion A. Hubert, Athens
* * *
Colquitt County Medical Society
President R. E. Stegall. Moultrie
Vice-President — John F. McCoy, Moultrie
Secretary-Treasurer Robert E. Fokes, Jr., Moultrie
Delegate — John F. McCoy, Moultrie
Alternate Delegate R. E. Stegall, Moultrie
Censors — A. G. Funderburk, Edgar C. Holmes, and
R. M. Joiner
* * *
Coweta County Medical Society
President — Joseph W. Parks, Jr., Newnan
\ ice-President — J. 0. St. John, Newnan
Secretary-Treasurer -N. B. Glover. Newnan
Delegate — H. D. Meaders, Newnan
Alternate Delegate — G. W. Hammond, Newnan
* * *
Crisp County Medical Society
President — C. E. McArthur, Cordele
Secretary-Treasurer — O. T. Gower, Jr.. Cordele
Delegate — P. L. Williams, Cordele
Alternate Delegate — C. E. McArthur, Cordele
* * *
Decatur-Seminole Medical Society
President- Henry A. Bridges, Bainhridge
Vice-President — Carl B. Welch. Attapulgus
Secretary-Treasurer -M. A. Ehrlich, Bainhridge
Delegate — Harry B. Baxley, Donalsonville
Alternate Delegate- John P. Tucker, Bainhridge
* * *
DeKalb County Medical Society
President Lawrence P. Matthews, Atlanta
V ice-President — H Homer Allen, Decatur
Secretary-Treasurer — F. C. Powell. Decatur
Delegate John T. Leslie. Decatur
Alternate Delegate — W. A. Mendenhall, Chamblee
* * *
Dooly County Medical Society
President 0. K. Coleman, Vienna
Secretary-Treasurer — Martin L. Malloy, Vienna
Delegate — O. K. Coleman, Vienna
Alternate Delegate — Martin L. Malloy, Vienna
* * *
Floyd County Medical Society
President — Edward L. Bosworth, Rome
Vice-President — Lee H. Battle, Jr., Rome
Secretary -Treasurer — Russell E. Andrews. Jr., Rome
Delegate -Lee H. Battle, Jr., Rome
Censors — John T. McCall, Warren M. Gilbert, and
Ralph B. McCord
* * *
Hancock County Medical Society
President Horace Darden, Sparta
V ice-President — C. S. Jernigan, Sparta
Secretary-Treasurer — H. L. Earl, Sparta
Delegate — C. S. Jernigan, Sparta
* * *
Houston-Peach Medical Society
Secretary-Treasurer -A. G. Hendrick, Perry
Delegate — A. Smoak Marshall. Fort Valley
Alternate Delegate — A. G. Hendrick, Perry
* * *
Lamar County Medical Society
President — J. H. Jackson, Barnesville
V ice-President — D. W. Pritchett, Barnesville
Secretary-Treasurer — S. B. Traylor, Barnesville
Delegate -J. A. Corry, Barnesville
* * *
Laurens County Medical Society
President — M. Fernan-Nunez, Dublin
Vice-President — Charles A. Hodges, Dublin
Secretary-Treasurer — O. H. Cheek, Dublin
Delegate — Tyrus R. Cobb, Jr., Dublin
Alternate Delegate Charles A. Hodges, Dublin
Censors — A. T. Coleman, C. G. Move, J. J. Barton, and
William A. Dodd
* » *
Montgomery County Medical Society
President — W. M. M oses, Uvalda
Vice-President — J. E. Hunt, Bynum, Ala.
Secretary-Treasurer J. Wr. Painter, Ailey
Delegate — Morris Kusnitz, Jr., Alamo
* * *
Richmond County Medical Society
President — Charles McL. Mulherin, Augusta
President-Elect — Thomas W '. Goodwin, Augusta
Vice-President — Allen G. Thurmond, Augusta
Secretary-Treasurer — Gilbert L. Klentann, Augusta
Delegate — Robert C. McGahee, Augusta
Delegate — David R. Thomas, Jr., Augusta
Delegate — John M. Martin, Augusta
Alternate Delegate — F. N. Harrison, Augusta
Alternate Delegate — John VI. Miller. Augusta
Alternate Delegate — J. Victor Roule, Augusta
* * *
Spalding County Medical Society
President -Ann Stuckey, Griffin
Vice-President — T. J. Floyd. Griffin
Secretary-Treasurer — Virgil B. Williams, Griffin
Delegate Kenneth S. Hunt, Griffin
Alternate Delegate — T. G. Srnaha, Griffin
Censors — George L. W^alker, J. T. Giles and Alex P.
Jones
* * *
Stephens County Medical Society
President — H. H. McNeely, Toccoa
Vice-President — Charles M. Henry, Toccoa
Secretary-Treasurer — C. L. Ayers, Toccoa
Delegate — Robert E. Shiflet, Toccoa
Alternate Delegate — Arthur E. Singer. Toccoa
Censors: E. F. Chaffin, LI. H. McNeely, and Charles M.
Henry
* * *
Sumter County Medical Society
President Henry R. Fenn, Americas
Vice-President Win. B. McMath, Antericus
Secretary-Treasurer — Bon M. Durham, Antericus
Delegate — Henry R. Fenn. Antericus
Alternate Delegate — Wnt. B. McMath. Antericus
Censors — Henry R. Fenn, Wnt. B. McMath, and Bon
M. Durham
* * *
Taylor County Medical Society
President — F. H. Sants, Reynolds
Vice-President — R. C. Montgomery, II, Butler
Secretary-Treasurer — E. C. Whatley, Reynolds
Delegate — R. C. Montgomery. Butler
Censors — Lewis Beason, and R. C. Montgomery
* * *
Thomas County Medical Society
President -Henrv S. Pepin, Jr., Thomasville
Vice-President — Marion A. Baldwin, Thomasville
Secretary-Treasurer — Kirk Shepard. Thomasville
Delegate — Rudolph Bell, Thomasville
Alternate Delegate — John W. Mobley. Thomasville
Censors — Charles H. Watt, Henry M. Moore, and John
W'. Mobley
* * *
Toombs County Medical Society
President — J. E. Mercer, Vidalia
Secretary-Treasurer — R. H. Dejarnette, V idalia
Delegate — H. D. Youmans, Lyons
Alternate Delegate — J. D. McArthur, Lyons
* * *
Tri-County Medical Society
Calhoun-Early-Miller Counties
President — W. C. Baxley, Blakely
Vice-President -James H. Crowdis, Jr., Blakely
Secretary-Treasurer — H. J. Merritt, Colquitt
Delegate — J. G. Standifer, Blakely
Alternate Delegate — C. K. Sharp. Arlington
Censors — James B. Martin. James W. Merritt, Jr., and
W. H. Wall
April, 1950
179
Troup County Medical Society
President Thomas N. Freeman. Jr., LaGrange
Vice-President — Evan W. Molyneaux, Hogansville
Secretary-Treasurer — H. A. Foster, LaGrange
Delegate— C. Mark Whitehead, LaGrange
Alternate Delegate — Evan W. Molyneaux, Hogansville
Gensors — Evan W. Molyneaux, Thomas N. Freeman, Jr.,
and H. A. Foster
* * *
Upson County Medical Society
President — Robert L. Carter, Thomaston
Vice-President -Douglas L. Head, Jr., Thomaston
Secretary-Tresaurer — Herbert D. Tyler, Thomaston
Delegate — John E. Garner, Thomaston
Alternate Delegate — Herbert D. Tyler, Thomaston
* * *
W alker-Catoosa-Dade Medical Society
President — Howard C. Derrick, Jr., LaFayette
Vice-President -John P. Hoover. Rossville
Secretary-Treasurer — L. LeBron Alexander, Rossville
Delegate — Fred H. Simonton, Chickamauga
Alternate Delegate — Frank L. O’Connor, Rossville
Censors — Fred H. Simonton, S. B. Kitchens, and Frank
L. O’Connor
* * *
If ashington County Medical Society
President -N. J. Newsom, Sandersville
Vice-President — Emory G. Newsome, Sandersville
Secretary-Treasurer F. T. McElreath, Jr., Tennille
Delegate — William Rawlings, Sandersville
Alternate Delegate — Emory G. Newsome, Sandersville
Censors — 0. L. Rogers, B. L. Helton, and R. L. Taylor
* * *
Wilkes County Medical Society
President — T. C. Nash, Philomath
Vice-President — C. E. Wills, Jr., Washington
Secretary -Treasurer — A. D. Duggan, Washington
Delegate — Albert G. LeRoy, Thomson
Alternate Delegate — M. C. Blair, Washington
Censors — L. R. Casteel, and A. W. Simpson, Sr.
COMMUNICATION
Dr. Edgar D. Shanks, Editor,
Journal of Medical Association of Georgia.
478 Peachtree Street,
Atlanta, Georgia.
Dear Dr. Shanks:
The following is a memorial to a recent member of
our County Society. Would you please publish this in
the next issue of the Journal?
The Medical Profession of Muscogee County received
with the deepest regret, the news of the tragic death of
Doctor and Mrs. S. E. Young of Midland. Dr. Young
had practiced medicine in this community for almost 60
years, and was an outstanding example of a type of
doctor that is unfortunately becoming rare in the medi-
cal profession. To the people of a large area he was a
steadfast friend at all times, as well as the family doctor
in time of sickness. He was loved by his patients and
held in the highest esteem by his fellow practitioners.
The members of the Muscogee County Medical Society
deplore his tragic death and extend to his family their
deepest sympathy in their great loss.
Thanking you for your kind cooperation, I am,
Sincerely,
Jack C. Hughston, M.D., Secretary,
Muscogee County Medical Society.
HEALTH PERSONNEL WANTED
To meet the increasing demand for experienced health
personnel to staff technical health missions overseas
which have been authorized by Congress, the Division of
International Health, Public Health Service, is develop-
ing an intensive recruiting program.
Opportunities for overseas assignments in the higher
grades are expected to develop for a number of physi-
cians, scientists, health educators, sanitary engineers,
sanitarians, nurses, administrators, and technicians. Some
of the projects will involve employment by the Public
Health Service and some will involve employment by the
World Health Organization.
Members of technical health missions can assist for-
eign governments in establishing public healtb training,
initiate health demonstrations, supervise specific projects,
and serve in an advisory capacity to foreign government
officials on health matters.
The various overseas health missions of the United
States have been authorized by Congress with a view to
strengthening mutual understanding between the people
of the United States and the people of other countries.
Such missions offer a challenge to American health
experts to cooperate with the other people of the world
in the development of human resources, as well as an
opportunity to broaden their own medical and personal
horizons.
Recruitment will be limited to highly qualified person-
nel possessing both expert knowledge in their technical
specialties and the ability to inspire cooperation in a
constructive program directed toward broad improve-
ments in public health and the general advancement of
human relationships.
Assignment will be made in the higher grades. Addi-
tional compensation will be provided in the form of
allowances for overseas service.
Qualified health personnel may obtain application
forms and further details concerning opportunities to
participate in these programs by writing to the Chief,
Division of International Health. Public Health Service,
Federal Security Agency, Washington 25, D. C.
NEWS ITEMS
Dr. Thomas Alsobrook, a native of Rossville, an-
nounces the opening of his office for the practice of
medicine at 304 Lake Avenue, Rossville. Dr. Alsobrook
graduated from Emory University School of Medicine,
Atlanta, in 1941, and served his internship at the
Missouri Baptist Hospital, St. Louis, Mo. He is a
graduate of the School of Aviation Medicine, Randolph
Field, Texas, and during World War II served as
flight surgeon with the Army Air Forces and held the
rank of major. Following the war he served a residency
in internal medicine at the Missouri Baptist Hospital,
St. Louis.
* * *
Dr. W. L. Ballenger, formerly of Sandy Springs, an-
nounces the opening of his office at 1292 Gordon Street,
S. W„ Atlanta, for the practice of medicine.
* * *
The Atlanta Chapter of A.O.A. Medical Fraternity
annual lecture will be held at the Academy of Medicine,
Monday, 8:15 P. M., May 8. Dr. Geza de Takats, Llni-
versity of Illinois School of Medicine, Chicago, 111., will
be guest speaker. His subject will be “The Surgical
Treatment of Hypertension.’’ Dr. de Takats has done
considerable work on vascular disease; has made impor-
tant contributions to this field, and is well known in the
field of vascular surgery. All Atlanta physicians,
visiting physicians and medical students are invited to
attend the lecture.
* * *
The Bibb County Medical Society held its regular
meeting at the S & S Cafeteria, Macon, March 7. Pro-
gram: “Public Relations and Pending Legislation” by
Ed Bridges, Atlanta, Director of Public Relations of the
Medical Association of Georgia. Dr. Henry H. Tift,
secretary.
The Bibb County Tuberculosis Association, Inc. di-
rectors recently named a committee to carry out an
educational program in connection with the tubercu-
losis-fighting unit for this year. Dr. Samuel Patton.
Macon physician, president, said that the program will
be a “very broad program.” Dr. R. Frank Cary, Macon-
Bibb health officer, predicted that the association will
play an important part in fighting tuberculosis, which
he termed the “major” health problem of Bibb county.
Drs. Henry H. Tift and Alvin Siegel, Macon physicians,
were welcomed as new members of the board.
180
The Journal of the Medical Association of Georgia
Columbus and Muscogee County recently set up the
nation’s first mass testing ground for a new anti-tuber-
culosis vaccine with a community of 100,000 as guinea
pigs. Columbus and Muscogee County pioneered in use
of the vaccine in 1947, following an x-ray survey for
traces of TB the previous year. Dr. George W. Com-
stock, Columbus physician and executive director of
the survey, said that all those who were x-rayed for
possible tuberculosis during the survey were also in-
formed if any heart trouble was found. The drive was
to determine how effective the drug — tagged BCG — is
when used on a large scale. Dr. Carroll E. Palmer, chief
of field duties of the U. S. Public Health Service, said
the mass survey would provide a rare opportunity to
determine the future role BCG may play in curbing
tuberculosis.
* * *
Dr. James B. Craig. Savannah physician, recently
spoke at a meeting of the Savannah Branch of the
National Vocational Guidance Association on the topic
"Causes of Mental Breakdown in School and Industry.”
Touching on nervous disorders in industry, Dr. Craig
explained that many are caused by lack of emotional
and financial security, concerning the job situation;
workers he pointed out always feel more secure if
they have some personal contact with the so-called
higher ups.
* * *
The Crawford W. Long Memorial Hospital held its
regular monthly staff meeting in the dining room of
the hospital. Atlanta. March 14. Program: "An Analysis
of Ovarian Pathology for a Three Months Period”, case
presentation by Dr. R. G. Arrington with discussion by
Dr. Darrell Ayer; “Discussion of Ovarian Tumors in
Relation to Carcinoma of the Ovary” by Dr. John H.
Ridley. Pediatric Section. “Mortality Statistics” — Dr.
Edwin Webb. Medical Section. “Diabetic Acidosis —
New' Concepts" by Dr. Philip Bondy. Surgical Section.
"Modern Trends in Anesthesia” by Dr. L. J. Miller.
General Practitioners, "Report of the Recent General
Practitioners Meeting in St. Louis" by Dr. Harry Ridley.
* * *
Dr. T. C. Davison. Atlanta, was elected president of
The American Goiter Association at its recent meeting
in Houston, Texas. The 1951 meeting will be held in
Columbus, Ohio.
* * *
Dr. Dan Duggan, Washington physician, recently
addressed the Lions Club on the subject of “Socialized
Medicine, or Compulsory Health Insurance” and the
arguments against such a practice. The various Interna-
tional Civic organizations including Lions, are on record
as bitterly opposed to such a plan and encourage the
general public to join in the fight.
* * *
Dr. Edgar Dunstan. Chairman of the State Medical
Civilian Preparedness Committee, will represent the
Medical Association of Georgia at the semi-annual meet-
ing of the Council on National Emergency Medical
Service of the American Medical Association in Chicago
on May 6. 1950. The entire meeting will be concerned
with civil defense planning and the relationship of the
State, county and local medical societies to the civil
defense program. Dr. Dunstan has been asked to partici-
pate in a round-table discussion on these problems with
Drs. Faus of Hawaii, Steele of Maine, Weston of Wis-
consin, Reymont of New Mexico, Fetter of Philadelphia,
with Kiefer of the National Securities Resources Board
serving as moderator.
* * *
The Eighth District -Medical Society held its meeting
at the Ware Hotel. W aycross, March 2. The W are County
Medical Society was host at the dinner meeting. Mem-
bers of the society heard three Georgia cardiologists at
a symposium on cardiovascular diseases. Dr. L. Minor
Blackford, Atlanta, spoke on “Modern Aspects of Rheu-
matic Fever and Rheumatic Heart Disease”; Dr. J. W.
Chambers’. LaGrange. subject was “Treatment of Coro-
nary Thrombosis," and Dr. W. Edward Storey, Columbus,
discussed "The Modern Treatment of Congestive Heart
Failure.’ Dr. Blackford is a director of the Georgia
Heart Association, and Dr. Chambers is vice-president
of that organization. The symposium in Waycross was
the fifth in a series to be held throughout the State
under the sponsorship of the Georgia Heart Association
and the Georgia Department of Public Health.
* * *
The Emory University School of Medicine, Depart-
ment of Surgery, Atlanta, was host to the Wisconsin
Surgical Club, March 10 and 11, a group of surgeons
from Wisconsin who are making a study tour of several
outstanding medical centers in the nation. The group
included Dr. Frederick A. Stratton. Director of the De-
partment of Surgery, Marquette University School of
Medicine, Milwaukee; Dr. Thomas J. Snodgrass, Chief
of Surgery, Mercy Hospital, Janesville; Dr. Joseph F.
Smith, Chairman of the Surgical Staff, St. Mary's Hos-
pital, Wausau: Dr. Stephen E. Gavin. President Wis-
consin Board of Health, and Dr. W. A. Bump, Director
of the Cancer Clinics at the l niversity of Wisconsin,
Madison.
* * *
Dr. Sidney Farher, Boston, lectured at the Grady
Memorial Hospital amphitheater, Atlanta. February 23.
He spoke on “Current Research in Cancer With Appli-
cation to Man.” All Atlanta area physicians were in-
vited. The Boston physician is professor of pathology at
Harvard Medical School and chairman of the division
of laboratories and research at Children's Medical Cen-
ter, Boston.
* * *
The Fulton County Medical Society held its semi-
monthly dinner meeting at the Academy of Medicine,
Atlanta. March 16. Scientific meeting opened with Dr.
Lament Henry, moderator, presiding. “The Clinical
Aspects of Hematemesis”, Dr. Louis M. Howell; “Ob-
structive Gastro intestinal Lesions in the Newborn”. Dr.
J. Dudley King; “Intestinal Obstruction from Medica-
tion", Dr. Herbert W. Burton. Members of the Polk
County Medical Society were special guests.
* * *
The Georgia Medical Society honored Dr. John L.
Elliott, retiring president, and Dr. H. M. Kandel, new
president of the society, with a dinner dance at the
Hotel Savannah. Savannah, February 28. It was also
the occasion of the annua] meeting of the society, and
marked the second time that wives of members were
invited.
* * *
The Georgia Medical Society held its regular meeting
at 612 Drayton Street, Savannah. March 14. Dr. J. H.
Kite, Atlanta, Chief Surgeon, Scottish Rite Hospital, was
guest speaker. His subject was “Errors in the Handling
of Orthopedic Patients Before They Reach the Ortho-
pedist. with Illustrations.” Dr. Sam Youngblood is
secretary.
* * *
The Glynn County Executive Committee of the Georgia
Division. American Cancer Society, met at the Oglethorpe
Hotel. Brunswick, March 7, and approved 1950 com-
mittee chairmanships and discussed plans for this year's
drive against the ravages of cancer. Dr. Frank Mitchell,
Jr., Brunswick physician, is chairman of the executive
committee.
* * *
The Glynn County Medical Society held its regular
meeting at the Citv Hospital. Brunswick, February 21.
A symposium on diabetes was discussed. Dr. T. V.
W illis, president, sketched the recorded history of the
disease. It was recognized by the ancient Greeks and
was well described by Roman physicians in the first
century, he said. Medical authorities of the 17th century
added greatly to the knowledge of “the scourge that
still remains, despite advances in modern treatment,’
he said. The problems of diagnosis were reviewed by
Dr. S. P. McDaniel, with references to literature avail-
able on the subject. Dr. T. W. Collier described the
treatment of diabetes in a digest of the measures now
April, 1950
181
employed here and abroad. Diabetic management was
discussed at length by Dr. I. G. Towson, who illustrated
with several case reports. The meeting was concluded
with an open discussion of the disease.
* * *
The Glynn County Medical Society held its regular
meeting at the City Hospital, Brunswick, March 22, with
Dr. T. V. Willis presiding. “Diseases of the Liver and
Gallbladder” was the subject presented as follows:
“Early Symptoms,” Dr. Herbert Kirchman ; “Diagnosis,”
Dr. Frank Mitchell, Jr.; “Treatment and Convalescence,”
Dr. J. B. Avera. An open discussion followed in which
the society’s members participated. Dr. T. H. Johnston,
secretary.
* * *
Dr. W. Justus Gower, Jr., Atlantan who returned from
one year duty with the Army Medical Corps in Japan
in December, announces his association with Dr. R. E.
Dallas of Thomaston. Drs. Dallas and Gower have
formed a partnership for the Dallas-Gower Clinic in
Thomaston. Dr. Gower graduated from the University
of Georgia School of Medicine, Augusta, in 1946 and
interned at Jersey Medical Center, Jersey City, N. J.
He served as resident physician at Crawford W. Long
Memorial Hospital, Atlanta. Dr. Gower also served a
year at the Memphis General Depot, Memphis, after
entering the U. S. Medical Corps and before going to
Japan. In Japan he was commanding officer of the
Station Hospital with the 7th Infantry Division serving
with the rank of captain.
* * *
Dr. W. F. Hamilton, Augusta, a member of the Uni-
versity of Georgia School of Medicine faculty, has re-
turned to Augusta from Cleveland, Ohio, where he at-
tended a meeting of the scientific council of the high
blood pressure division of the National Heart Institute.
The council, Dr. Hamilton said, discussed raising of
funds and allocations of funds for work in the field of
cardiac research.
* * *
Dr. Raymond L. Harris, a native of Wrightsville, Ga.,
has been appointed manager of the Franklin Delano
Roosevelt Hospital, Peekskill, N. Y. It is said to be
the finest hospital among all the Veterans Administration
institutions. Nothing has been spared in making it
complete in every way. It cost 122.000,000 and has
2,000 beds. Dr. Harris graduated from the University
of Georgia School of Medicine, Augusta, in 1921 and
retains his membership in the Laurens County Medical
Society and the Medical Association of Georgia.
* * *
Dr. Alvin D. Josephs, Atlanta, announces the removal
of his office to Suite 202 West Peachtree Doctors Build-
ing, 663 West Peachtree Street, N. E., Atlanta. Practice
limited to internal medicine and diagnosis.
* * *
Dr. J. H. Kite, Atlanta, was elected vice-president of
the American Academy of Orthopedic Surgery at the
meeting held recently in New York City. Drs. William
Bondurant, Thomas P. Goodwyn, H. Walker Jernigan,
Paul L. Rieth and Ernest B. Dunlap, Jr. attended the
above named meeting. Drs. Bondurant and Dunlap took
examinations for the American Board of Orthopedics.
* * *
Pursuant to recommendations made by Dr. George D.
Strayer of Columbia University and his associates who
made a special survey of the University System of Geor-
gia, the Board of Regents of the University System on
January 18, 1950, (1) declared the medical school a
separate and independent unit within the System, (2)
restored the name to Medical College of Georgia, and
• 3) changed the title of the head of the school from
Dean to President.
* * *
The Medical College of Georgia, Augusta, is one of
the 48 institutions in the United States which will
participate in an $863,496 research grant announced by
the National Cancer Institute on March 12. The Medical
College of Georgia was awarded $5,940 for continuation
of a project started under an earlier Institute grant,
the announcement said.
* * *
The Medical College of Georgia received another
large grant for research from the National Heart Insti-
tute. The Heart institute has allocated $105,000 to the
Medical College for expanding its research program
on the circulatory system. This is the second allocation
received by the college, the first having been allocated
for the enlargement of the laboratory in Dr. W. F.
Hamilton’s department. Dr. Hamilton is in charge of
the research work on the circulatory system.
* * *
Dr. J. C. Metts, Savannah, lectured at the Veterans
Administration Hospital, Dublin, March 23. His sub-
ject was “Abdominal Pain in Chronic Disease.” His
was one of a series of lectures by visiting clinical teach-
ers which the hospital constantly provides for its staff.
The members of the Laurens County Medical Society
were guests of the hospital at the dinner and scientific
meeting. Dr. F. M. Nunez, president, Laurens County
Medical Society, and Dr. O. H. Cheek, secretary-treas-
urer.
* * *
Dr. D. S. Middleton, beloved physician of Rising
Fawn and Dade County, was honor guest of the Dade
County Lions Club at the annual Ladies’ Night meeting
held at the Dade High School, February 14. Dr. Middle-
ton has been practicing medicine for over 55 years and
says during this time he has delivered more than 5,000
babies which would almost make up the entire popula-
tion of Dade County. Inscribed on the bronze plaque
presented to Dr. Middleton was: “A testimonial of
sincere appreciation presented to D. S. Middleton, M.D.,
in honor and with deep appreciation of the distinguished
and unselfish service given the people of Dade County
during the past 55 years as a Doctor of Medicine.
Presented by The Lions Club of Dade County, 1950”.
Dr. Middleton in his speech of thanks said that usually
nice things were said about you after you were dead and
it was a wonderful experience to receive this token of
thanks while he could still appreciate it.
* * *
Dr. Frank K. Neill, Albany physician, recently told
members of the Albany Registered Nurses Club that
under a socialistic state, medical schools would suffer
for lack of donations and foundations established by
the wealthy. He stated that the medical profession is
taking steps to eliminate some of the faults which laymen
find in medical practice today.
* * *
The Oliver General Hospital medical officers held
their monthly meeting at the hospital, Augusta, Febru-
ary 23. Dr. Leonard W. Edwards, Nashville, Tenn.,
professor of clinical surgery, and chief of surgical
service, St. Thomas Hospital, was guest speaker. Dr.
Edwards’ subject was “Present Day Trend in the Surgi-
cal Treatment of Duodenal Ulcer.”
* * *
Dr. Wendell L. Hughes, New York City physician,
addressed the personnel of the E.E.N.T. clinic at the
Oliver General Hospital, March 2. In conjunction with
his address. Dr. Hughes showed the following motion
pictures: “Cartilage Implant for Depressed Fracture of
Orbital Margin and the Maxilla”; “Exenteration of the
Orbit: Removal of Dermoid Extending Along the Floor
of the Orbit to its Apex”; “Lymphoma of Conjunctiva:
Pulsating Exophthalmos in Neurofibromatosis”, and
“Modifications of Wheeler Operation for Spastic Entro-
pion.”
* * *
Dr. Morgan Raiford, Atlanta, recently addressed the
Lions Club of Sparta in connection with the examination
of eyes of all Hancock County school children, white and
colored. Special machines were furnished for the eye
tests and much treatment was necessary in some cases.
Sponsored by the Georgia Lighthouse for the Blind and
the Sparta Lions Club, the campaign was continued for
several weeks. The cases needing immediate attention
were attended to at the Grady Clay Memorial Eye Clinic,
The Journal of thk Medical Association of Georcia
182
Atlanta. Dr. Raiford told the Sparta Lions that he
would help all he could in (itting the children for
better eyesight, either by glasses or operation.
* * *
I)r. Samuel R. Poliakoff, Atlanta, announces the open-
ing of his office at 26 Linden Avenue, N. E., Atlanta, for
the practice of obstetrics and gynecology.
* * *
Dr. C. L. Roles, Camilla, who has been engaged in
the general practice of medicine for a number of years,
recently moved his office from a downtown building to
his residence on South Scott Street, Camilla.
* * *
The Southeastern Surgical Congress held its eighteenth
assembly in Washington, D. C., March 6-9. 1950. Georgia
physicians registered were Drs. W. R. Raker, Hawkins-
ville, B. T. Beasley, Atlanta. Enoch Callaway, La-
Grange, Oiin S. Cofer, Atlanta, H. S. Colquitt, Smyrna,
W. W. Daniel, Atlanta, Ralph Davis, Rome, J. H. Dew,
Atlanta, Frank Eskridge, Atlanta, W. M. Feild. Albany,
I). B. Fillingim. Savannah. T. J. Floyd. Jr., Griffin, G. W.
Fuller, Atlanta, Regina Gabler, Atlanta, J. P. Garner,
Atlanta, 0. D. Gilliam, Atlanta, Kenneth D. Grace. La-
Grange, Irving L. Greenberg, Atlanta. M. M. Hagood,
Marietta, W. I). Hall. Calhoun, S. P. Holland. Blakely,
M. A. Hubert, Athens, Kenneth S. Hunt, Griffin, E. R.
Jennings, Milledgeville, W. P. Jordan, Jr., Columbus,
Harold P. McDonald, Atlanta, J. D. Martin, Jr., Atlanta,
R. C. Montgomery, Butler, Perrin Nicolson. Atlanta,
W. A. Norton, Savannah, J. C. Patterson. Cuthbert,
C. S. Pittman, Jr., Tifton, J. E. Steadman, Hapeville,
John P. Tucker, Bainbridge, and W. J. Williams, Au-
gusta. Dr. B. T. Beasley, secretary-treasurer.
* * *
Dr. John K. Stalvey, Savannah, chairman of the medi-
cal and scientific committee of the Chatham-Savannah
Tuberculosis and Health Association, announced that
Dr. Clair A. Henderson, health commissioner of the
Savannah-Chatham County Health Department, recently
spoke to the nurses of Warren A. Candler and St. Jo-
seph's hospitals on "The Health Department and the
Community in the Control of Tuberculosis."
* * *
Drs. Philip R. Stewart and Harry B. Nunnally, Mon-
roe, announce the opening of the Stewart-Nunnally Clinic
on East Highland Avenue, Monroe. The clinic is
equipped to do complete physical examinations, x-ray.
physiotherapy, and cardiography.
♦ ♦ ♦
Drs. \ . P. Sydenstricker, John H. Sherman and Edgai
R. Pund, Augusta physicians, have been commended by
Major General R. W. Bliss, Surgeon General, for their
outstanding contributions to the success of the Graduate
Professional training program. Colonel H. S. Villars.
commanding officer of Oliver General Hospital presented
Drs. Sydenstricker, Sherman and Pund letters of com-
mendation from the Surgeon General. The letters ex-
pressed General Bliss’ “sincere and heartfelt gratitude
for their efforts; since without their full and continued
support, the program would not have been implemented”.
Also receiving a letter was Dr. G. Lombard Kelley, dean
of the Medical College of Georgia, who although not a
consultant "was extremely helpful in the establishment
and conduct of the training program at Oliver General
Hospital.”
* * *
Dr. E. William Sunderman, formerly of Houston,
Texas, investigator in experimental medicine, recently
joined the staff of the Communicable Disease Center of
the U. S. Public Health Center, Atlanta. Dr. R. A.
Vonderlehr, Atlanta, medical director of the center, an-
nounced. L'ntil recently Dr. Sunderman was a pro-
fessor at the University of Texas, and a director of
clinical cancer research of M. 1). Anderson Hospital,
Houston. He is president-elect of the American Society
of Clinical Pathologists, and author of a medical text-
book. He is known for his work in explosive research
and was acting medical director at an Atomic Energy
.Commission research center.
Dr. Corbett Thigpen, Augusta, of the Speakers’ Bu-
reau of the Georgia Medical College was guest speaker
at the regular meeting of the Altamaha Medical Society
(Appling County) held at the Mimosa Club, Baxley,
February 15. Dr. Thigpen's subject was "Depression
Diagnosis, and Electric- Shock. Electric Narcosis Treat-
ment.” Dr. Harold W. Muecke, pediatrician of Way-
cross, was also a guest of the society. The group ap-
proved payment of $1.00 per member to the Eighth
District Medical Society and $25.00 each to the Ameri-
can Medical Association to fight socialized medicine.
* * *
Dr. R. A. Vonderlehr, Atlanta, medical director in
charge of the Communicable Disease Center, U. S.
Public Health Service, was elected first president of the
Atlanta Branch of the Scientific Research Society of
America, the first established in the South. Installation
ceremonies were held at Mammy’s Shanty, Atlanta,
March 1. Dr. Donald B. Prentice, director of the
society, and Dr. George A. Baitsell. treasurer, were guest
speakers. Other officers are Dr. J. M. Andrews, vice-
president ; Dr. M. M. Brooke, secretary-treasurer, and
Dr. G. H. Bradley and Dr. W. M. Fisher, executive
committee members. There are 93 chatter members.
* * *
The Waycross Eye Clinic, Inc., Waycross, has finished
the first year of work and has mailed to the doctors of
Georgia the first annual report and analysis of cases.
Dr. B. H. Minchew, Waycross, director, surgical serv-
ice; Dr. B. E. Collins, secretary and treasurer, and Drs.
Leo Smith, W. D. Mixson are directors. The clinic, a
non-profit organization, was incorporated in September
1948. It was made possible by a generous friend of the
medical profession who is in great sympathy with the
indigent blind. Through his generosity and benevolence
the work has been accomplished. One hundred-fifty-six
patients have received ophthalmic surgery without cost.
* * *
Dr. Fred H. Simonton, Chickamauga physician, re-
cently attended the 1950 Scientific Assembly of the
American Academy of General Practice held in St.
Louis, Mo. Dr. P. L. Williams, Cordele physician, and
his son. Dr. P. L. Williams, Jr., M aeon, also attended.
More than 5000 family doctors from every part of the
country attended. The scientific program included lec-
tures by outstanding physicians of Boston, New York
City and Ann Arbor, Mich.
* * *
Dr. Peter B. Wright. Augusta, well known physician
and professor of orthopedic surgery at the Georgia
Medical College, was signally honored by the American
College of Orthopedic Surgery in session in New York
City. Dr. Wright was presented a gold medal for the
most outstanding exhibit at the annual session. His
scientific exhibit, which won first place, was entitled
“Paget’s Disease.”
* * *
Dr. Caroline Jane Williams, Savannah physician, re-
cently discussed “A Successful Tuberculosis Program in
a lecture to the student nurses of Warren A. Candler
and St. Joseph’s Hospitals. The lecture revealed the
importance of occupational therapy; in hospital train-
ing for the patients; the establishment of a rehabilita-
tion program, and the services of medical social work-
ers, as well as the treatment of the physical condition of
the patient. Dr. Williams is the wife of Dr. Fenwick T.
Nichols.
* * *
Dr. Neal F. Yeomans, Augusta, of the University Hos-
pital and Georgia Medical College, is studying the
technics of using radioisotopes in research at Oak
Ridge Institute of Nuclear Studies, Oak Ridge, Tenn.
Dr. Yeomans, a resident in the x-ray department, Uni-
versity Hospital, Augusta, plans to use radioisotopes in
diagnostic and therapeutic applications in medicine with
special reference to cancer.
April, 10S0
Dr. James E. Paullin, Atlanta physician, will present
a paper at the Thirty-first Annual Session of the Ameri-
can College of Physicians to he held in the Grand Hall,
\fechanics" Building, Boston, Mass. I)r. Paullin will read
his paper Thursday afternoon, April 20, entitled “Lessons
from Forty Years of Experience in Medical Teaching”.
Dr. Carter Smith, Atlanta, is a member of the Board of
Governors of the American College of Physicians. He
will attend the Boston meeting.
OBITUARY
Dr. Wilbur Clair Hafford, aged 63, Wayeross physi-
cian, died February 26, 1950 at a Wayeross hospital after
a short illness. Dr. Hafford graduated from the Univer-
sity of Louisville School of Medicine, Louisville, Ky., in
1911, and had practiced medicine in Wayeross and Ware
County for 33 years. He was a tireless civic worker and
during his 33 years in Wayeross had been engaged in
practically every civic movement of importance. He was
president of the Okefenokee Swamp Park Association
and loved the swamp, spending much time there working
on many and various committees for its promotion. The
main trail of Okefenokee Swamp Park and into the
swamp has been named “Hafford Trail' in his honor.
But it was in his profession where he served most, as
former president of the Ware County Medical Society
and also as an officer of the Eighth District Medical
Society. He was a member of the Medical Association
of Georgia and a fellow of the American Medical
Association. Dr. Hafford served as a steward of the First
Methodist Church of which he was a member. He was
acting Health Commissioner of Ware County, and was
particularly interested in improving public health in
Ware and Clinch counties. Survivors include his wife;
a son, Wilbur A. Hafford, Atlanta; one daughter, Mrs.
Lois Elizabeth Grossmann, Wayeross; two sisters, and
two grandsons. Funeral services were held at the First
Methodist Church with the pastor, the Rev. Woodward
Adams officiating, assisted by the Rev. J. C. G. Brooks.
The Ware County Medical Society members and stew-
ards of the First Methodist Church served as an hon-
orary escort. Burial Was in Oakland Cemetery, Wayeross.
* * *
Dr. William Roy Richards, aged 59, physician and
former Mayor of Calhoun, died at Lawson VA Hospital,
Chamhlee, after a long illness March 23, 1950. He was
a native of Jasper, moving with his parents to Calhoun
when he was 12 years old. He was a graduate of the
Atlanta School of Medicine, now Emory University
School of Medicine, Atlanta, in 1913. Dr. Richards was
a member of a family that had furnished three physi-
cians for Calhoun and Gordon County; his father, the
late Dr. W. A. Richards; himself and his son, Dr.
Charles Richards. He served in World War I, was a
member of the American Legion, the ATO Fraternity,
the Methodist Church, the Rotary Club and a Shriner.
He was a member of the Gordon County Medical So-
ciety, the Medical Association of Georgia, and a fellow
of the American Medical Association. He is survived by
his wife, the former Miss Helen Martin, Culloden; two
sons, Roy Martin Richards, Atlanta, and Dr. Charles
Richards, Calhoun; three grandchildren; one sister,
Mrs. C. B. Dyar, Sr., Atlanta, and one brother, Luther
Richards, Baton Rouge, La. Funeral services were held
at the Methodist Church with the Rev. C. W. Fruit,
pastor, and the Rev. W. H. Gardner, Monroe, former
pastor, officiating. Burial was in Fain Cemetery, Cal-
houn.
HEALTHGRAMS
It is increasingly clear that screening the general
population for tuberculosis must be combined and co-
ordinated with other screening programs for other im-
portant pathological conditions — such as cardio-vascular
disease, cancer, syphilis, and diabetes — similarly char-
acterized by relatively long subclinical periods in which
detection may be life conserving or important to com-
munity protection. James E. Perkins, M.D., Bull. Nat.
Tuberc. A., Jan., 1950.
loo
It is almost axiomatic that tuberculosis cannot he
controlled as well as we know how to do it when there
is a weak health department, a short-sighted appropria-
tion authority, lack of hospital beds, poor community
chest or lack of coordinated program for all community
health services. William P. Shepard, M.D., Nat. Tuberc.
A. Bull., Oct., 1949.
Little can he accomplished in preventive medical
service without the intelligent cooperation of the family.
The physician rendering such service is therefore pri-
marily a health educator. Although health education in
the mass has been adopted by schools, health depart-
ments and industries, individual and family instruction
is the most effective approach. Every health examination
from the prenatal period to old age should be a session
in health education, with simple explanation of the
reasons for various tests, favorable comment on normal
findings and instruction on how deviations from the
normal can he overcome or held in check. Such pro-
cedures are paramount in winning the confidence of the
individual anti family in the skill and personal interest
of the physician. Henry E. Meleney, M.D.. The Milbank
Mem. Fund Quart., July, 1949.
The early diagnosis of tuberculosis remains one of the
major problems of general practice. The standard of
what constitutes early diagnosis has considerably altered.
In the days before the general use of chest radiography
one had to depend upon the finding of abnormal physical
signs in the chest or on the presence of the bacilli in
the sputum — a stage nowadays considered too late. In
theory, of course, early diagnosis is quite easy. The
chest is X-rayed and the problem is solved. But in
actual practice things can work out very differently. The
early signs are so slight, so varied, so indeterminate,
that unless a doctor is tubercle-conscious an X-ray may
not be called for and precious time is wasted. R. J.
Perring, M.D., Lancet, (London) Dec., 1949.
Tuberculosis control does not begin at the door of
the sanatorium nor does it end there. After the patient
has been returned to his community, many agencies —
the tuberculosis association, the health department, the
local welfare agency — all work together with him to get
him back on his feet and to keep him there. R. D.
Thompson, M.D., Bull., Nat. Tuberc. A., Oct., 1949.
As a result of intensive studies during the past few
years, evidence has accumulated which suggests that
histoplasmosis — formerly believed to be a rare and
usually fatal disease — also exists as a mild asymptomatic
syndrome which is very prevalent in certain parts of
the world. Although quite typical cases of clinical his-
toplasmosis are probably much more frequent than pre-
viously thought, the principal significance of the asymp-
tomatic form is that in certain respects the disease so
closely resembles tuberculosis as to be frequently con-
fused with it. Michael L. Furcolow, M.D., Pub. Health
Rep., Nov., 1949.
WHY A PHYSICAL EXAMINATION?
A periodic physical examination is the best insurance
anyone can have to maintain a good health status.
Many persons will pay more attention to their automo-
biles, forgetting entirely that the good functioning of
their body machinery is equally important to health
and safety, the Educational Committee of the Illinois
State Medical Society observes in a Health Talk.
A complete physical examination serves two ends: the
early detection of disease and the prevention of disease.
The latter objective is the chief aim of medicine, but if
disease is present, its early detection will lend itself
to control more easily.
In a complete physical examination, the history of the
patient is very important. In other words the health
background of the patient and his family may yield
184
The Journal of the Medical Association of Georgia
information of great importance to the physician in
making a diagnosis.
And that is why trust and confidence in your physi-
cian is essential. Holding hack information, being
secretive and otherwise uncooperative are unwise. A
person in describing his complaints to a physician
should tell the whole story. Aches and pains stem from
a cause. If an examination by the physican proves
that organically the body is sound, hidden fears, resent-
ments, and worry may be placing such an emotional
strain on the individual that physical discomforts will
be noticed.
So in giving your health background to your physician,
be truthful. Give him opportunity to understand your
emotional problems too.
The next step in the physical examination is the
check-up on the body. This includes an investigation
of the heart, the lungs, reflexes, an examination of the
eyes, ears, glands; a probing or palpation of the pelvic
organs, and a study of the blood pressure.
The physical examination also includes examination of
the blood and of the urine, both of which reveal condi-
tions that may be present, even though symptoms may
not be too marked. Blood tests show various abnor-
malities, such as anemia or leukemia, the presence of
infection in the body, and syphilis. A urinalysis will
reveal diabetes or some kidney disease.
The physical examination should include a chest x-ray.
Very often, the physician will examine the patient
through the fluoroscope, which enables him to see cer-
tain organs of the body in action.
Many people would like to have a physical examina-
tion, but postpone it because they do not have a physi-
cian, or do not understand how to find one. Every state
has a medical society which in turn is made up of
county medical societies. To obtain a physician, check
with your county medical society. Some county medical
societies are not large enough to maintain their own
headquarters or a full time staff. To learn the name of
the secretary of your county medical society, direct your
inquiry to the state medical society.
Always in the complete physical examination, your
physician will look at your teeth and ask when you had
your last dental check-up. Good dental care is important
in the entire picture of the health of the body.
Why a physical examination? Because the findings
will help keep you in good condition and permit the
correction of any abnormalities should they exist.
NEW BOOKS
UROLOGICAL SURGERY. By Austin Ingram Dod-
son, M.D., F.A.C.S., Richmond, Virginia. Professor of
Urology, Medical College of Virginia; Urologist to the
Hospital Division, Medical College of Virginia; Urologist
to Crippled Children’s Hospital; Urologist to St. Eliza-
beth’s Hospital; Urologist to St. Luke’s Hospital and
McGuire Clinic. With contributions by twelve leading
urologists. Second edition. Cloth. Price $13.50. Pp. 855,
with 645 illustrations. The C. V. Mosby Company, St.
Louis, 1950.
This book is concisely written, easily read, well illus-
trated and well documented with reference. Written by
a man outstanding in his field it is of more than passing
interest to the urologic surgeon. It is an outstanding
contribution to modern urology. A timely volume, whose
deep importance to the urologist and the student plan-
ning to practice urology cannot be stressed too much.
COAGULATION, THROMBOSIS, AND DICUMA-
ROL: With an Appendix on Related Laboratory Pro-
cedures. By Shepard Shapiro, M.D., Assistant Pro-
fessor of Clinical Medicine, New York University College
of Medicine; Visiting Physician, Third (New York
Lfniversity) Medical Division, Goldwater Memorial Hos-
pital; Associate Physician, Lincoln Hospital; and Mur-
ray Weiner, B.S., M.S., M.D., Fellow in Medicine, New
York University College of Medicine; Research Assist-
ant, Third (New York University) Medical Division,
Goldwater Memorial Hospital; Assistant Visiting Physi-
cian, Willard Parker Hospital Chest Service; Clinical
Assistant Visiting Physician, Bellevue Hospital. Cloth.
Price, $5.50. Pp. 131, with illustrations. Brooklyn Medi-
cal Press, Inc., P. 0. Box 99, Cathedral Station, New
York 25, N. Y., 1949.
Says this book: “The practitioner using dicumarol
should be familiar with the effects of vitamin K. He
should he on guard against the simultaneous use of
dicumarol and salicylates. It may also be wise to be
alert to the possible effects of the xanthenes on coagula-
bility. Other than these, no commonly used drug is
known to significantly influence the effect of dicumarol
therapy.”
THE CYTOLOGIC DIAGNOSIS OF CANCER: By
the Staff of the Vincent Memorial Laboratory of the
Vincent Memorial Hospital. A Gynecologic Service Af-
filiated with the Massachusetts General Hospital, Boston,
Massachusetts. The Department of Gynecology Harvard
Medical School. Published under the Sponsorship of
the American Cancer Society. 229 pages with 153 figures.
Philadelphia & London: W. B. Saunders Company, 1950.
Price $6.50.
This book written by the staff of Vincent Memorial
hospital and dedicated to Dr. George N. Papanicalaou.
the father of modern cytologic diagnosis of cancer by
the smear method, is one of the best illustrated volumes
printed on the subject ; therefore the book will com-
mand a place not only in doctors’ clinics, but should
prove of great value to teachers and students of medi-
cine. It is brief and well written and printed in a pro-
gressive manner from normal to pathologic types of
cells. We unhesitatingly recommend it to any one inter-
ested in cytologic diagnosis.
Jack C. Norris, M.D.
POSTGRADUATE GASTROENTEROLOGY — As
Presented in a Course Given Under the Sponsorship of
the American College of Physicians in Philadelphia
December MCMXLVI1I: Edited by Henry L. Bockus,
M.D., Professor of Gastroenterology, University of
Pennsylvania Graduate School of Medicine. 670 pages
with 258 figures. Philadelphia and London: W. B. Saun-
ders Company, 1950. Price $10.00.
The contents of this book represent current thinking
regarding the many problems dealing with gastro-enter-
ology. Every practitioner of medicine and surgery will
find the book useful.
CURRENT THERAPY 1950 — Latest Approved Meth-
ods of Treatment for the Practicing Physician — Editor:
Howard F. Conn, M.D. Consulting Editors: M. Edward
Davis, Vincent J. Derbes, Garfield G. Duncan, Hugh J.
Jewett, William J. Kerr, Perrin H. Long, H. Houston
Merritt, Paul A. O'Leary, Walter L. Palmer, Hobart A.
Reimann, Cyrus C. Sturgis, Robert H. Williams. 736
pages. Philadelphia and London: W. B. Saunders Com-
pany, 1950. Price $10.00.
Current Therapy 1950 is what its name implies. All
contributors to this volume are reputable and the book
has been carefully edited. All practitioners of medicine
should have a copy, since therapy is a necessary part of
their work.
THE 1949 YEAR BOOK OF DRUG THERAPY. (No-
vember, 1948-October, 1949). Edited by Harry Beckman,
M.D., Director, Department of Pharmacology, Marquette
University School of Medicine. Cloth. Price $4.75.
Pp. 718, with illustrations. The Year Book Publishers,
Inc., 200 E. Illinois St., Chicago 11, 1950.
Year Books always are a source of current thinking,
and this one is full of meat for the year 1949.
MEDICAL MANAGEMENT OF GASTROINTESTI-
NAL DISORDERS. By Garnett Cheney, M.D., Clinical
Professor of Medicine, Stanford University Medical
(Continued on Page XVI)
The Journal of the Medical Association of Georcia
XV
Extensive mucosal destruction
and ulceration from chronic
ulcerative colitis with only a
few inflammatory polyps.
SEARLE
In COLITIS MANAGEMENT— In the constipation of spastic, atonic
and even ulcerative colitis, [the smoothage action of METAMUCIL
is of proved value.
METAMUCIL® provides a bland, soft bulk with a
tendency to incorporate irritating particles with the fecal residue
and is thus a valuable adjunct in correcting the constipation and
minimizing irritation of the inflamed mucosa. METAMUCIL is
the highly refined mucilloid of a seed of the psyllium group,
Plantago ovata (50%), combined with dextrose (50%).
Please mention this Journal when writing advertisers.
XVI
The Journal of the Medical Association of Georgia
(Continued from Page 184)
School. Cloth. Price .§6.75. Pp. 478, with illustrations.
5 ear Book Publishers, Inc., 200 E. Illinois St., Chicago
11. 1950.
The medical management of gastrointestinal disorders
can tax the patience of any physician. This moderate
size hook by Dr. Cheney will be found most useful in
solving many of these problems.
SEXl \L DEV IATIONS: A Psychodynamic Approach.
By Louis S. London, M. D., Diplomate, American Board
of Psychiatry and Neurology, Member American Psy-
chiatric Association, Fellow of the American Medical
Association and other medical societies; and Frank S.
Caprio, M.D., Member, American Psychiatric Associa-
tion, Society for the Advancement of Psycho-therapy,
American Medical Association and other medical so-
cieties. With a foreword by Nolan D. C. Lewis, M.D.,
Professor of Psychiatry, College of Physicians and Sur-
geons, Columbia I niversity. Director New \ ork State
Psychiatric Institute and Hospital. Editor The Psycho-
analytic Review. Cloth. Price $10. Pp. 702. Published by
The Linacre Press, Inc., Washington 6, D. C., 1950.
However much laymen and physicians wish to avoid
some of the problems of sex. they arise anew and must
be met at some time. This book is an excellent effort
in the right direction.
A MANUAL OF CARDIOLOGY: By Thomas J. Dry.
M.A., M.B., Ch.B., M.S. in Medicine. Associate Professor
of Medicine, University of Minnesota (Mayo Founda-
tion): Consultant in Section on Cardiology, Mayo
Clinic. New, Second Edition. 35:5 pages with 97 figures.
Philadelphia and London: W. B. Saunders Company,
1950. Price $5.00.
Another good book on cardiology, and not loo bulky.
It is well worth the money.
MEDICAL GYNECOLOGY: By James C. Janney,
M.D., F.A.C.S., Associate Professor of Gynecology, Bos-
ton University School of Medicine; Associate Visiting
Gynecologist, Massachusetts Memorial Hospital. New,
2nd Edition. 454 pages with 103 figures. Philadelphia
and London: W. B. Saunders Company, 1950. Price
$6.50.
This book is most excellent in every detail. Every
practitioner of medicine should have a copy.
A CENTURY OF MEDICINE IN JACKSONVILLE
AND DUVAL COUNTY. By Webster Merritt, M.D.
Price, $3.50. Pp. 220. Illustrations 44. Gainesville, Fla. :
University of Florida Pre s, 1949.
Physicians and laity alike will find in this engaging
narrative a most important contribution to Florida’s
medical and historical lore. With the sure and forth-
right touch of the true historian. Dr. Merritt presents in
panoramic review the fascinating events, towering per-
sonalities and progressive movements of the entire nine-
teenth century as they pertain to medicine in Jackson-
ville and Duval County. His exhaustive research and
painstaking efforts have brought to light in highly
readable form history long obscured, owing to loss of
official records in the Jacksonville fire of 1901. In sifting
out the facts for this entertaining and accurate account,
he pictures the physician as community builder and
harbinger of progress as well as practitioner of medicine,
and his facile pen loses none of the drama of the terri-
fying yellow fever and other epidemics or the gala
events of the times. With equal skill he traces the foun-
dation and early history of the Florida Medical Associa-
tion and of the Florida State Board of Health.
As related editorially in this issue of The Journal, the
author is a brilliant scholar and able historian who has
made notable contributions to Florida bistory in The
Journal and in historical publications. His book is
profusely illustrated throughout its twenty chapters and
makes a valuable addition to any library, particularly
that of the physician. Journal of the Florida Medical
Association, August 1949.
I INTERNSHIP OR GENERAL RESIDENCY
available immediately at City Hospital,
Brunswick, Ga. 100 bed capacity with pro-
visional ACS approval. Full maintenance
plus $200.00 per month salary. Write Dr.
M. E. Winchester, The City Hospital,
Brunswick, Ga.
LONG established hospital for immediate
sale in South Georgia — Surgeon in
charge retiring. Well equipped and fully
accredited by College of Surgeons. Nurses
home and doctors’ apartments joining hos-
pital. Contact Journal Medical Association
of Georgia, 478 Peachtree St., N. E., At-
lanta, Ga.
WANTED — -Graduate of class A medical
school — preferably a young man with
family. A large practice consisting of gen-
eral medicine and surgery. Have 16-bed
hospital, 16 miles from Atlanta. Salary
open. Partnership at later date if both sat-
isfied. J. G. Bussey, M.D., Austell, Ga.
FOR SALE — Complete office equipment
for general practice. Also General Elec-
tric X-ray unit from the estate of Dr.
Raymond Harris. Will sacrifice. Mrs. Ray-
mond Harris, P. O. Box 154, Phone 157,
Ocilla, Ga.
FOR SALE: Millen Georgia Hospital. Fully
accredited by American College of Surg-
eons since 1930. Modern 26-bed hospital,
completely equipped. Large attractive
apartment for Resident Doctor, Nurses’
quarters. Beautiful and ample grounds to
allow for expansion. Hospital owned and
has been operated, until last few weeks, by
one of the leading surgeons in the South.
Ill health reason for selling. For particulars
write —
JOHN W. DICKEY COMPANY, Realtors
128 8th St., Augusta, Ga.
ESTES SURGICAL SUPPLY COMPANY
Phone WAlnut 1700-1701
56 Auburn Avenue
ATLANTA, GA.
THE JOURNAL
OF THE
Medical Associa tionof Georgia
PUBLISHED MONTHLY under direction of the Council
Yol. XXXIX Atlanta, Georgia. May, 1950 No. 5
MEDICINE AND FREEDOM
Ernest E. Irons, M.D.
Chicago
Physicians traditionally dislike publici-
ty. The medical profession is well known
for its reticence with the press, and at
times has been roundly criticized for it.
This avoidance of publicity is unfortunate,
because through the American Medical
Association and its journals and bureaus,
physicians have openly opposed low stand-
ards and bad medical practice. They have
fought for medical advances, for healthier
citizens, for a healthy nation. But they
have failed to tell of their many achieve-
ments in the public interest. Thus they
have allowed promoters of socialist ideas
to create a widespread opinion that physi-
cians are opposed, for selfish reasons, to
the improvement of medical care of the
people. Such propaganda is absurd, and
its political sponsors well know the un-
truthfulness of their charges, but until the
people are made fully aware of the true
facts, they are in danger of becoming the
innocent and intended victims of this un-
truth.
This attack on the quality and freedom
of American medicine is an important part
of a far more dangerous program which
will destroy free enterprise and shackle
the freedom, typical of our American de-
mocracy. The destruction will be complete
il the socialist welfare state is established.
This present attack poses a national emerg-
President of the American Medical Association.
Guest speaker before the Medical Association of Georgia
in annual session, Macon, April 19, 1950.
ency far more serious than those following
the repeated politically manufactured crises
to which we have been subjected in re-
cent years. It is so serious that medicine
must add its forces to those of other profes-
sional, business and social groups, inde-
pendently of political parties, if we are to
prevent our country from being dragged
to the level of the nations already victim-
ized by socialistic programs.
Service of American Medicine
to the Public
Since its organization in 1847, the
American Medical Association has con-
tinually promoted measures for improve-
ment of medical care of the American
people. Soon after its organization the
Association began its long service to the
public, in the extension of preventive medi-
cine, by urging a nation-wide use of the
well proved vaccination against smallpox.
Measures for raising standards of medical
education, and for the exposure of medi-
cal frauds and quackery followed. The
Council on Pharmacy and Chemistry was
organized to establish standards for new
drugs and honest advertising. Even then
the American Medical Association was at-
tacked as a selfish group, because these
activities interfered with the schemes of
reckless promoters. The Federal food
and drug laws followed the crusading
efforts of this Council of the American
Medical Association; they were passed
only after years of effort to overcome gov-
ernmental delay and resistance of vested
selfish interests. Through other councils
and bureaus the American Medical Asso-
ciation has promoted sound extension of
186
The Journal of the Medical Association of Georcia
rural medical service; it is stimulating and
participating in industrial health and re-
habilitation programs; it has actively sup-
ported the establishment of county health
units; it has formulated standards for hos-
pital service, and for medicinal foods and
appliances, all for the protection of the
public. The Association cooperated with
medical sections of the armed services and
provided much help in securing the par-
ticipation of 60.000 physicians in World
War II. It is now assisting these services
in planning adequate defense for the
future. Its help has been utilized by the
Department of the Interior for the im-
provement of medical care of the Indians
and of other citizens in Puerto Rico, the
Virgin Islands and Alaska.
The Association is actively promoting
an educational campaign for voluntary
health insurance, hut only after an experi-
mental period of trial in the 1930's, to
assure the actuarial soundness of plans
offered to the public. Hospital insurance
plans are now used hv more than 65 mil-
lion of our people, and this phenomenal
growth is continuing. Insurance to pro-
vide for medical hills is growing at a
still faster rate. These and many more
similar objectives of the Association in the
public interest are being realized by an
orderly evolution and by careful applica-
tion of the progressive increase in medical
science and medical knowledge. Physi-
cians thus are truly in favor and in active
support of all sound measures for the bet-
terment of the health and welfare of our
people, but they prefer to gain these objec-
tives by evolution rather than by revolu-
tion.
But when the physicians of this country,
represented by the American Medical
Association, refused to how down to the
demands of the advocates of a politically
inspired program of nationalized medicine
and the medical invasion of States' rights
as a step in the transformation of our gov-
ernment into a socialist welfare state, we
were charged with being in opposition to
progress and to the best interests of the
health of our citizens.
We as physicians are opposed to quack-
ery, political as well as medical. We are
opposed to trifling with human life by the
use of dangerous quack remedies and to
deceptive proposals of medical charlatans.
We are likewise opposed to trifling with
human welfare by the promulgation of any
so-called welfare measure which saps the
vitality and incentive of citizens and ulti-
mately leaves them enmeshed in the toils
of socialism.
We as physicians and citizens are op-
posed to the imposition on the American
people of a system of compulsory taxation
to pay for a medical program which will
destroy the quality of present medical care,
and make impossible the remedying of
recognized faults in our present system.
We are opposed to the saddling on our
national budget of an additional burden
which will add to the present waste of our
national financial resources, increase our
taxes, and accelerate the progress of infla-
tion.
Finally, and most important of all, we
are opposed to the undermining of our
American democracy by the insidious pro-
paganda of false security of the socialist
welfare state. We are in accord with
Benjamin Franklin who said, “Those who
would give up essential liberty to purchase
a little temporary safety, deserve neither
liberty nor safety.''
Diagnosing the Welfare State
Nations throughout all history have ex-
perienced periods of economic and social
distress and have tried remedies whose
technics were the same as those employed
in more modern times. Attempts to de-
velop a managed economy antedated the
theories of Karl Marx by many centuries.
May, 1950
I shall cite the experiences with the wel-
fare state in three nations in which you
will note a startling similarity of symp-
toms.
Economic and social distress in nations,
arises through the inability of the masses
of the people to adjust to new economic
and social conditions. Among the causes
of this distress in national groups have
been the destruction by war of savings and
capital represented by property; failure
of food supply with increasing population;
growth of urban populations induced by
industrialization; and revolution itself pre-
cipitated by incompetence, excessive taxa-
tion and compulsion on the part of gov-
ernments.
The fall of the Roman Republic, hast-
ened by the economic distress of the masses
of the Roman populace, resulted from a
combination of causes including rivalry
and dishonesty of public officials, and by
failing food supply of the greatly expanded
population of Rome. Roman businessmen,
avariciously unmindful of the poor, suf-
fered financial losses by reason of the
Asiatic wars; farmers, dispossessed of
their land and homes by military confisca-
tion and destruction, gravitated to the city.
In these critical years the currency was
devalued; finally all debts were scaled
down 75 per cent. To placate the people,
the government bought wheat and sold it
at a low price. Later wheat was given free
to the citizens. Relief measures, designed
to meet temporary emergencies, tended to
become permanent. The number receiving
the wheat dole rose steadily to 300,000.
To correct this abuse, Caesar instituted a
means test, and the number on dole fell
to 150,000.
Some Roman leaders were impelled
exclusively by political and self-seeking
considerations. Others, while mindful of
political implications, were motivated by
true patriotism; but few realized the ulti-
187
mate effect of this paternalistic course on
the Roman republic. These attempts at
a managed economy, not unlike some
modern experiences, failed, and the Roman
republic became a dictatorship.
Another Welfare State
Centuries later, another government suf-
fering from the late repercussions of war
with its attendant destruction of property,
passed under the leadership of a man, an
idealist in many respects, self-confident,
intolerant of criticism, willing to manipu-
late facts so as to forward his own ideas.
His plans for change of government at first
were limited to the combatting of finan-
cial depression. Small businesses were
regulated, and new rules of business and
price structure were instituted. “Reaction-
aries” and “selfish men” who did not go
along with his “New Deal” were eliminat-
ed from the councils of the “progressives.
The financial difficulties of the govern-
ment, occasioned in part by the new era
of spending “for the good of the people ,
were explained by the statement that
former officials had not understood govern-
ment finance. He said “A good financier
can increase government revenue without
increasing taxation.”
The new leader saw that under free en-
terprise merchants and landlords were
making money. He proposed to take the
profits from free enterprise and to stop
“monopoly” of capital by taking it away
from the rich and giving it to the poor.
He set up a government bureau, with large
capital to deal in commodities and thus
regulate prices and trade. This required
a new bureau of “economic planning” and
a large staff of high salaried officials,
housed in new office buildings. Another
heavily capitalized bureau of trade was
created because the country’s goods had
“fallen into the hands of capitalist mon-
opolies,” and prices fluctuated to the “detri-
ment of the government and of the poor.”
188
The Journal ok the Medical Association of Georgia
Inexorably the government absorbed and
destroyed small business. Farm loans and
subsidies were set up, at first to the advan-
tage and later to the ruin of the farmers,
who came at last under the complete domi-
nation of the government.
One “reform” followed another, always
financed by new taxes until “there was not
a chicken or a pig on a farm or a beam
or rafter in a roof that was not reported
and registered with the government.” “Like
all collectivist systems, the government
could not leave the people alone. It had
to know exactly what they did and what
they possessed,'" and a system of secret
agents was instituted. The imperial censor-
ate, which partook in function that of a
supreme court and also that of a modern
press, had to he brought under control
and was packed with the party’s underlings
who were willing to follow the party line.
That is the story of China and of Su
Tungpo in the eleventh century, as related
by Lin Yntang. This experiment in state
capitalism and ultimately collectivism last-
ed eight years and brought China to finan-
cial and social ruin, with the loss of her
northern provinces. “An iron rule was
clapped over the people in the holy name
social reform." “This was the last of China’s
experiments in state capitalism, though bv
no means the first. In the 4,000 years of
China’s history, four great political experi-
ments in totalitarianism, state capitalism,
socialism and drastic social reforms were
attempted and each of these failed miser-
ably.”
Our American Symptoms
Consider now our own experience. Fol-
lowing World War I after a temporary
lull in business, easy money and some in-
flation led to increased speculation. The
stock market boomed. Basic principles of
credit and business were forgotten; morals
deteriorated. Even some formerly conserv-
ative bankers were persuaded that the basis
of banking credit somehow had changed and
that increased borrowing increased the eco-
nomic foundation of credit. This unhealthy
expansion was world-wide, involving alike
nations whose economic status was funda-
mentally solvent as well as those financially
already insolvent. When the inevitable
crash came, it involved nation after na-
tion.
The depression in America (1930-34)
affected the thrifty as well as those who
never save. The small man whose savings
were swept away, often through no fault
of his own, was embittered, and accepted
temporary measures of relief, which under
a less severe blow, he would have refused.
Work relief and other devices helped many,
but at the same time sapped their sense
of independence. A fertile field was pro-
vided for the growth of the welfare state.
People looked with less disfavor on meas-
ures that formerly their sense of individual
responsibility and independence would have
led them to spurn. In such periods of eco-
nomic distress, socialism thrives. Regu-
lations directed from Washington were
applied to business under the general
heading of the “New Deal.” Even the
name seemed to afford license for dis-
regarding fundamental constitutional and
economic principles. The currency was
devalued so that we now dealt with 59
cent dollars. Gold was taken out of circu-
lation. For a time the theory was main-
tained that by lavish government spending
we could “spend ourselves rich.” A gov-
ernment counselor stated— “We shall tax
and tax, and spend and spend, and elect
and elect.”
Administrative law was urged in replace-
ment of common law of the Constitution.
A National Recovery Act was passed to
regulate prices and trade. This limited
the freedom of the individual business man.
The Supreme Court later held this act
May, 1950
189
unconstitutional, so that this facet of eco-
nomic planning had to he replaced by
others. A commission of economic plan-
ning was appointed, and a heavily capi-
talized bureau of finance was provided.
An economy of scarcity was attempted,
by limiting the size of pig families and
by plowing up cotton and grain. Subsidies
at first attractive to the farmer later became
burdensome and offensive by reason of
intrusion of government into his private
affairs. Governmental monopoly of plan-
ning made individual planning more and
more difficult, especially for the small
farmer who now found that he was unable
to operate his farm business under govern-
mental restrictions, and that he must yield
still further to governmental regulation.
He began to feel the pressure of the police
welfare state.
Then came World War II which, in the
interest of national survival, properly re-
quired the regimentation of total war. Citi-
zens were thus increasingly conditioned to
regimentation. With the close of the war,
many regulations were relaxed, but not all,
and citizens were induced to accept fur-
ther invasion by government of their per-
sonal freedom.
This nibbling at freedom is part of the
socialistic program of establishing a
planned economy in a country which has
always boasted of freedom of opportunity.
Recently when it became evident that the
administration bill for nationalization of
medicine with its enormous addition to
the already unbalanced budget, could not
be expected to pass this Congress, the an-
nouncement was made that only parts of
the plan for the welfare state would be
attempted. This is the Fabian technic of
placing “a foot in the door.”
Federal aid to education including medi-
cal education is one of these parts in the
welfare program. New money is attractive
to schools which find themselves in finan-
cial difficulties. Other more prosperous
schools are willing to be included. Proffers
of easy administration are as dangerous
to freedom of thought and action in medi-
cal education, as are offers of easy living.
Every subsidy carries with it the threat
of regulation, despite any disclaimer of
present intent. In 1942 the Supreme Court
rendered an opinion involving benefits and
subsidies. An Ohio farmer maintained that
his rights were invaded in violation of the
5th Amendment to the Constitution which
provides that no citizen shall be deprived
of life or property without due process
of law. The court held that “It is hardly
lack of due process (of law) for the gov-
ernment to regulate that which it subsi-
dizes.”
Measures of relief which should have
been temporary and locally administered
have become permanent through centraliza-
tion in bureaucratic administrations, which,
when they are started, never cease to
grow. Ever new projects are initiated,
each with axguments to recommend it. In
the past 15 years, bureaucracies in Wash-
ington have grown apace; some have be-
come unmanageable, even by the Con-
gress.
Now the socialistic promoters of these
measures assume that their power has
grown sufficiently to make it safe to re-
veal their true intent. People are being
advised that they have a right to demand
that more and more be done for them. Our
federal administration sees a wonderful
chance to secure votes. After nationaliza-
tion of medicine will come nationalization
of businesses and of the other professions.
Under the pretense of preventing mon-
opolies such as those of business or of
utilities, there has been created a great
monopoly of government.
The New Deal has been outmoded and
is now replaced by the Fair Deal. Under
the Fair Deal we store up potatoes to rot,
190
The Journal of the Medical Association of Georgia
and pile up grain to spoil in thousands of
quonset huts, to say nothing of eggs, milk
and nuts in a futile attempt to set up a
planned economy. Food is withheld from
the needy and destroyed in order to main-
tain the fiction of prosperity by subsidies.
High prices for food bring about demands
for increased wages with resulting increase
in cost of manufactured commodities which
the farmer must buy, and in the end the
small farmer loses not only his freedom,
but also the value of the subsidy graciously
given him by a paternalistic government.
The spiral of inflation, begun by wasteful
governmental spending and administration
is given added impetus by these abortive
efforts for a planned economy.
In all this we are repeating in one form
or another the ruinous experiments of an-
cient China and Rome, or those of more
modern nations. We must discard “deals”
and their unsavory connotations, and re-
turn to a sound program of honest thinking
and free enterprise before it is too late.
Marxian materialism must not be substi-
tuted for moral principles and for indi-
vidual freedom and responsibility. The
19th Century observation of the German
economist and philosopher, Fichte, that
“Only a self-sufficient nation can plan”
is forgotten. Under present world changes
in transportation and growth of science, no
nation is economically self-contained.
To administer the multiple activities of
the welfare state, enforcement of regula-
tions is necessary, and the welfare state
becomes the police state. Even at such
late stage many would still prefer to do
for themselves, but now the police state
steps in and makes this impossible, and
they are told that they must allow the gov-
ernment to provide.
We here in America are at the point
now where prohibition is being replaced
by compulsion. The democracy in our re-
public is threatened by the steady en-
croachment of socialistic bureaucratic gov-
ernment. What began as an apparently
innocent effort for comfort and happiness
is becoming a destructive instrument of dic-
tatorship.
The real intent of this propaganda for
nationalized medicine is becoming evident
to men in all walks of life. From the be-
ginning, the attack on medicine was de-
signed as a part of the far more serious
attack on our American way of life; but
this larger concept was so astounding that
most of our citizens refused to believe that
any of our political leaders could be so
blind to the interests of our country. The
socialist bait of easy living, something
for nothing, everything done for the citizen
by a paternalistic government and the
socialist welfare state, has a great appeal
to the uninformed and unthinking citizen.
He must be shown that with each govern-
mental gift, for which he himself will pay,
there is imposed an additional shackle on
his personal freedom.
“Freedom” and “easy living” are not
synonymous now, any more than they were
in our colonial days. Loaf and spend can-
not replace work and save, in the economy
of a free people. Willingness to accept
government largesse in return for less
work results in progressive loss of liberty
and ultimate submission to the whip of
dictatorship and communism.
Medical Standards
We must not sacrifice principles and
ideals to the chimera of easy living, nor
can we condone the making of false prom-
ises of government medicine and care, de-
manded by leaders of blocs as the price
of political preferment, even though it is
clearly evident that those promises cannot
be kept.
Standards of quality of medical prac-
tice in the United States, the highest in
the world, have been attained by educa-
tional efforts, initiated and carried forward
May, 1950
191
almost entirely by the medical profession
itself. There are faults in distribution of
medical care which are co-existent with
economic and cultural faults, especially
in sparsely settled or economically poor
areas. These are being corrected, often
by the communities themselves.
In all professions and businesses there
are conscienceless individuals who bring
discredit on their colleagues. To meet medi-
cal injustices, neglect, and overcharging,
medical grievance committees have been
set up by local and state medical societies
to deal with such transgressions. How-
ever, these transgressions are relatively few
in number compared to the vast and de-
voted service of physicians to their patients
and to the public.
We are in the midst of a campaign to
save medicine from the degrading effects,
professional, financial, and moral, of the
proposed nationalization of medical prac-
tice. This inspiring purpose would itself
merit our wholehearted efforts. But the
cause is far greater than this — it is the
saving of our American institutions, our
freedom, from destruction inevitable under
socialism, and the police welfare state.
This campaign has for all of us a great
patriotic appeal and our efforts should be
directed toward the stimulation of every
doctor to exert his individual effort for the
saving of his country from socialism. Our
cause has everything — humanity, patrio-
tism, freedom. No cause in recent years
has offered so effective a rallying point for
citizens, whether physicians, other profes-
sional or business men or laboring men.
Some people pride themselves on seeing
both sides of every question. They usually
see so much of both sides that they take
a position on the fence, to await results.
Ve need men with convictions who are
willing to voice them. Now is the time for
every citizen to make up his mind whether
he wants economic freedom or socialist
slavery of the welfare state.
In this campaign there is no place for
double talk or double dealing — no com-
promise. You can’t compromise on the
truth. We have a great cause in which
we can all unite in action as well as^ in
purpose — that of the saving of this coun-
try from a downfall similar to that of the
European nations.
THE WELFARE STATE VERSUS
THE WELFARE OF THE STATE
Enoch Callaway, M.D.
LaGrange
Freedom is a word that we have all been
taught to consider as synonymous with
America and the American way of life.
Freedom to work and study and strive for
better things. Freedom to live where we
want to live. Freedom to choose our oc-
cupation. Freedom to speak our thoughts.
Freedom of religion. Freedom to rise to
the highest pinnacle of success; or if we
desire, freedom to shed responsibility and
respectability and sink to the depths. Per-
sonal liberty of each individual to order
and govern his own life as he desires
so long as he does not infringe on the same
rights of others. On this foundation of
personal freedom and individual initiative
the United States has grown and prospered
and has become the leading nation of the
world in science, art, literature and indus-
try. The welfare of the State has steadily
and consistently advanced.
This freedom which we have enjoyed
for a century and a half is being threatened.
It is not only being threatened; it has al-
ready been partly destroyed. Much ground
has been lost which must be regained. The
enemy must be known and must be fought
on every front. No point can be given.
President's address to the Medical Association of Georgia
at its 100th session, Macon, April 19, 1950.
192
The Journal of the Medical Association of Georcia
No compromise can be made.
Die terms Welfare State, Social Security,
Planned Economy and other similar phrases
in themselves have pleasant heartwarming
connotations, carrying to mind immediate-
ly. a vision of all those things which we
have been taught and trained to consider
desirable. Many persons are apt to accept
these terms as being absolutely identical
with their own religious and humanitarian
concepts of the duty that one individual
owes to another. It can he shown that when
used in a political and economic sense
this is far from true.
Communist, Welfare State Advocates,
Economic Planners, Fascists, and Nazis are
all socialists who differ only in one respect,
and that is as to who shall control the
nation when democracy has been destroyed.
They all desire complete state control over
all industries, individuals, and commodi-
ties. Up to a certain point they will work
together. Like a pack of wild dogs, they
will cooperate to bring down the quarry,
each hoping to he able to gain control after
the kill. Since the communist adheres to
a foreign government, his presence in the
pack has now become a liability. He can
he recognized as a wolf, so he must he
eliminated to divert attention from the
socialistic aims of his former mates.
Many group leaders who are nowr court-
ing public favor by diligently purging com-
munists from the ranks of their organiza-
tions are socialists of another breed and
are equally anxious to destroy the tradi-
tional American way of life.
The idea of the Welfare State is not
new. As far hack as we have written his-
tory, we find that this plan has been used
to undermine the morale of free peoples
so that they would become subservient to
the state. Where this has succeeded and
the individual has become convinced that
it was not his duty to see to the welfare
of the state hut the duty of the state to see
to his welfare, neither the state nor the
citizen has long maintained their freedom.
Demosthenes in the Philippics frequent-
ly referred to the fact that the power and
virility of Athens was being destroyed by
the citizens considering the state responsi-
ble for their welfare. This reversal of re-
sponsibilities inevitably led to a personal
and national degeneration of character
which caused the glory that was once
Greece, to he hut a memory. Hannibal
fought in Italy for the very existence of
Carthage, using mercenary soldiers, while
her citizens enjoyed all of the benefits of
a welfare state at home. The exact site
of this once powerful city is not now known.
Rome followed the same road and suf-
fered the same fate. Germany and Italy
have also tried the welfare state and failed.
England is now on the brink of utter dis-
aster.
Let us briefly viewr the road to this prom-
ised Utopia. Where does it actually lead?
How far have we traveled it? Does it lead
to Utopia or does it lead to individual slav-
ery and national ruin?
The creeping revolution slipping stealth-
ily upon this nation is not of the Russian
Communist type, hut is the same type
which has taken over England. By con-
sidering recent developments in England,
we may best view the parallel road we are
traveling- England started on this road
in 1883 when the Fabian Society was or-
ganized. Their method is called Fabian
Socialism. Quintus Fabius, the Roman
General, held that the only way to defeat
Hannibal was to avoid a general engage-
ment and by strategic withdrawals lure
him into battle in small sectors and then
defeat him in sections.
The Fabians in England began by advo-
cating not a socialist state, but a welfare
state. Constantly promising increasing
government benefits to the voters in return
for their support. Constantly telling the
May, 1950
193
working man that these benefits would he
given by taxing industry and the rich, the
English Socialists now control the Bank
of England and thereby all credits, cables
and wireless, civil aviation, railways, pas-
senger buses, cargo trucks, inland water-
ways, coal mines, electricity, gas and medi-
cal services.
This is the road: The use of handouts
to individuals and localities to justify
taxes and to gain support in elections.
Where does this road lead? One can-
not read newspapers or listen to the radio
without becoming well acquainted with the
sad plight of the English people who have
traveled this road. The once well fed
British now are on bare maintenance food
allowance, insufficient fuel and scanty
clothing, all of which justly stir in us pity
for the sad conditions which would be
even worse except for Marshall Plan aid
from Capitalistic America. I will quote
from their own minister of finance to show
to what condition their national finances
haven fallen. He stated that any additional
benefits could only be given by taxing
wages, as individual incomes and busi-
nesses had been taxed to the limit.
There are now less than one hundred
individuals in England with incomes above
twenty-five thousand dollars a year.
John L. Lewis who is far from a preju-
diced friend of Capitalism, states, and I
quote, “Let us begin with the case of Great
Britain. The population there is sitting on
a coal deposit which, if taken from the
earth by modern methods, would solve the
economic problem of the British. But first
Biitish management made the mistake of
letting obsolescence weaken the industry.
Vnd then British labor made the mistake
of becoming a political party and using
the political instead of the economic ap-
proach to National problems. The result
is what you see.”
“In 1948 American miners took out
approximately six hundred million tons.
British miners took out less than two bun-
dled million tons, and in this country the
mining force was four hundred, four thou-
sand and in Britain it was seven hundred,
thirty-nine thousand.”
Statements such as these made not bv
opponents of socialism, but by proponents
of socialism or socialistic trends, show
very clearly that the road leads to high
taxes which ultimately must be assumed
by the laborer who will then be handi-
capped by inefficient management and ob-
solete and dangerous equipment. By now
he is bound to his job and does not have
the freedom to leave. He has sold his lib-
erty for a promise of security. He must
work under hopeless conditions or have his
ration card revoked and starve.
Even though his wages are high, pro-
duction has dropped to such a low point
that only the barest necessities of life are
available.
The following verse by Rudyard Kipling
aptly describes all the ghastly failures of
socialism going on in England today.
In the Carboniferous Epoch we were prom-
ised abundance for all.
By robbing selected Peter to pay for col-
lective Paul.
But, though we had plenty of money, there
was nothing our money could buy.
And the Gods of the Copybook Headings
said: If you don’t work you die.
How far have we traveled this road?
We have traveled this road much farther
than most of our citizens realize. Through
giants to cities, counties and states, the
federal Government has gained partial
or complete control of many essentially
local matters. Local governments have
lost authority to the Federal Government
at many points and the Federal Govern-
ment continues to encroach upon the duties
traditionally regarded as belonging to the
states, particularly concerning tax matters.
In 1916, 23.7 per cent of taxes paid went
194
The Journal of the Medical Association of Georgia
to the U. S. Treasury, while this year 84.93
per cent of your taxes will be paid to the
National Government. The average Georgia
citizen must work two and one-half months
this year to earn his tax payments. Last
year the Federal Government collected
eleven times as much taxes from this State
as it returned.
This return of taxes to the states is very
interesting and should be very carefully
considered. Why should we pay taxes to
the Federal Government and have them
return as a gift for local use? Are we
unable to collect our own taxes? Are we
incompetent to decide how they should be
used? The answers of course are apparent.
As to how efficiently and economically
the Federal Government does this for us
can easily be learned.
We are all, as doctors, interested in the
Hill-Burton Act which allows the Federal
Government to make grants-in-aid for the
construction of hospitals. This act, I be-
lieve, is administered as well or better than
any other Federal agency. For this reason
I have asked for and obtained from Gov-
ernmental agencies a statement of money
spent under this Act with a statement or
an estimate of the amount which had or
would eventuallv be actually paid to con-
tractors. Out of three hundred million
dollars, contractors will receive two hun-
dred nineteen million. The three hundred
million does not include salaries of public
health officers assigned to this work. We
pay approximately 30 per cent for the
privileges of having our taxes handled on
a National basis.
States, cities and counties cannot collect
taxes from any project financed by the Fed-
eral Government as long as the title to the
property rests with the Federal Govern-
ment. This applies to housing projects,
power projects and many other types of
property financed through Federal loans.
This property increases each year and
forms a considerable part of the source
of taxes for local use. At the present time
most but not all of such authorities are
paying by administrative order 85 to 95
per cent of the amount of state, county
and city taxes as a grant. This is a danger-
ous situation. Since the money is being
paid, our local authorities are lulled into
a sense of security from which they could
be suddenly and rudely awakened by the
stroke of a bureaucratic pen.
As Federal taxes increase, the ability to
assess and collect taxes on a state and
local level decreases and we become more
and more dependent on Federal grants for
local needs. This is a vicious cycle and
can only lead to ultimate destruction of
local self-government and absolute de-
pendency on the National Treasury. Eco-
nomic dependency goes hand in hand with
loss of freedom and liberty.
Although we are paying in Federal taxes
the staggering sum of thirty-seven billion,
three hundred million dollars yearly, last
year there was a deficit of five billion, five
hundred million. On top of this, President
Truman wishes to impose a cost for social-
ized medicine which can easily exceed
twelve billion dollars. This in the face
of imminent National bankruptcy and in a
country with the finest medical service and
best condition of health in the world. As
a physician and as your retiring president,
I am proud to say that America today has
the most widely applied medical service
and the most extensive hospitalization ever
achieved in any country. Here in Georgia
this Association was chiefly instrumental
in the passage, by the recent Legislature,
of two bills designed to provide broad hos-
pital and medical care insurance well with-
in the reach of the low income group. This
is our strong and positive answer to an
impossible socialistic medical scheme.
For the lowest income groups, we have
the services of free clinics. Recently an
May, 1950
195
old man living near Raymond wrote a letter
asking for aid for a cancer on his face.
This letter was addressed to Cancer Hos-
pital, no town, street or state. The postal
clerk, using his freedom of decision, which
would have been unheard of under Social-
ism, delivered the letter to the Cancer
Society and immediate action was taken. A
private physician from Newnan visited him,
an emergency application was made, and
seventy-two hours after mailing his letter
the patient was receiving care in the City-
County Hospital, LaGrange. Under a sys-
tem of Nationalized Medicine, I am willing
to say that I believe if the old man had sur-
vived without medical care, he would still
he filling out application forms for hos-
pitalization.
The care of the individual by the State,
which is the chief stock in trade of the
proponents of a Welfare State, is not and
never has been motivated by high ideals,
but by a desire to gain and hold absolute
control over people to whom the apparent
benefits are being directed. The ultimate
effect, if indeed one does not consider it
the primary aim, is to make the mass of
the population so dependent for the neces-
sities of life on handouts that they do not
dare oppose or vote against the party in
power. This can very rapidly develop an
obligatory one party system which can
easily be controlled by a small group, or
even by one individual, with the subsequent
results of totalitarianism which are only
too well known to us all.
As the Welfare State grows and more
and more taxes and benefits are added, it
becomes increasingly necessary to enforce
the collection of taxes and curtail the im-
proper distributions of benefits by the use
of police power. Gradually the right of
the citizen to be free from search without a
specific warrant becomes abridged. This
has already happened here to some extent.
As police power is built up, its use,at first
to annoy, and later arbitrarily to suppress
political opposition becomes a natural and
inevitable consequence. Anyone keeping
up with current events must be alarmed by
the fear that we are even now entering the
phase of police annoyance which is only
countered by the fact that many of our
judges are still free from the control of
the proponents of socialism.
The socialization of medicine is only one
aspect of the danger of socialism. I have
said repeatedly, and here again emphatical-
ly state, that I oppose the Truman Health
Scheme more as a citizen than I do as a doc-
tor. On every front the gradual process is
being pushed. There is a constant effort
being made to enlarge the powers of the
President at the expense of Congress and
the courts. Government control of banking,
credit and security exchanges is being
gradually increased. More and more hous-
ing is being Government-controlled or
owned. I have a definite suspicion that for-
feiture of housing to the Government is
being encouraged. The socialization of
medicine and indoctrination of youth camps
are essentials which have not yet been
accomplished even in part. Revival of the
Civilian Conservation Corps should be
viewed with grave suspicion.
Many of our Congressmen assure us
that the danger is closer and more immi-
nent than we suspect. The present situa-
tion is critical and only a small step is
needed before the ultimate end of the Wel-
fare State will be reached. Then it will
no longer be a Welfare State, but a police
state and the welfare of the State will be-
come secondary to the individual desires
of a totalitarian group.
The Welfare State road has been trav-
eled before by many nations and led to
ruin. No other Nation once entering this
road has turned back before reaching de-
struction. Can we, the first Nation to estab-
lish the sanctity and dignity of individual
196
The Journal of the Medical Association of Georgia
human rights accomplish this reversal? I
not only believe we can, hut also am firmly
convinced that we will. This will not be
easy. We must be willing to sacrifice our
pet projects, suffer financial loss and per-
sonal disappointments, keeping constantly
in mind that the ultimate welfare of the
individual depends on the Welfare of the
State. We must keep in mind that the
marvelous heritage of freedom which we
received from our forefathers is not ours
to squander and destroy, but a sacred trust
to be passed intact to our children, to be
enjoyed by generations to come.
We must not only fight the socialization
of medicine, but socialism wherever it be-
comes manifest.
Human freedom should be protected. No
single personal liberty should be given
up for any price.
We should forget political affiliations
and remember that voting for a man who
favors socialism is being a traitor to our
principles.
Our representatives should be elected on
a basis of uncompromising leadership.
Compromise leads to ultimate defeat.
Socialistic indoctrination through press,
radio and in the school room should be
counteracted by the same methods used
by our enemies.
Socialization must not be allowed to ad-
vance. It must not only be stopped, but it
must be pushed back and destroyed.
The following quotation from Washing-
ton’s Farewell Address is very appropriate
at this point. “As a very important source
of strength and security, cherish public
credit. One method of preserving it is
to use it as sparingly as possible, avoiding
occasions of expense by cultivating peace,
but remembering, also, that timely dis-
bursements, to prepare for danger, fre-
quently prevent much greater disbursements
to repel it; avoiding likewise the accumula-
tion of debt, not only by shunning occa-
sions of expense, but by vigorous exertions,
in time of peace, to discharge the debts
which unavoidable wars may have occa-
sioned, not ungenerously throwing upon
posterity the burden which we ourselves
ought to bear.”
The power of the Federal Government
to tax must be curtailed. Unless this is
done, the continual tendency to tax and
bribe will continue until all local and per-
sonal liberty will be gone. Freedom will
have perished from the earth. The welfare
of our State, like the glories that were
Greece, will be but a memory.
CAROTID SINUS SYNDROME
C. Raymond Arp, M.D.
Hal M. Davison, M.D.
and
John S. Atwater, M.D.
Atlanta
The carotid sinus reflex and its disorders
have been studied intensively by both for-
eign and American workers, the latter group
concentrating their study in the past two
decades. However, this subject has not been
presented before our Association in recent
years. The purpose of this presentation is to
recall this important problem to our atten-
tion and to report some observations on the
routine testing of this reflex in patients seen
in the private practice of medicine.
A short history of the recognition of the
carotid sinus syndrome was given in the
excellent study of Weiss and Baker1. In
1799 P. H. Parry2 reported the observation
that in some patients whose hearts were
beating with undue quickness and force,
pressure over one of the carotid arteries
caused slowing by many pulsations per min-
ute.
Read before the Medical Association of Georgia in annual
session. Savannah, May 13, 1949.
May, 1950
197
In 1862 Waller'1 reported a similar reac-
tion, but stated that there is initial accelera-
tion with subsequent slowing of four to live
beats per minute. He attributed this to irri-
tation of the vagus and sympathetic nerves
by pressure on the carotid artery.
In 1866 Czermak4 noticed a swelling of
one of his own carotid arteries and that
pressure on it produced slowing of the heart
rate. He decided it was due to stimulation
of the vagus nerve.
In 1923 Hering’ demonstrated a similar
slowing of the heart rate in animals by pres-
sure on the dilated portion of the bifurcat-
ing common carotid artery (carotid sinus),
even after the vagus nerve was separated
from the artery.
The carotid sinus reflex is normally one
of the mechanisms in man that regulates
blood flow to various parts of the body. The
carotid sinus syndrome is the symptom com-
plex which results from accidental stimu-
lation of a carotid sinus which, for some
unknown reason, is hypersensitive. The
symptoms that usually cause the patient to
consult his physician are intermittent at-
tacks of extreme vertigo or loss of conscious-
ness, and at times, convulsive seizures.
When a large number of so-called epileptics
in a large mental institution were carefully
tested, it was found that a goodly number
merely were cases of carotid sinus hyper-
sensitivity and had been confined need-
lessly.
It was thought by the early investigators
that the symptoms and signs were produced
by stimulation of the vagus, or of the vagus
and sympathetic nerves. As mentioned
above, Hering and his group showed this
was not true in dogs by sectioning both vagus
nerves and obtaining the same symptoms by
pressure on the carotid sinus.
Hering" and his followers, Koch," ' and
Huymans8 " and his associates, and de Cas-
tro1" demonstrated that the dilated portion
of the bifurcating common carotid artery
(carotid sinus) is richly supplied with sen-
sory receptors which terminate in character-
istic menisci. From these the sinus nerve of
Hering (the inter-carotid nerve of de Cas-
tro) is formed and corresponds to the “ram-
us caroticus hypoglossie ". This nerve joins
the glossopharyngeal nerve giving direct
connection between the carotid sinus and the
medullary centers.
Smith11 states that the carotid sinus is a
bulbous dilatation of the first portion of the
internal carotid artery and that its wall is
thinner than other portions of the artery and
contains special nerve cells called nerve re-
ceptors.
Code and Dingle1', working on dogs, used
electrical stimulation of the nerves, stimula-
tion by raising and lowering pressure in
the isolated sinus section and survival de-
nervation experiments. They found that the
carotid sinus has three possible sources of
nerve supply: (1) glossopharyngeal nerve,
(2) from the superior cervical ganglion,
and (3) a minute, variable twig which
passes upward along the medial side of the
internal carotid artery from the carotid
sinus, accompanying the internal carotid
artery into the skull and communi-
cates with the nodose ganglion of the
vagus nerve. Evulsion of the carotid
sinus nerve alone without impairing the
functions of other nerves in the region of the
blood supply to the head removes the regu-
latory influence of the sinus on the heart
rate and blood pressure. Code, Dingle and
Morehouse13 found on detailed dissection
in 25 dogs that the nerve of Hering arises
from the glossopharyngeal nerve shortly
after it issues from the jugular foramen of
the skull. It usually communicates with a
large branch from the superior cervical
ganglion. It usually is distributed mainly
to the posterior aspect of the carotid sinus
and carotid body. A small, more variable.
198
The Journal of the Medical Association of Georgia
nerve accompanies the internal carotid ar-
tery into the skull and may communicate
with the nodose ganglion of the vagus nerve.
Bucy14 reported observations after sec-
tion of one glossopharyngeal nerve in four
cases. There was an immediate rise in blood
pressure, then a slight fall, and a secondary
rise in blood pressure in twelve to sixteen
hours which persisted for five to twelve
days. Ray and Stewart10 in 1942 reported
four cases, and in 1948 reported 15 more
cases of section of the glossopharyngeal
nerve for relief of neuralgia. In all but four
of the 19 cases there was a transient rise in
blood pressure and heart rate, returning to
normal within three days. This return to
normal indicates a compensation by other
regulatory mechanisms. After section of the
glossopharyngeal nerve, pressure on the
carotid sinus of the side operated on caused
no reaction, but procainization of this same
sinus caused a rise in blood pressure, even
though it was to a lesser degree than is
usually seen. Tests were made from two
weeks to five years postoperatively, ruling
out the possibility of regeneration of the
nerve. These observations show that the im-
pulses of the carotid sinus reflex are not
solely transmitted through the glossopharyn-
geal nerve. In one case there was traumatic
paralysis of the vagus nerve at the time of
intracranial division of the glossopharyn-
geal nerve. Postoperative procainization of
the homolateral carotid sinus did not result
in elevation of blood pressure and cardiac
rate as had been seen in the cases with
an intact vagus nerve. In a related experi-
ment they have shown that chemical stimu-
lation of the carotid sinus with sodium cvan-
J
ide resulted in a reflex which traveled path-
ways other than the glossopharyngeal nerve.
This must have been by way of the vagus,
sympathetic, or hypoglossal nerves.
The effect of section of the glossopharyn-
geal nerve w’as also shown by Weiss and
Baker1. Denervation of the carotid sinus
gave the same result. Pinching the vagus
during the operation did not produce these
results.
Bronk and Stella have shown that in
rabbits there is a rhythmic discharge of
nervous impulses over the carotid sinus
nerve as long as the pressure within the
sinus nerve is about 40 mm. of mercury.
The rate of discharge is in proportion to
pressure. The higher the pressure, the fast-
er is the rate of discharge. Sections of the
nerves interrupts a constant flow of depres-
sor impulses to the vasomotor centers of the
brain, resulting in hypertension.
A quantitative inter-relationship between
the degree of alteration in the heart rate and
of the blood pressure due to a depressor
vascular reflex was also shown by Koch',
and by Huymans and Bouckaert" in differ-
ent species of mammals. Huymans8 demon-
strated that the continuous secretion of
epinephrine is reflexly controlled by the
afferent aortic and carotid sinus nerves.
Thus the carotid sinus controls the circula-
tion not only directly, but indirectly through
chemical regulation.
According to Weiss, Capps, Ferris, and
Munro ', stimulation of the reflex may be in
the form of a stretching of the wall of the
carotid sinus from distention within, or a
relaxation by decrease of the arterial con-
tents. Hormones or other chemical sub-
stances, such as sodium cyanide, can stimu-
late the carotid sinus (Weiss & Baker1).
Thus, it is well established that the caro-
tid sinus reflex arises in nerve receptors in
the wall of the carotid sinus, which is a bul-
bous dilatation of the common carotid ar-
tery at its bifurcation, or the first part of
the internal carotid artery. It is transmitted
centrally by the nerve of Hering (inter-
carotid nerve, or carotid sinus nerve) to the
vasomotor and respiratory centers of the
brain, to the superior cervical sympathetic
May, 1950
199
ganglion and often, at least, to the nodose
ganglion of the vagus nerve. The carotid
sinus nerve at times communicates with the
hypoglossal.
The efferent paths may he through the
vagus nerve, through the aortic depressor
nerves, or may act centrally on the medulla
and he distributed from there as motor im-
pulses directly to certain vegetative centers
in the region of the hypothalamus or the
blood vessels that supply such centers
(Weiss et al 1 ) . There may be a combina-
tion of these three or any two of them.
Thus, there are three types of response:
1. Vagal type : In this type the symptoms
are due to cardiac standstill or asystole
which in turn is due to sino-auricular or
auriculoventricular block. This results in
cerebral anoxemia which causes the symp-
toms.
2. Depressor type: In this type the effer-
ent impulse travels through the aortic de-
pressor nerves (sympathetics), resulting in
reflex dilatation of the small blood vessels
including the splanchnics and secondarily
causes a fall in blood pressure without any
slowing of the heart rate, asystole, or other
disturbance of heart rhythm. Symptoms re-
sult again from cerebral anoxemia. This is
the least common type and usually accom-
panies one of the other two types.
3. Cerebral type: In this type the effect
is apparently due to direct effect on vegeta-
tive centers in the brain or the blood vessels
that supply them and cerebral anoxemia re-
sults even with no change in heart rate or
rhythm and no change in blood pressure.
When there is a mixed type it should be
classified according to which of these three
predominates. The vagus type, as one would
expect, can be abolished by the administra-
tion of atropine in adequate amounts, which
will have no effect on the other two types.
The depressor type can be aborted by
epinephrine by its action on the small blood
vessels and ephedrine often is effective in
preventing attacks.
The cerebral type is not influenced by
atropine, epinephrine, or ephedrine.
Infiltration of the region of the carotid
sinus with procaine will make it insensitive
to stimulation of all kinds and thus will
prevent all three types of reactions.
Numerous factors will influence the sen-
sitivity of the carotid sinus reflex. It is
more frequently sensitive when other dis-
eases or conditions are present, such as
arteriosclerosis, hypertension, heart dis-
ease, cervical lymphadenopathy, syphilis,
neurosis, and carotid body tumor. McSwain
and Spencer18 reported one case of carotid
body tumor associated with carotid sinus
syndrome and states that this makes a total
of 197 reported in English literature.
Chemical influences, especially digitalis,
are important in increasing the sensitivity
of the reflex. If digitalis is given to a car-
diac patient who complains of dizziness,
fainting, or weakness because he is suspect-
ed of having congestive heart failure, it will
make him worse instead of better if he is
suffering from carotid sinus syndrome.
Downs19 reports one surgical death and tells
of others that he thought were due to sensi-
tive carotid sinus reflex. He produced a
similar picture in susceptible dogs. All
were not susceptible. He concluded that
nitrous oxide anesthesia made the reflex
more active and accidental pressure on the
carotid sinus by the anesthetist in adjusting
the mask or maintaining the position of the
head can be the cause of this syndrome.
Rovenstine and Cullen2" report that digi-
talis and morphine make the reflex more
active and that low oxygen or high carbon
dioxide tension of inspired atmosphere in
anesthesia is more dangerous in patients
with an abnormal carotid sinus reflex. Bar-
bituric acid derivatives make it less sensi-
tive and ether, vinethane, and chloroform
200
The Journal of the Medical Association of Georcia
depress the reflex when deep narcrosis is
obtained but light anesthesia will usually
make it more sensitive.
Clinical Symptoms
The most dramatic symptoms are sudden
unconsciousness with or without convul-
sions. The convulsions are usually pre-
ceded by an aura of weakness, dizziness,
nausea, dyspnea, pallor of the face, tingling
of the extremities, loss of vision, epigastric
distress, faintness, profuse perspiration,
spots before the eyes, staggering or tinnitus.
During the convulsion there is no biting of
the tongue and no loss of sphincter control.
There are definite and often vigorous clonic
movements, at first on the contra-lateral side
and then generalized. Dilatation of the ipso-
lateral pupil, strabismus, lacrimation, la-
bored deep respiration, states resembling
catalepsy may occur. Unconsciousness may
last a few seconds to 15 minutes or more.
There may be a temporary loss of memory.
Symptoms almost always occur when the
patient is in the upright position and are
relieved by lying down at the first warning,
although frequently there are no warning
symptoms. Fatigue, menstruation, or emo-
tional upsets may act as precipitating fac-
tors. Quick movements of the head to one
side or the other, looking back over the
shoulder with rotation of the head, as when
driving a car, may exert enough pressure
on the carotid sinus to result in an attack.
This syndrome was long known as “Minis-
ter’s disease’’ when it was customary for
the ministers to wear tall stiff collars. On
leaning the head forward to read from the
Bible, or in prayer, one would exert enough
pressure on the sinus by the stiff collar to
initiate an attack. Sudden changes of posi-
tion of the head from horizontal to vertical,
or vice versa, may cause it.
Diagnosis is made by reproducing the
signs and symptoms on mechanical stimu-
lation of the carotid sinus reflex by pressure
on one of the carotid sinuses. They should
not both be stimulated at the same time. The
test is best done with the patient in the
sitting position. The head should be tilted
backward and rotated away from the side
to be tested. The bulbar dilatation of the
internal carotid artery then can usually be
seen or easily palpated. It is usually near
the angle of the jaw, but its position is quite
variable and may be as low in the neck as
the inferior border of the thyroid cartilage.
It is best to exert pressure with the index,
middle, and ring fingers all at the same
time, so that all of the sinus will be covered.
It is then compressed against the transverse
processes of the cervical vertebrae. Pres-
sure should be initiated quickly and not
gradually. The degree of reaction is di-
rectly proportional to the suddenness of
pressure, as well as to the degree of pres-
sure. Gentle massage often will accentuate
the reflex. Pressure should be maintained
for 40 seconds. Counting of the pulse rate
and the taking of blood pressure should be
started as soon as pressure is begun, since,
in many people, the pulse will slow con-
siderably, but in five to thirty seconds, will
return to normal, even though pressure on
the sinus is maintained. The electrocardio-
gram can be made and changes in heart
rate and rhythm can be recorded during the
test. It is important to determine the type
of reflex — vagal, depressor, or cerebral, as
described above. Pressure above or below
the carotid sinus will cause no reaction and
further proof of the diagnosis can be ob-
tained by procainization of the sinus. This
will prevent a reaction when pressure is
again applied (Peck and Wertheim33).
Treatment should first be directed at any
disease or physical abnormality that may
be influencing the reflex, such as removal of
carotid body tumor, or treatment of en-
larged cervical lymph nodes, no matter
what the etiologic agent. In digitalis intoxi-
May, 1950
201
TABLE 1
Carotid Sinus Reflex Symptoms
Asystole
Convulsions
Syncope
Bradycardia-severe 40-60/min. decrease
Bradycardia-moderate 10-40/min. decrease .
Vertigo .
Hyperpnea
Visual Disturbance
Pallor
Tingling of extremities _
Numbness of extremities
Epigastric distress
Nausea
Sweating __
Faintness —
Cardiac irregularity —
Patients showing reaction
cation, reducing the dose of digitalis may
be all that is necessary to control the symp-
toms. Avoidance of excessive fatigue, wor-
ries, and emotional upsets may be very help-
ful. Tight, starched collars should not be
used.
1. Vagal Type — Atropine sulfate, 1/150
grain, by mouth 3 or 4 times a day or an
equivalent amount of tincture of bella-
donna is effective. Ephedrine hydrochlo-
ride, grain 1/b, 3 times a day is often satis-
factory and it can be combined with a bar-
biturate to avoid causing nervousness.
2. Depressor Type — Ephedrine hydro-
chloride, grain 1/b, with or without a bar-
biturate is the drug of choice in this type.
3. Cerebral Type — Medications are of
no help in this type, but surgical denerva-
tion of the carotid sinus will abolish this
type of reflex as well as the other two types.
If treatment of the patients’ health in gen-
eral and correction of other disease pro-
cesses in the body or local tumors in the
neck fail to control symptoms, one may
have to resort to operation. Surgical treat-
ment has been well described by Cattell and
Welch"1 and by Ray and Stewart10. The
latter authors report relief of the carotid
sinus syndrome by intracranial section of
the glossopharyngeal nerve.
97 Reactors on
34 Reactors
Tested With
Routine
Examination
Special Care to Technic
Number
Per cent
Number
Per cent
13
13
0
0
0
0
2
6
5
5
4
12
30
31
6
18
49
50
16
48
38
38
13
39
1
1
16
48
8
8
5
15
3
3
6
18
2
2
4
12
1
1
1
3
1
1
0
0
1
1
1
3
0
0
2
6
0
0
7
21
0
0
1
3
97
100
34
100
Stevenson and Moretoir" have reported
24 cases of carotid sinus syndrome treated
by x-ray therapy. Eight had the cerebral
type and 16 had the vagal type. Most of
these patients had two or more courses of
x-ray therapy. Ten obtained complete re-
lief, six partial relief, four slight relief, and
three obtained no relief. One patient could
not be traced. Four of these patients were
observed from 1939 until December 1946,
and three of them had no attacks. The fourth
had mild and less frequent attacks.
In our study the carotid sinus reflex was
checked by us, four different examiners,
routinely on physical examinations. Each
examiner followed his own technic with no
attempt at standardization.
Observations consisted only of noting
whether there was cardiac slowing or asys-
tole or any subjective symptoms. In 337
examinations 71 patients, or 21.3 per cent,
showed some reaction. Table 1 summarizes
the symptoms observed in these 71 and an
additional 26.
Two of us then checked a series of 40
patients, using more careful technic as de-
scribed above, and taking blood pressure
and pulse determinations before and during
carotid sinus pressure. The results are
202
The Journal of the Medical Association of Georgia
summarized also in Table 1. The much
higher percentage of noticeable reactions
shows clearly the variations that occur ac-
cording to proficiency of the examiner. Of
40 patients tested 34, or 85 per cent, showed
some reaction. Locating the bulbous dila-
tation of the artery and putting pressure di-
rectly on it instead of haphazardly pressing
on the neck under the angle of the jaw and
maintaining pressure for 40 seconds seemed
to be the two most important factors. Ap-
plying pressure suddenly instead of gradu-
ally also was important in our experience.
In attempting to make a movie of typical
reactions, five patients who had shown
asystole and or syncope, were gotten to-
gether on a Sunday afternoon. There was
considerable excitement and conversation
among them while waiting for the photog-
raphers. Interestingly enough, only one of
the five showed a good reaction. We at-
tribute this to either the improvement of
their general health and primary illness
since the time of their first examination, or
to the increased output of epinephrine dur-
ing their excitement, or both.
Some patients showed no reaction while
pressure was applied, but noted dizziness
or visual disturbance when pressure was
released.
These examinations were done on people
coming to us with some complaint and so
most of them had some associated organic
or psychic abnormality. Table 2 gives a
summary of these. The number with aller-
gic conditions is greater than one would
ordinarily find, because approximately 50
per cent of our patients have some allergic
condition.
The distribution according to age is given
in Table 3. The greatest number occur in
the fifth decade of life.
Difference in sex distribution was not too
great, there being 54 males and 43 females
in the group of 97 reactors.
Table 4 presents the changes in pulse as
observed in the group of 40 patients that
were carefully tested and observed. Patients
that had a lowering of pulse rate by pres-
sure on each carotid sinus are credited to
the side showing the greatest change. The
blood pressure changes as observed in the
40 patients in whom it was checked are re-
corded in Table 5. It is surprising to note
that in an appreciable number there was an
elevation in the blood pressure. Frequently
this occurred after one side had been
checked and during the stimulation of the
second. This was found usually in a person
who, in the beginning, was apprehensive be-
cause of having this special test, which re-
quired a nurse taking the pulse on one arm,
a doctor taking the blood pressure on the
arm, and another doctor “choking” the
neck. The apprehension was magnified if
the patient experienced unpleasant symp-
toms, such as tingling, blindness, faintness,
etc., or experienced too much discomfort
due to the firm pressure used on the first
side tested.
Determining the type of reaction can be
done only if one counts the pulse and takes
the blood pressure as the carotid sinus is
stimulated. In our series, therefore, the type
was determined only in 34 patients, and of
these 19 were vagal, 3 were depressor, and
12 were cerebral. In the mixed reactions
the patient’s classification was determined
according to which of the three types of
reactions predominated. The depressor type
occurred three times associated with the
vagal and one time associated with the
cerebral type.
A negative reaction was arbitrarily de-
fined as one that produced no objective or
subjective symptoms, did not reduce the
pulse rate as much as ten beats per minute,
and did not lower the systolic or the dias-
tolic blood pressure as much as 10 mm.
of mercury.
May, 1950
203
TABLE 2
Carotid Sinus Reflex Symptoms:
Accompanying psychic and/or somatic conditions.
Allergic Coryza
Blood cholesterol over 200 mg. per cent
Asthma, bronchial
Obesity
Eczema
Gastro-intestinal allergy
Migraine headache
Neurosis
Anemia
Underweight
Urticaria
Colitis
Pyorrhea
Arteriosclerosis (excessive for age)
43
35
26
19
17
17
15
13
13
13
11
10
8
8
Hypertension (over 150S/90D)
Duodenal ulcer
Menopause (symptomatic)
Diabetic or “Prediabetic”
Arteriosclerotic heart disease
Hypochlorhydria
Hypertensive heart disease
Hypotension -
Peripheral neuritis
Paroxysmal tachycardia -
Lues
Angioneurtic edema
Gastric ulcer
Avitaminosis
Rheumatic heart disease
8
7
7
6
6
5
4
3
3
3
2
2
2
2
1
■auricular block
raves without ventricular response - A-V block
Pressure on right carotid a intis - Asystole
?. W. f.t Sight reflax - Asystole (S-A block)
TABLE 3
Carotid Sinus Reflex Symptoms
Age Group Number
0 — 10 yrs. . 0
11 — 20 yrs 4
21 — 30 yrs . 12
31 — 40 yrs 19
41 — 50 yrs 28
51 — 60 yrs 23
61 — 70 yrs 9
71 — 80 yrs 2
81 — 90 yrs 0
Total 97
Summary
1. Attention is called to the carotid sinus
syndrome because it seems likely that it is
often overlooked as a cause of dizziness,
faintness, convulsions, and syncope and as
a cause of sudden anesthetic death.
2. A brief review of the literature is
given.
204
The Journal of the Medical Association of Georgia
TABLE 4
Carotid Sinus Reflex Symptoms: Pulse Changes
De crease per minute
in 40 patients.
Pressure on left Pressure on right Total left
carotid sinus carotid sinus and right
Less than 10 19 19
10 to 20 7 5
21 to 40 3 5
41 to 60— 1 0
Total 10 to 60 11 10
Asystole 0 0
19
12
8
l
21
0
Per cent
48
30
20
2
52
0
TABLE 5
Carotid Sinus Reflex Symptoms : Blood Pressure
Changes
Fall in blood pressure
Systolic and/or Diastolic Pressure on left Pressure on right
in 40 patients carotid sinus carotid sinus
Less than 10 mm. Hg 31 31
10-20 2 2
21-30 2 2
31-40 0 1
41-50 0 0
Total 10-50 .. ..... 4 5
Rise in Blood pressure
Less than 10 mm. Hg jj 20 20
10-20 4 13
21-30 0 2
31-40 L 0 1
41-50 0 0
Total 10-50 .V. 4 16
Total
31
4
4
1
0
9
20
17
2
1
0
20
Per cent
78
10
10
.0:
0
22.5
50
42.5
5
2.5
0
50
3. Observations on routine examinations
of the carotid sinus reflex in a practice of
internal medicine and allergy are presented.
4. The variations in number and severity
of reactions according to the efficiency of
the examiner is demonstrated.
5. Kodachrome movies of the reactions
are shown.
BIBLIOGRAPHY
1. Weiss, Soma, and Baker, James P. : The Carotid Sinus
Reflex in Health and Disease. Its Role in the Causation of
Fainting and Convulsions, Medicine vol. 12, no. 3 (Sept.)
1933.
2. Parry, P. H. : An Inquiry Into the Symptoms and
Causes of Syncopies Anginosa Commonly Called Angina
Pectoris, Art Cruttwell, Bath., 1799.
3. Waller, A.: Experimental Researches on the Functions
of the Vagus and Cerebral Sympathetic Nerves in Man,
Proc. Roy. Soc. Med. 11:302, 1682.
4. Czermak, J. : Eeber Mechanische Vagus Reizund Beim
Menschen, Jenaisch Ztschr. f. Med. u. Naturwiss, 2:384, 1866.
5. Hering, H. E. : Die Karotissinusreflexe auf Herz and
Gefasse, The Stinkopfs, Dresden, & Leipzig, 1927.
6. Koch, E. : Munchen. med. Wchnschr. 71 :704, 1924.
7. Koch, E. : The Steinkopff, Dresden & Leipzig, 1931.
8. Heymans, C. : The Carotid Sinus and The Other Re-
flexogenic Vasosensitive Zones, London, H. K. Lewis and
Company, 1929.
9. Heymans, C., and Bouckaert, J. J. : Vasomotor Reflexes,
Colbt. Rend. Soc. de biol. 103:31, 1930.
10. deCastro, F. : Tra. Lab. Recherch, Madrid. 25 :331,
1928.
11. Smith. Harry L. : A Consideration of the Hyperactive
Carotid Sinus Reflex Syndrome, M. Clin. North America,
31 :841, 1947.
12. Code, C. F., and Dingle, W. T. : The Carotid Sinus
Nerve, Proc. Staff Meet, Mayo Clin. 10:129 (Feb.) 1935.
13. Code, C. F., and Dingle, W. T. : The Cardiovascular
Carotid Sinus Reflex, Am. J. Physiol. 115:249 (April) 1936.
14. Bucy, Paul C. : Carotid Sinus Nerve in Man, Arch. Int.
Med. 58:418, 1936.
15. Racy, C. S. and Stewart, H. J. : The Role of the
Glossopharyngeal Nerve in the Carotid Sinus Syndrome by
Intracranial Section of the Glossopharyngeal Nerve, Surgery
23:411, 1948.
16. Bronk, D. W., and Stella, G. : Afferent Impulses in
the Carotid Sinus Nerve, J. Cell. & Comp. Physiol. 1:113-130,
1932.
17. Weiss, Soma; Capps, R. B. ; Ferring, E. P., Jr., and
Munro, Donald: Syncope & Convulsions Due to a Hyperactive
Carotid Sinus Reflex — Diagnosis and Treatment, Arch. Int.
Med. 58:407, 1936.
18. McSwain, Barton, and Spencer, Frank C. : Carotid
Body Tumor in Association with Carotid Sinus Syndrome,
Surgery 22:222, 1947.
19. Downs, T. McKean : The Carotid Sinus as an Etiologi-
cal Factor in Sudden Anesthetic Death, Ann. Surg. 99:974.
1934.
20. Rovenstine, E. A., and Cullen, Stuart C. : The Anes-
thetic Management of Patients with a Hyperactive Carotid
Sinus Reflex, Surgery, 6:167 (Aug.) 1939.
21. Cattell, Richard B., and Welch, Mark : The Carotid
Sinus Synrome: Its Surgical Treatment, Surgery 22:59-67,
1947.
22. Pick, Joseph, and Wertheim, H. : A Technique for
Blocking the Carotid Sinus Nerves, Ann. Surg. 127 :144-149
(Jan.) 1948.
23. Stevenson, C. A., and Moreton, R. D. : A Subsequent
Report on Roentgen Therapy in Carotid Sinus Syndrome,
Radiology 50:207, (Feb.) 1948.
The Medical Association of Georgia
will hold its 1951 annual session at the
Bon Air Hotel, Augusta, April 17-20. Part-
ridge Inn will cooperate. Make your hotel
reservations now.
May, 1950
205
ROENTGEN THERAPY FOR BURSITIS
OF THE SHOULDER
David Robinson, M.D.
Savannah
An article written by Weinberg20 states
that Sokolow first attempted to use x-rays
to treat joint pain m 1897. Later reports
were more or less sketchy and the use of
the roentgen ray was mentioned incidental
to some other form of therapy. In 1929
Titus20, stated that other workers had noted
beneficial results in calcified bursitis of
the shoulder when a simple x-ray exposure
of the shoulder was made for diagnostic
purposes.
The advent of deep x-ray apparatus,
with its greater penetrability and skin
tolerance, radically changed the use of the
roentgen ray for the treatment of many
benign conditions, including bursitis of
the shoulder. Roentgen therapy has with-
stood the test of time and each year more
favorable reports are confirming the work
of earlier investigators. Many excellent
articles have been written on this subject
which include the work of Lattman12, de-
Lorimerb Sandstrom22, Henman1 ", Young" ,
Young", Roxo Nobre and Araujo Cintra1",
Pendegrass10, Borak4 and others. It would
be difficult to elaborate on a subject so
adequately covered.
Terminology
In reviewing the literature, one finds
considerable variation in the terminology.
The disease first described by Duplay in
1879 has the clinical features of the con-
dition we know today as bursitis of the
shoulder. For the sake of brevity I shall
mention some of these synonyms and omit
the nature of their derivation. Such terms
include: periarticular calcification, para-
articular calcification, subacromial or sub-
Read before the Medical Association of Georgia in annual
session, Savannah, May 13, 1949.
Fig. 1. Semi-diagrammatic demonstration of the relationship
of bursa to the tendon of the supraspinatous muscle in ab-
duction and adduction. When the subacromial bursa is
inflamed so as to cause painful friction, the arm cannot be
rotated or abducted.
deltoid calcification, humeroscapular or
scapulohumeral periarthritis, para-arthri-
tis, Duplay’s disease, peritendinitis cal-
carea, calcification of the subacromial
bursa, rheumatism, peritendinitis calcarea
and a few others.
Anatomy
In 1906 Codman' described in detail
the anatomy of the shoulder and demon-
strated that the subacromial and subdeltoid
bursae were one and the same. It has been
shown that there is only one bursa and
the general trend of opinion is to call it
“subacromial”. The subacromial bursa is
nearly as large as the palm of the hand
of the individual in whom it is located and
except for a small projection beneath the
deltoid muscle, it lies between the acromial
process and the head of the humerus. The
bursa is composed of thin walls and con-
tains little fluid. It is intimately in con-
tact with the tendons of the short rotators
of the shoulder, explaining the difference
in the location of calcific deposits in these
tendons.
The first illustration (fig. 1) is a semi-
diagramatic demonstration of the relation-
ship of the bursa to the tendon of the
supraspinatous muscle in abduction and
adduction. When the subacromial bursa is
inflamed so as to cause painful friction,
206
The Journal of the Medical Association of Georgia
the arm cannot he rotated or abducted.
Etiology
Many diversified opinions have been
expressed concerning the etiology of this
condition. Codman believed that strain
and trauma produced small bloody de-
posits in the tendon with subsequent cal-
cification. Others mentioned infection, en-
docrine disturbances, faulty metabolism,
vitamin deficiencies and thermal changes.
Sandstrom and Walgren21 following a
thorough histopathologic study could find
no evidence of trauma. They felt that the
deposit was secondary to local tissue
anemia and that improvement in symptoms
and disappearance of the calcific deposits
were due to an increased vascularity. Thus,
explaining the response to x-ray therapy.
I ncidence
Bursitis of the shoulder occurs most fre-
quently in the middle-age group. -Bosworth5
examined 6,061 normal individuals for
shoulder involvement. He concluded that
the condition was seen in the period of
greatest activity in individuals whose oc-
cupations require abduction of the arm.
Some writers disagree as to the side most
frequently involved or the sex. This differ-
ence is so slight that it is not of much sig-
nificance. Not a single article that I re-
viewed mentioned racial statistics. In my
series I have seen only one case of calcific
bursitis in a Negro. Statistically, my series
of 61 cases agrees more or less with the
results of other writers. (Table 1).
TABLE 1
Bursitis of the Shoulder
Total number of cases reported 61
Mate 46%
Sex Female 54%
Average Age 47
(ranging fom 22 to 70)
X-ray positive for calcium 44%
Extremity involved Right 66%
Left 34%
Bilateral 5%
Elbow 1 case
Duration of symptoms.— 4 months avg. (3 days to 2 yrs.)
Symptomatology
For x-ray treatment purposes I prefer
to use a simple classification; namely,
acute or chronic bursitis. This excludes
such things as rupture of the supraspi-
natous tendon and acute traumatic bursitis.
The patient with acute bursitis usually
presents a history of sudden pain in or
around the shoulder girdle. This pain
may radiate down the arm or to the neck.
There may he tenderness on pressure over
the greater tuberosity. Signs of inflamma-
tion may be present. It is almost impossible
to rotate or abduct the arm. In the chronic
condition the pain is duller in type and
the patient may notice difficulty in raising
the arm to right angles with the body-
There may be a moderate degree of dis-
comfort in the region of the biceps. In the
chronic type of long duration, there may
be some atrophy of the muscles of the
shoulder due to disuse. The classification
is more or less flexible and while it is also
influenced by the duration of the symptoms,
the latter is arbitrary.
Roentgen Diagnosis
A gross calcific deposit lateral to the
greater tuberosity is one of the most posi-
tive diagnostic criteria for bursitis of the
shoulder (fig 2). However, it is often dif-
ficult to demonstrate this calcification by
ordinary views and special views of the
shoulder in internal and external rotation
are necessary to demonstrate this point
(fig. 3). These views should be routine
on all cases suspected of bursitis. Addi-
tional filtration may help at times. It is
not necessary for calcific deposits to be
present in order to make tbe diagnosis.
Other roentgen changes include local areas
of rarefaction, decalcification and trabe-
cullar atrophy. Neither the size of the
calcific deposit, its presence nor its ab-
sence determines tbe severity of the symp-
toms. Many cases are positive for calcifica-
tion and still may be symptom-free. Since
the condition is often bilateral, a routine
May, 1950
207
Fig. 2. Calcific dc|>osit lateral to the greater tuberosity.
examination of the opposite shoulder
should be made on all proven cases. Cal-
cific deposits may be present in joints
other than the shoulder.
Included among my present series of
cases is that of a 26-year-old white female
who was successfully treated for bursitis
of the shoulder by roentgen therapy. Four
months later the patient hit her elbow on
a hard object. This resulted in an intense
pain in the elbow together with the usual
signs of bursitis. X-ray examination showed
calcification within the soft tissues of the
elbow (fig. 4). The patient was again
given a series of roentgen therapy and at
present has been symptom-free for one
year. This is similar to a case reported
by Young28 at the Mayo Clinic.
Differential Diagnosis
Other conditions in and about the should-
er should be ruled out both clinically and
through the use of roentgenograms. Ac-
cording to Barford', arthritis of the should-
er is very rare, occurring in about five per
cent of all cases with shoulder involvement.
In evaluating a possible bursitis case, one
must rule out fractures of the humerus, neo-
plastic changes, inflammatory changes,
herpes zoster, calcinosis universalis, angina
pectoris, neuralgia, brachial plexus syn-
Fig. 4. Bursitis of the elbow. After therapy the patient
was symptom-free after 1 year.
drome, cervical spondylitis, metastatic
bone disease, tuberculosis and syphilis.
Nathanson14 reported several cases in which
an apical pulmonary tumor was associated
with a calcifying bursitis.
T reatment
The treatment of bursitis of the shoulder
is still controversial. Bosworth' stated,
“Bursitis of the shoulder is a self-limiting
and curative disease. This fact makes it
possible for the proponent of any particular
form of therapy to claim cures”. Many
methods have been reported as successful,
both medical and surgical. Among the
medical methods are included the use of
iron cacodylate by Richards1', vitamin A
by Roxo Nobre and Araujo Cintra19, and
the usual methods of physiotherapy by
Titus2'5, Feldman9, Martucci13, Troedsson"1
208
The Journal of the Medical Association of Georgia
and others. Chapman" mentioned the use
of large doses of ammonium chloride by
Dick, Hunt and Ferry. However, Chapman
felt that the usual methods of physiotherapy
had almost everywhere proven unsatisfac-
tory. This has resulted in the adoption of
several types of surgical procedures, such
as open operation and excision by Bartels3
and Howorth" and various methods of
“needling” by Patterson and Patterson15
and Bosworth'.
In view of the favorable reports now
available, deep roentgen therapy can be
considered as one of the most successful
forms of treatment for this condition.
Many surgeons agree that conservative
therapy should lie given a trial prior to
the utilization of any of the surgical pro-
cedu res. Among those surgeons sharing
this feeling are Hubert J" and Rogers15.
Table 2 was taken from Rubert’s series
showing that the results he obtained by con-
servative treatment were better than those
obtained in operative cases. He reserved
operations for cases due to complete tendon
rupture (which did not fall in my classi-
fication) and for cases which did not re-
spond to conservative methods.
TABLE 2: RUBERT
Treatment of Bursitis of the Shoulder
Improved
No. Or Not
Patients Improved
Results — nonoperative treatment 147 78%
Operative treatment 21 13%
Results with nonoperative group
Cured 102 69%
Improvement 28 19%
No improvement ... 17 12%
Results with operative treatment
Cured 10 48%
Improvement 5 24%
No improvement 6 28%
Allen1 stated, “To secure happy results
calls for close cooperation between the
surgeon or physician and the radiologist,
as this will only lead to the best results.
In the hands of the skilled radiologist, this
form of treatment is harmless to the patient
and no untoward effects have occurred
from its use.”
All patients treated by me have been
referred by other physicians and usually
one or more of the previously mentioned
forms of therapy have been tried and prov-
en unsuccessful. Routine films are made
on all cases prior to the institution of any
treatment.
Table 3, presents treatment data. All
cases are divided into the acute and chronic
type, although there is no definite line of de-
marcation. In the acute stage I treat the
patient 3 to 6 times every third day. If after
the third treatment the patient show’s com-
plete relief, no further treatment is admin-
istered. If after the third treatment there is
no response or incomplete relief, three more
treatments are given at the same time in-
terval.
In chronic cases the treatments are given
at longer intervals. These may be either
weekly or bi-weekly for four to six treat-
ments. Where adhesions are suspected,
three treatments may be given prior to a
manipulation of the arm under anesthesia
and three may he given afterwards.
TABLE 3
Treatment Data for Bursitis
200 Kvp. 15MA, V2 Cu 1A1.10 x 10 port, 50 Cms. TSD,
HVL .9 Cu
Number of treatments 3-6
Average dose per treatment 100-150 r/air
Area treated . anterior, lateral, posterior
each
Interval between treatments 2-5 days average.
The results obtained in this series are
seen in Table 4 which is self-explanatory.
As noted by other workers, the best results
were obtained in those cases treated in the
acute stage. However, in chronic cases
good results may be obtained after a long
period of time. It is important that the
roentgenologist and physician encourage
the patient, reassuring him in order that
he might not become impatient at the appar-
ent failure to receive immediate relief. I
have followed several of these cases by
x-ray examinations six and twelve months
after therapy and have seen a complete
disappearance of the calcific deposits.
May, 1950
209
This, however, is not too significant since
Codman and others state that the calcium
will disappear if no treatments were given.
TABLE 4
Results from treatments of 61 Cases of
Bursitis of Shoulder
No response at all 2 cases 3%
Poor to fair response 4 cases 7%
No response to survey 4 cases 7%
Total assumed and known poor response .. 10 cases 17%
Known satisfactory response 51 cases 83%
Reaction to x-ray (mild) 2 cases 3%
Recurrence 1 case 2%
Summary
A brief review of the literature on bur-
sitis of the shoulder is presented, including
the diagnosis, etiology and the various types
of treatment in use at present. A number
of surgeons advocate conservative therapy
prior to the adoption of a surgical pro-
cedure for this condition. The results ob-
tained in a series of 61 cases confirm the
work of other writers, demonstrating that
83 per cent of the average patients with
bursitis of the shoulder will show a satis-
factory response to deep roentgen therapy.
BIBLIOGRAPHY
1. Allen, M. L. : X-ray Treatment of Infections, Surg.,
Gynec. & Obst. 67:393-399, 1938.
2. Barford, L. J. : Subdeltoid Bursitis and a Few Other
Conditions Causing Pain in the Shoulder, Rheumatism
3:12-14, 1946.
3. Bartels, W. P. : The Surgical Treatment of Acute
Subacromial Bursitis, J. Bone & Joint Surg., 22:120-121,
1940.
4. Borak, J. : Tendogenic Disease and its Treatment With
X-rays, New York State J. Med. 45:725-729, 1945.
5. Bosworth, B. M. : Calcium Deposits in the Shoulder
and Subacromial Bursitis: Survey of 12,122 Shoulders,
J.A.M.A. 116:2477-2482, 1941.
6. Chapman, J. F. : Subacromial Bursitis and Supraspinat-
ous Tendinitis: Its Roentgen Treatment, California & West.
Med. 56:248-251, 1942.
7. Codman, E. A. : On Stiff and Painful Shoulders, Bos-
ton M. & S. J. 154:613-620, 1906.
8. deLorimer. A. A.: Roentgen Therapy in Acute Para-
arthritis, Am. J. Roentgenol. 38:178-195, 1937.
9. Feldman. L. : Short Wave Diathermy in Subdeltoid Bur-
sitis, Arch. Phys. Therapy 18:411-414, 1937.
10. Herrman, W. G. : Value of Roentgen Therapy in Acute
Subacromial Bursitis, J. M. Soc. New Jersey, 36:529-532,
1939.
11. Howorth, M. B. : Calcification of the Tendon Cuff
of the Shoulder. Surg., Gynec. & Obst. 80:337-345, 1945.
12. Lattman. I. : Treatment of Subacromial Bursitis by
Roentgen Irradiation, Am. J. Roentgenol. 36:55-60, 1936.
13. Martucci, A. A. : Treatment of Painful Bursae of the
Shoulder, Arch. Phys. Therapy Apical Tumefaction Simu-
14. Nathanson. L. : Pulmonary Apical Tumofaction Simu-
lating Bursitis: Necessary for Routine Chest Examination
in Patient with Shoulder Pain, New York State Med. J.
40:860-864, 1940.
(Robinson, David: Roentgen Therapy for Buritis of the
Shoulder. )
15. Patterson, R. L., Jr., and Patterson, R. H. : Further
Observations in Treatment of Bursitis of the Shoulder, Am.
J. Surg., 49:403-408, 1940.
16. Pendegrass, E. P., and Hodes, P. J.: Roentgen
Irradiation in the Treatment of Inflammations, Am. J.
Roentgenol. 45:74-106, 1941.
17. Richards, T. K. : A New Treatment for Bursitis, New
England J. Med., 205:812-813, 1931.
18. Rogers, M. H. : Treatment of Subdeltoid Bursitis,
Am. J. Surg. 43:292-297, 1939.
19. Roxo Nobre, M. O.. and de Araujo Cintra, R. R. :
Radiotherapy in Duplay’s Disease, Am. J. Roentgenol. 52:415-
422, 1944.
20. Rubert, S. R. : Subacromial Bursitis, Arch. Surg.
37-619-641, 1938.
21. Sandstrom, C., and Wahlgren, F. : Beitrag Zur Ken-
ntnis der "Peritenditis calcarea'’ (Sogen "Bursitis Cal-
culosa") speziell vom pathologisch-histologischen Gesicht-
spunkt. Acta radiol. 18:263-296, 1937.
22. Sandstrom, C.: Peritenditis Calcarea, Am. J. Roent-
genol. 40:1-21, 1938.
23. Titus, N. E. : Electrical Treatment of Subdeltoid
Bursitis, Am. J. Surg. 6:318-321, 1929.
24. Troedsson, B. S.: Diathermy in Calcium Deposits
Around the Subacromial Bursa and Supraspinatous Tendon,
Arch. Phys. Therapy 19:166-172. 1938.
25. Villaca, J. ; Falci, A., and Ribeiro, J. D. : Contribuicao
a Terepeutica dos Depositos Calcareos Sub-deltodanos Pela
Vitamina A. Hospital, Rio de Janeiro, 30:937-950, 1946.
26. Weinberg, T. B.: Arthritis and Para-arthritis Treated
with the Roentgen Ray, Am. J. Roetngenol. 43:416-424,
1940.
27. Young, B. R. : Roentgen Treatment of Bursitis of
the Shoulder, Am. J. Roentgenol. 56:626-630, 1946.
28. Young, H. H. : Calcified Bursitis, Proc. Staff Meet.,
Mayo Clin. 19:250-253. 1944.
DIAGNOSTIC AND THERAPEUTIC
BLOCK FOR THE TREATMENT
OF PAIN
C. MacKENZiE Brown, M.D.
Albany
Every day most of us are faced with a
common problem: What is the best way
to relieve this patient’s pain? Often it is
not done easily; sometimes not satisfac-
torily.
Like most long-term developments, the
progress in the control of pain has been
accomplished through a great amount of
hard work and physiologic analyses upon
the part of many investigators.
It is my purpose to bring to your atten-
tion some of the conditions which may be
satisfactorily diagnosed or treated by
nerve block procedures. The list is so long
that some conditions must be omitted and
those mentioned must be described briefly.
The crux of successful nerve block is
accurate diagnosis. This latter fundamen-
tal fact cannot be emphasized too strong-
ly. Very essential is a working knowledge
of the anatomy of the part, of the use of
proper solutions and adequate experience
in the various technics.
Read before the Medical Association of Georgia in annual
session, Savannah, May 13, 1949.
210
The Journal of the Medical Association ok Georgia
Some headaches are amenable to nerve
block therapy: Post-traumatic occipital
headaches may be relieved by blocking the
second and third cervical somatic nerves
paravertebrally1. Tender areas may be in-
jected for fibromyositis. An attack of
migraine may be aborted if the involved
nerve is blocked early.
Often the etiologic factor of face pain
is obsecure and if there is a causative
factor present that is overlooked, this pain
will not usually be helped by block. Tic
douloureux may be relieved by blocking
the trigeminal nerve or its involved
branches. Face pain may have its origin
in the occiput or upper cerivical vertebrae;
cervical somatic nerve block helps some
of these. Stellate ganglion block may be
of value iu relieving some cases of atypical
face pain2.
Four months ago a case of- trismus of
five days’ duration, probably caused by
a reflex from the temporomandibular joint,
was completely relieved by a single block
of the mandibular nerve with 3 cc. of pro-
caine.
For torticollis, block of the second and
third cervical somatic nerves and the spinal
accessory may be indicated. Laryngotuber-
culosis may be associated with such marked
pain on swallowing that inanition develops.
In such a case, block of the supeior laryn-
geal nerve may be a life-saving procedure3.
Persistent hiccoughs refractory to the usual
methods of treatment may be relieved by
blocking the roots of the involved phrenic
nerve (third, fourth and fifth cervical).
Shoulder pain requires a good examina-
tion. Bursitis and “frozen shoulder” are
usually benefited by blocking the supra-
scapular nerve or brachial plexus4. This
simple effective therapeutic block is not
used with the frequency that it merits.
Myalgias and postcoronary pain in the
shoulder may be helped by infiltrating the
tender areas with procaine.
Herpes zoster, usually a virus disease
attacking the sensory nerve ganglia, in-
volves the cervical and thoracic nerves
most commonly. Paravertebral blocking
of the nerves which supply the painful seg-
ments may produce excellent results, par-
ticularly in the acute cases.
In blocking nerves for herpes zoster,
sciatica or any other pain syndrome which
might he indicative of chronic nervous sys-
tem disease, every effort should he made
to obtain an accurate diagnosis first, hut
sometimes it becomes necessary to give
symptomatic relief during the investigation.
Fortunately, in spite of the fact that
many pathologic disorders may produce
sciatica, a large number of these cases are
not due to serious organic disease. In
many cases of sciatica, after investigation,
it has been found of value not only to block
the sciatic nerve, hut also to perform a
caudal block; sometimes the roots of the
sciatic nerve as well. This combined prac-
tice is effective therapy. Thus far we have
considered somatic nerves for the most
part.
Autonomic nerve fibers make up part
of the mechanism of many disease entities3.
Pain usually rouses up increased sympa-
thetic activity. This results in vasocon-
striction. Regardless of the part of the
body in which vasoconstriction occurs,
whether it is in a blood vessel to the brain
or in a blood vessel to the lower limb, the
fibers responsible have their origin from
that part of the spinal cord between the
first thoracic and the third lumbar6.
It is well established that vasoconstric-
tion due to sympathetic activity may be
changed to vasodilation by procaine block
of the sympathetic fibers involved'. Sympa-
thetic fibers may he anesthetized by sub-
arachnoid block, by an epidural block, by
a ganglion block, or by a somatic nerve
block. By means of the latter method, post-
May, 1950
211
ganglionic fibers may be anesthetized. Sym-
pathetic fibers to the lower limb are sent
by way of L 1, 2, 3 sympathetic ganglia6.
Extremities exhibiting vascular spasm
and edema, with any stage of phlebitis, may
have dramatic improvement by means of
sympathetic block*. Vascular spasms from
trauma, arterial embolism, exposure to
cold, and other causes, may be effectively
treated by this means0.
Pain and edema of the extremities asso-
ciated with a fractured bone may be effec-
tively treated by sympathetic block1". Post-
traumatic dystrophy, osteoporosa atrophy
of bones and phantom limb pain may be
greatly benefited by repeated sympathetic
blocks.
For the diagnosis and surgical evalua-
tion of peripheral vascular disease, sym-
pathetic block may be used11. Diagnostic
block may also be performed in Hirsch-
sprung’s disease.
Sympathetic fibers to the upper extremity
may be readily blocked by infiltrating the
stellate ganglion. This procedure is wide-
ly used in causalgic states of the upper ex-
tremity, sometimes in the shoulder-hand
syndrome associated with coronary dis-
ease12, in pulmonary emoblism13, and in
cerebral embolism and thrombosis14.
Reflex anuria has been relieved by
spinal anesthesia, by epidural block and
by paravertebral block (Til, T12, LI,
L2)15.
Pain from the heart can be relieved by
blocking the first to the fifth thoracic sym-
pathetic ganglia. Alcohol blocks should
be reserved for the poor risk, emotionally
stable patients with pain so severe that it
prevents ordinary activity and which is not
controlled by ordinary medical manage-
ment.
Some of the arthritides may be helped
by nerve blocks. Sympathetic blocks for
rheumatoid arthritis in a non-inflammatory
stage are useful. Where osteoarthritis
causes pressure on intervertebral nerves,
somatic nerve block may produce relief.
One injects the trigger points in cases of
fibrositis.
One of the biggest problems in medicine
is the treatment of malignancy. Intract-
able pain in this condition is difficult to
manage1'* '*. When the origin of pain is
from a viscus, alcohol block of the sympa-
thetic pathways should be tried. For pain-
ful metastases, somatic nerve block should
be performed; the pain of metastases is
more easily relieved-
Intraspinal alcohol is of definite use in
these cases and in some other debilitating
painful syndromes1*. By adjusting the
position of the patient, the alcohol can be
directed to the desired areas of the posterior
roots in an effort to destroy the sensory
fibers. Nerve block for the pain of malig-
nancy should be used to a greater extent,
with more relief for the patient and with
less need for narcotics.
Again I wish to re-emphasize the need
for accurate diagnosis, the use of procaine
and the use of procaine early. It is
necessary to ascertain not only where pain
originates, but also the underlying patho-
logic process.
After much training doctors of medicine
are equipped to diagnose and to treat dis-
ease. For the purpose of combatting pain,
we are becoming more effective by using
our available ammunition from our store-
house of knowledge and experience.
REFERENCES
1. Judovich, B.. and Bates, W. : Pain Syndromes, Phila-
delphia, F. A. Davis Company, 1949, p. 256.
2. Judovich, B., and Bates, W. : Pain Syndromes, Phila-
delphia, F. A. Davis Company, 1949, p. 259.
3. Pitkin, G. P. : Conduction Anesthesia, Philadelphia,
J. B. Lippincott Company, 1946, p. 874.
4. Milowsky, J., and Rovenstine, E. A.: Suprascapular
Nerve Block: Evaluation In The Therapy of Shoulder Pain:
Anesthesiology 10:76-81 (Jan.) 1949.
5. Livingstone, W. K. : Pain Mechanisms, New York,
Macmillan Company, 1947, p. 209.
6. Best, C. H., and Taylor, N. B.: Physiological Basis
of Medical Practice, Baltimore, Williams & Wilkins Com-
pany, 1945, p. 937.
7. Nash, J. : Surgical Physiology, Springfield, Charles C.
Thomas Company, 1947, p. 403.
8. Ochsner, A. : Indications and Technic For Interruption
of Impulses Transversing the Lower Sympathetic Ganglia,
S. Clin. North America 23:1318 (Oct.) 1943.
9. Mandl, F. : Paravertebral Block, New York, Grune and
Stratton, 1947, p. 196.
(Continued on page 219)
212
The Journal ok the Medical Association of Georgia
THE JOURNAL
OK THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
May, 1950
MACON SESSION, 1950
The Macon session of the Association
of 1950 — also known as the 100th annual
session — showed again that Georgia physi-
cians are not only eager to meet and enjoy
good fellowship, but are at all times will-
ing to do those things which develop im-
provement in their knowledge both of medi-
cine and public affairs.
In addition to the scientific program,
highlights of this session were: continued
serious discussion of compulsory health
insurance, further development of non-
profit prepayment medical care plans and
nonprofit hospital insurance coverage, and
improved health education for the public.
All told, the session was most profitable
to those persons who attended it. Distin-
guished guest speakers included the presi-
dent of the American Medical Association,
Dr. Ernest Irons of Chicago, whose sub-
ject was “Medicine and American Free-
dom.”
Other distinguished guest speakers
were: Dr. Thomas M. Rivers of New York
City, whose subject for the Calhoun Lec-
ture was “Reaction and Relation of Host
Cells of Viruses.” Dr. Rivers, a native
Georgian, calls Jonesboro borne. Dr. Jacob
E. Finesinger of Baltimore spoke on “Hand-
ling the Emotional Problems of the Cancer
Patient”, and Dr. Richard L. Meiling of
Washington, D. C. gave a paper concerning
the “Medical Services in the Department
of Defense.” All these papers will be pub-
lished in The Journal.
Scientific and Technical exhibits were
excellent in every respect and proved again
their educational value.
Registration for the session was as fol-
lows:
REGIST
RATION
Exh
ibitors
V isiting
Scien-
Techni-
Members
Physicians
tific
cal
April 18
135
11
April 19
. 253
65
April 20
143
20
11
94
April 21
6
3
Total pli'
tsicians registered
626
Total ex
hibitors
..... 105
731
Womans
Auxiliary ....
..... 186
Grand to
tal April 21, 1950.
.... 917
NEW OFFICERS OF THE ASSOCIATION
AND DELEGATES TO THE A.M.A.
At the Macon session of the Association,
concluded April 21, Dr. A. M. Phillips,
Macon, was duly installed president of
the Association; Dr. W. F. Reavis, Way-
cross, was elected president-elect; Dr.
Leon Porch, Macon, was elected first vice-
president; Dr. Thos. A. Peterson, Savan-
nah, was elected second vice-president.
Continued in their respective positions
were: Dr. J. W. Simmons, Brunswick,
parliamentarian, and Dr. Edgar D. Shanks,
Sr., Atlanta, secretary-treasurer, and editor
of The Journal.
Other officers elected follow: Dr. Marion
C. Pruitt, Atlanta, councilor for the Fifth
District; Dr. H. D. Allen, Jr., Milledgeville,
councilor for the Sixth District; Dr. D.
Lloyd Wood, Dalton, councilor for the
Seventh District, and Dr. Sage Harper,
Douglas, councilor for the Eighth District.
Dr. W. G. Elliott, Cuthbert, was chosen
chairman of Council.
Dr. B. H. Minchew, Waycross, was re-
elected delegate to the A. M. A., and Dr.
E. A. Allen, Atlanta, was elected delegate
to the A. M. A. to succeed Dr. Allen H.
Bunce, Atlanta, who did not offer for re-
election to this position.
The next session of the Medical Association
of Georgia will he held in Augusta, April 17-20,
1951. The Bon Air Hotel will be headquarters,
with the Partridge Inn participating.
May, 1950
213
WILLIAM FARRELL REAVIS, M. D.
At the closing meeting of the 100th an-
nual session of the Medical Association of
Georgia, it was announced that Dr. William
Farrell Reavis, of Waycross, had been
unanimously elected President-Elect of the
Association. Dr. Reavis will he inducted
into office as President next year.
Dr. Reavis was born May 3, 1889, in
Cherokee County, Alabama, the son of
William Posey and Lora Ann (Crayton)
Reavis, both of Georgian birth and both
now deceased. His fathei’, who lived in
Milton County, Georgia, was a farmer. His
mother came from Floyd County, Georgia.
He had four sisters, three of whom are
living.
Public schools provided the early edu-
cation of William Farrell Reavis, who
afterward was a student at Georgia State
Normal College, in Athens. In 1911 he
was awarded the degree of Doctor of Medi-
cine at Emory University, in Atlanta, and
at once began the active practice of his
profession in Waycross. Until 1925 he
was engaged in general medical work, but
in that year he shifted his efforts to his
present specialty of urology. In this spe-
cialized realm of medicine he has done
his major work, serving in many useful
capacities in Waycross and vicinity. He
is attending urologist on the staffs both of
Ware County Hospital and Atlantic Coast
Line Hospital.
Reports of Dr. Reavis’ work have ap-
peared in the form of articles and mono-
graphs in different medical journals. He
is a past president of the Ware County
Medical Society, Eighth District Medical
Society, and Georgia Urological Society.
He was a charter member of the Southeast-
ern Branch of the American Urological
Society, a delegate to the Medical Associa-
tion of Georgia for thirty years, and coun-
cilor of the Medical Association of Georgia
for several years. Dr. Reavis is a fellow of
/•s
WILLIAM FARRELL REAVIS, M.D.
the American Medical Association, and
a member of Phi Chi medical fraternity.
Dr. Reavis interested himself extensive-
ly in the civic and social life of Waycross
and surrounding community. He has been
a consistent Democrat, and belongs to the
Free and Accepted Masons, the Benevolent
and Protective Order of Elks, and the
Woodmen of the World. He was the first
president of the Rotary Club of Waycross.
He is a Methodist in his religious faith.
He enjoys fishing, hunting and playing
golf.
On April 4, 1912, Dr. Reavis married
Olive Gladys Parker of Ware County,
Georgia. The children of this marriage
are: Mrs. J. Frank Pugh, Atlanta, Ga.;
Mrs. Sid Willingham, Rome, Ga.; Dr. Wil-
liam Farrell Reavis, Jr., a retired veteran,
Augusta, Ga.; Mrs. Ed Roe Stamps, Way-
cross, Ga., and Mrs. M. A. Cooper, Jr.,
Trion, Ga. One son, Jack, died in infancy.
214
The Journal ok the Medical Association of Georgia
Dr. Reavis’ long experience in the af-
fairs of organized medicine, particularly
as a member of the Council of this Asso-
ciation, qualifies him to meet squarely and
solve some of the intricate socio-economic
problems which confront the medical pro-
fession of today. Let each member resolve
to cooperate with him and make his task
easier.
AWARDS, 1950
It was a happy occasion at the annual
banquet of the Medical Association of
Georgia, held at Idle Hour Country Club,
Macon, April 20. Not only did the mem-
bers and their wives enjoy good fellowship,
but the food and other refreshments, and
entertainment, were good. Added to all
of this was the report of the Committee
on Awards. They had selected for two
awards the names of two distinguished
Georgia physicians. Dr. Cleveland Thomp-
son, of Milieu, was awarded the Hardman
Loving Cup, and Dr. Claude A. Smith, of
Stockbridge, was awarded the Ware County
Medical Society Hookworm Cup.
Other awards were made by another com-
mittee of the Association, these being for
scientific and educational exhibits. At the
moment — as this Journal goes to press —
all the facts concerning the awards are not
at hand, therefore detailed information re-
garding all awards will appear in a later
number of The Journal.
SYNTHESIS OF ACTIVE PORTION OF
ACTH SEEN AS POSSIBLE
Recent research should make possible the
eventual synthesis of an “active fragment" of
ACTH which produces relief from symptoms of
rheumatoid arthritis, according to an editorial
in the April 29 Journal of the American Medi-
cal Association.
Synthesis of ACTH in the laboratory has
been considered to be of insurmountable dif-
ficulty, owing to the weight of the molecule and
the fact that it is protein in nature.
The editorial refers to the work of Choh Hao
Li of the Institute of Experimental Biology,
University of California. Berkeley, and Norman
G. Brink, Melvin A. P. Meisinger and Karl
Folkers of the Research Laboratories of Merck
& Co., Inc.. Rahway, N. J.
Dr. Li obtained fragments of the hormone
which retained biologic activity. The three
Rahway research chemists recently reported a
component or components of ACTH derived
from the hormone compound by a laboratory
process (peptic digestion), according to the
editorial. This substance kept rheumatoid arthri-
tis in remission in two patients previously treated
with ACTH and was “clinically active" in a
third patient.
“The effect was equivalent to the intact
ACTH,” the editorial says, adding:
“With the activity of ACTH being confined
to a relatively small molecular weight com-
pound, it should be possible eventually to synthe-
size this active fragment in the laboratory. This,
in turn, would free the amount of the drug
which could be produced from the number of
pituitary glands available.”
In further processing of the fragmentary
product, the Rahway chemists found it to con-
tain at least seven common amino acids, com-
pounds which serve as building blocks for
the body.
“The revelation that the active fragment is
composed of a chain of approximately seven
amino acids makes commercially feasible synthe-
sis from other than glandular sources a possi-
bility,” Dr. Paul L. Wermer, Chicago, assistant
to the secretary of the A.M.A.’s Council of
Pharmacy and Chemistry, said.
“Although this synthesis may prove extremely
difficult, the discovery of this product consti-
tutes an important basic step toward assuring
a more adequate supply of material having
ACTH activity, ”he added.
The natural supply of ACTH from pituitary
glands of hogs definitely is limited by the
source, and as the situation now stands, could
never approach the demand.
Armour & Co. estimated that some 70,000,000
hogs will he processed commercially between
November 1, 1949 and November 1, 1950. If
every pituitary could be saved, which is im-
possible, and if one milligram of ACTH, which
is high, could be extracted from each gland,
there would be obtained a theoretical amount
which would give only one dose each per year
to less than half the persons with arthritis in
the nation.
At present, the supply of ACTH still is inade-
quate to meet all the research requirements of
groups desiring to study the hormone.
FEDERAL INCOME TAX LAWS UNFAIR
TO PROFESSIONS, SAYS ECONOMIST
Present federal income tax laws discriminate
against physicians and other professional men
and women, Frank G. Dickinson, Ph.D., Chicago,
May, 1950
215
economist and statistician of the American Medi-
cal Association, points out.
Because a considerable portion of physicians’
lifetime earnings are “bunched” into a relatively
few peak earning years, they pay more income
taxes than other persons who receive the same
lifetime incomes spread more evenly over a
greater number of years. Dr. Dickinson says in
an article in the April 29 Journal of the Ameri-
can Medical Association.
This discrimination in lesser degree applies
to a number of other professions, according to
the article.
“A physician undergoes a long training period
(the longest among the professions) during
which he foregoes income and incurs expenses
accumulating to approximately $35,000 at the
time of entering medical practice, at approxi-
mately age 28,” Dr. Dickinson says. “The
working lifetime remaining after this prolonged
training period is shortened.
“To pay off this investment in training in
annual installments, his annual gross earnings
would have to be at least $5,000 more than
those of a person whose earning period started
at age 18.
“Under the 1942 Federal Internal Revenue
Code, funds used by companies for the purpose
of providing employees with pensions or shares
in profit-sharing trusts are deductible* from gross
receipts as business expenses and thus are not
a taxable part of the employer’s or company’s
income, if the particular plan is approved by
the Bureau of Internal Revenue.
“Since the provisions are restricted to em-
ployees, professional men who can qualify as
employees — for example, company lawyers and
company physicians — can receive the benefits
of these pensions and profit-sharing trusts, while
those who conduct their professions as single
proprietorships or partnerships may not qual-
ify for these benefits.
“The Board of Trustees of the American Medi-
cal Association authorized its representatives
to record, at a meeting of the Association of
the Bar of the City of New York, its support,
in principle, of the proposal that the Internal
Revenue Code be amended to permit physicians
who practice as individual proprietors or part-
ners to declare as business expenses the costs
of pension programs for themselves, with the
proviso that there should be a reasonable maxi-
mum pension.
“The American Medical Association believes
that such an amendment would appreciably re-
duce the present discrimination.”
The Medical Association of Georgia will hold
its 1951 annual session in Augusta. The dates
are April 17, 18, 19 and 20. Bon Air Hotel
will be headquarters.
BEWARE OF TICKS THIS SPRING.
AMERICAN MEDICAL ASSOCIATION SAYS
From now throughout the summer, ticks in certain
areas of the United States will carry Rocky Mountain
spotted fever, says an editorial in the April 15 Journal
of the American Medical Association.
The mortality of the disease throughout the nation
average 23 per cent in 4,033 cases reported during the
period 1939-1946. the editorial points out. Fortunately,
two of the newer antibiotics, aureomycin and Chloro-
mycetin, give promise of being effective in treatment
of Rocky Mountain spotted fever.
The important foci of the infection are Wyoming,
Montana. Colorado, Virginia, Maryland and North
Carolina, according to the editorial. In the West, the
majority of cases appear between April and June, and
in the East, during July and August. Throughout the
nation, more cases occur during July than in any
other month.
Many cases occur in persons seeking recreation and
on vacation in rural or suburban areas, the editorial
says. Rocky Mountain spotted fever is characterized
by a high fever, muscle pains and a red, spotted rash.
Protection against infection lies in preventing the at-
tachment of a tick to the skin. High boots, leggings
or socks worn outside the trousers hinder the tick from
attaching itself to the leg. If there are no openings,
in the clothing, however, the tick will crawl up and
attach itself on the neck.
In tick-infested country one should pass the hand
frequently over the back of the neck and behind the
ears to remove ticks that may not yet be attached to
the skin. After becoming attached, ticks seldom trans-
fer the infection until they have fed on the victim for
several hours. Therefore, inspection of the body and
clothing twice daily when in tick-infested country
usually '-s sufficient.
A tick attached to the skin should be removed im-
mediately and as gently as possible. If the tick is
pulled off with the fingers, it should be handled with
a small piece of paper and the abrasion should be
touched gently with a disinfectant such as iodine or
gently washed with soap and water.
Vaccines have definite protective value for a period
of less than a year, the editorial says. Tourists who go
to areas where the infection is present and persons who
live in areas where the infection highly virulent should
be vaccinated.
NEW EYE INSTRUMENT MAY
HELP PREVENT BLINDNESS
A new instrument which measures pressure within
the eye may result in the prevention of much unneces-
sary blindness. Development of the instrument, called
a tonometer, is reported in the April 29 Journal of
the American Medical Association by a New York
doctor and a research worker.
Dr. Conrad Berens and Charles P. Tolman, B.S.,
also of New York, point out that the instrument is for
“screening” large numbers of persons rather than for
diagnosing specific diseases.
The instrument was developed from the basic design
of an older instrument used for diagnosing eye condi-
tions. Intraocular pressure is measured when the instru-
ment is applied to the eye. The working parts are
mounted in a plastic holder. The instrument is slightly
less than three inches long and three-fourths an inch
in diameter.
“We believe that this instrument, placed in the
hands of general practitioners, may prevent blindness
through earlier discovery of hypertension within the
eye and earlier reference of the patient to an ophthal-
mologist,” the authors say.
Increase of pressure within the eye is an early symp-
tom of glaucoma, a principal cause of blindness, and
other eye diseases.
The Journal of the Medical Association of Georcia
216
GEORGIA DEPARTMENT OF PUBLIC HEALTH
THE TWO FOLD PROBLEM OF
PREMATURE BIRTHS
Helen W. Bellhouse, M.D.
Atlanta
The problems of premature birth are two-
fold. On the one hand lies prevention of occur-
rence; on the other, care of the infant itself. In
the past proportionately more attention has
been paid to the care of the premature infants
than to the preventive aspects of prematurity.
Until 1947 the death rate was the only local
or national vital statistical material available
on prematurity. As a result of efforts to obtain
special reporting on births of infants 5V2 pounds
and under, a more complete picture is now
becoming available. Too, until 1948, when Bain
and Hubbard1 reported figures developed from
the study of the American Academy of Pediatrics,
a 5 to 10 per cent premature birth incidence
figure has been loosely employed, due to lack
of better information, with little or no allowance
made for variations by locale or race. Bain
and Hubbard, studying the records of 22 hos-
pitals which reported both births and deaths, by
race, and by weight groups, established an ex-
pectancy of 5.6 per cent for the white race
and 9.5 per cent for the non-white. If more of
the 323 hospitals had kept records of both births
and deaths — by weight and race — the group of
infants reported would have been larger, and
would have afforded more valid information.
Bain and Hubbard noted this limitation.
Prevention is obviously the responsibility of
obstetricians, general practitioners, and their
patients. The care of the “unfinished” baby
has long been shared by the general practitioner
and the pediatrician. The health department has
figured as the third party. It is interested both
in assisting in developing the program for the
prevention of early arrival, and in aiding the
program for increasing the survival of these
infants of 5% pounds and under. But, until
a picture is factually developed for each com-
munity, local needs cannot be evaluated for a
constructive program, since the problems of
premature births vary in each community, not
only as to arrival and survival rate but as to
race and socio-economic level.
To illustrate, we can use the figures on pre-
mature births and deaths, by race, reported for
1947 and 1948, in five large population centers
in Georgia. All of these counties have health
departments and a sizable urban population.
These five relatively statistically reliable areas,
reported premature births, by percentage of
live births, ranging from 5.1 to 9.3 per cent
for whites; and from 7.5 to 18.8 per cent non-
white. Using the same figures, the reported
mortality percentage of premature live births
ranged from 3 to 40 per cent. The area with
the highest premature birth incidence is reported
as next to the lowest in premature mortality. On
the other hand, the area with the smallest re-
ported percentage of premature live births re-
ported the highest death rate. Not unexpectedly,
the non-white premature birth incidence ex-
ceeded the white, with one exception. In two
of the counties, the reported white mortality for
both years was higher than for the non-white.
In two other counties the white premature mor-
tality exceeded the non-white in one year or
the other.
In some of Georgia's other large counties
there seems to be a need for stimulating interest
and awareness of physicians, midwives, neigh-
bors, registrars, and public health personnel,
in local premature birth problems. Some re-
markably low premature birth rates are re-
ported, usually for the non-white group. Case
finding on the part of everyone concerned will
undoubtedly bring these figures more in line
with those accepted, and give a truer picture.
In other large counties, meticulous reporting
shows a higher than expected incidence of pre-
mature births among white or non-white, or
both groups.
Dr. Ethel Dunham's handbook for physicians,
“Premature Infants”2, covers all phases of the
problem — prenatal and intrapartal, as well as
neonatal, and is useful resource material.
Good prenatal care includes individual coun-
seling and advice at each visit as well as early
periodic visits, thorough physical examination
and clinical study. And while it is difficult to
evaluate the specific contributions toward pre-
vention of premature births made by a diet
high in protein, and a healthy emotional status,
recent studies suggest time given to this type
of education may be considered well spent.
Georgia physicians can make many and varied
contributions, individually and as a group.
Complete reporting of premature or immature
births and deaths, by weight and by race, will
give a more accurate picture for community
program planning. The two-fold premature birth
problems should be valuated cooperatively. Gen-
eral practitioners, obstetricians, pediatricians,
and public health physicians, working together,
can make great strides toward reducing the in-
cidence of unnecessary premature births and
premature infant morbidity and mortality.
There is a very critical period during the
first 24 hours of a premature’s life when the
responsibility of the physician who has given
prenatal care and done the delivery, and the
physician who is to care for the baby subse-
May, 1950
217
quently, overlaps. Fifty-seven per cent of the
deaths of prematures occur in that period. This
area, being of common interest to obstetric,
pediatric, and public health groups, should be
a good place to start cooperative study and
work.
Physicians, as leaders in community planning
for health needs, can study individually, by
special interest groups, and in medical societies,
the information tabulated by the health depart-
ment from physicians’ individual reports. Obste-
tricians and general practitioners will find that
in some areas it is the “private practice” class
that needs more help and education in the
prenatal period. In other communities there
will obviously be a need for more adequate
provision for the indigent and near-indigent
group, be it white or non-white.
The campaign toward improved prenatal care
and prevention of premature birth should, when-
ever possible, be carried on in the office of the
obstetrician or general practitioner. Unfortu-
nately, not every expectant mother in Georgia
can, or will, see the private physician in his
office. Those facilities and personnel for good
prenatal care available in the doctor’s office
can be supplemented by maternal conferences,
strategically located, under the auspices of local
health departments. Attention to provisions for
good prenatal care, easily available to both races,
and to all socio-economic classes, should ma-
terially reduce the maternal morbidity and mor-
tality rates, as a whole.
Specifically, 6,219 premature births have been
reported in Georgia for 1949. Georgia ranks
poorly, next to the bottom, in the most recent
national maternal mortality rating for the white
race. It ranks 3th from the bottom in the non-
white maternal mortality rate, although the rate
itself is almost three times as great as that of
the white race. There are areas in Georgia
notably low and notably high in reported pre-
mature births. All of these problems deserve
study. Every resource should be explored and
developed.
Educational information should be made more
available on “quality” prenatal and intrapartal
care. The favorable influence of such factors
as early medical care, and counseling to promote
good nutritional habits and good emotional
hygiene, should be stressed. In the intrapartal
period, the benefits derived by the premature
infant from a high oxygen intake for the mother;
little or no analgesia or anesthetic; and routine
episiotomy to protect the more delicate head
structures from damage; should receive more
study.
In Georgia, cooperation between physician
and health department has made possible more
effective contributions toward improving care
of premature infants. This same cooperative
effort can be just as effective in developing pro-
grams which will improve care of all expectant
mothers, reduce premature birth incidence, mor-
bidity, and mortality, and favorably influence
the entire maternal welfare picture.
REFERENCES
1. Bain. Katherine; Hubbard. John P., and Pennell,
Maryland U. : Hospital. Fatality Rates for Premature In-
fants. Pediatrics 4:54 (Oct.) 1949.
2. Dunham, Ethel C.: Premature Infants, a Manual for
Physicians: Children’s Bureau Publication no. 325. 1948.
NEWS ITEMS
Dr. Henry T. Adkins, Waycross physician, and re-
gional health official, was recently named commissioner
of tile Ware County Department of Public Health. Dr.
Adkins was elected to fill the vacancy in the Waycross
office caused by the death of Dr. W. C. Hafford. acting
commissioner of health. Dr. Hafford had served Ware
County for several months following the death of Dr.
George E. Atwood, commissioner of health. Dr. Adkins
is well qualified to head Ware County’s health program,
for he had previously served as commissioner of public
health in Sumter and Bleckley counties where he made
outstanding progress in public health. He received his
field training in public health work with Dr. M. E.
Winchester of the Glynn County Health Department
in Brunswick. He also completed a course in public
health at the University of North Carolina.
'* * *
The Albany and Dougherty County Board of Health,
Albany, recently announced through Dr. David M.
Wolfe, health commissioner, in his annual report to the
City-Couunty Board of Health, that despite “consider-
able progress” recorded in controlling the disease,
tuberculosis remains the number one health problem.
The progress referred to, the report states, is that de-
rived from obtaining skin tests, x-ray clinics and field
visits, a true picture of the disease as it affects the
people of the city and county. There were nine deaths
from tuberculosis in Albany and Dougherty County in
1949. During the year, 2,431 x-rays were made; 404
of them being rechecks. There were 676 admissions
to service; and of this number, 69 were positive (18
new cases) ; 151 were suspicious caces and 262 were
contacts, the report revealed. Dr. Wolfe’s comprehensive
report also stated that control of venereal diseases con-
tinues to be a major health activity, despite new
“miracle” drugs and development of rapid treatment
for svphilis.
* * *
Athens Medical Center construction was recently
begun on the northwest corner of Prince Avenue and
Chase Street, Athens. Owners of the new building will
be Medical Center of Athens. Inc., of which Dr. John
A. Simpson is president. Corporation members are
Drs. Simpson, J. B. Neighbors. Jr., Goodloe ^ . Erwin,
John Stegeman, H. G. Byrd. M. A. Hubert. Herschel
Harris, Tom Dover. James A. Green, Sam Talmadge,
John McPherson, Jr., and dentists James B. Allen,
Charles F. Elder, Paul Keller, and Edwards Prescrip-
tion Laboratory. The building will be of brick con-
struction, one story in height, will be 15.000 square feet
in area and have complete air conditioning facilities.
* * *
The Atlanta Radiological Society elected the follow’-
ing officers at the March meeting: Dr. William W.
Bryan, president : Dr. George Hrdlicka, vice-president,
and Dr. Ted F. Leigh, secretarv-teasurer.
* * *
The Atlantic Coast Line Railroad Surgeons Associa-
tion held its forty-sixth annual meeting in Tampa, Fla.,
March 30 and 31. Dr. Ben Hill Clifton, Atlanta, presi-
dent of the association, presided. Dr. J. Elliott Scar-
borough, Atlanta gynecologist, was among the guest
speakers. He discussed “Present Status of Hormone
Therapy in Treatment of Malignancies.” Dr. Braswell
E. Collins, Waycross, secretary-treasurer of the Atlantic
Coast Line Railroad Surgeons Association, also took
(Continued on Page 220)
218
The Journal of the Medical Association of Georgia
WOMAN’S AUXILIARY TO THE MEDICAL ASSOCIATION OF GEORGIA
Highlights of the 1950 Convention
The Bibb County Auxiliary of Macon enter-
tained the State Auxiliary April 18-21. Our
hostesses left nothing undone for our pleasure
and entertainment.
M rs. Milford Hatcher as president and Mrs.
A. M. Phillips as general chairman are to be
congratulated on the success of the meeting.
There was a total registration of 186.
The first session held Wednesday, April 19,
was opened with invocation by the Rev. Tracy
Lamar. Rector St. James Episcopal Church.
The Pledge of Loyalty was read by Mrs. Sam
Anderson, Atlanta.
Mrs. Milford B. Hatcher, president of the
Bibb County Auxiliary, welcomed tbe members.
Mrs. W. H. Benson of Marietta, responded.
Mrs. J. Lon King, of Macon, introduced
officers and guests.
Mrs. J. Harry Rogers, presided, and gave a
splendid account of her year as president. She
fulfilled her pledge to “Fight With Knowledge”
and carried the message against socialized medi-
cine to every auxiliary under her jurisdiction.
We know that auxiliary members are certainly
better informed and better prepared to carry on
a crusade against political medicine than ever
before.
Mrs. Bruce Schaefer, chairman of Legislation
for the Auxiliary to the A.M.A., gave an excel-
lent talk on the danger confronting American
freedom and urged our renewed interest and
efforts.
The Auxiliary was honored by the presence
of Mrs. David B. Allman, Atlantic City, presi-
dent of the Auxiliary to the American Medical
Association. She praised the members for the
work done and recognition they have gained
during the past year. She believes every doctor’s
wife should be an auxiliary member and do her
part in good public relations for the profession.
Dr. Enoch Callaway, president of the Medical
Association of Georgia, spoke on "Our Present
Situation,” which inspired us to continue our
crusade against political medicine.
District and county officers gave excellent
reports.
Mrs. Allen H. Bunce gave an interesting re-
port of the convention of the Woman’s Auxiliary
to the A.M.A. last year in June.
Mrs. Ernest R. Harris, of Winder, conducted
the memorial service for the following members
who died during the year:
Mrs. E. D. Peacock, Sandersville.
Mrs. George F. Hagood, Sr., Marietta.
Mrs. Willis P. Jordan, Sr., Columbus.
The second session on Thursday was opened
with prayer by Dr. Wm. E. Denham, pastor,
First Baptist Church.
Pledge of Loyalty was led by Mrs. W. G.
Elliott, Cuthbert.
Mrs. Wm. K. Jordan, president-elect of Bibb
County Auxiliary, welcomed the guests. Mrs.
Robert E. Jones of Tifton responded.
Dr. A. M. Phillips, president-elect of the
Association, made a short talk asking the Auxili-
ary to continue its splendid work and pledged
his support to the Auxiliary.
Dr. Murdock Equen, chairman of the Advis-
ory Committee, made a short report. He re-
minded the members of the power and influ-
ence of women, stating that 80 per cent of the
property in our country is owned by women,
therefore her infleuence for or against any issue
is vital.
Mrs. R. C. Haynes, Marshall, Mo., president
of the Auxiliary of the Southern Medical Asso-
ciation, reviewed the objectives of the Southern,
viz: (1) Doctors' Day observance; (2) Research
in Romance of Medicine; (3) Jane Todd Craw-
ford Scholarship and Student Loan Fund. She
urged increased interest among younger doctors’
wives.
Mrs. John W. Turner, Atlanta, gave a report
of the Southern Medical Convention. She re-
ported the red carnation adopted as official
flower for Doctors’ Day.
Mrs. Jas. N. Brawner was introduced as
Honorary President for Life as the first presi-
dent of the State Auxiliary and a past president
of the County, State and Southern Auxiliaries.
Officers and chairmen of Standing Committees
gave reports for the year.
Bibb County won the Mrs. Jas. N. Brawner
Cup for general excellence.
Richmond County won the Achievement
Award for sponsoring a series of lectures on
Child Guidance.
Chatham County won the Exhibits Award.
Fulton County won first for the Scrapbook.
The entertainment consisted of a reception
on Tuesday evening at the Sidney Lanier Cottage
to which doctors and their wives were invited.
On Wednesday a delicious Southern style lunch-
eon was served at Wesleyan College. Attractive
favors marked each place. Bathing beauties
staged a fashion show dating from the “covered
up” gay nineties to the “barely covered” models
of today. Mrs. Harry Rogers was presented
a silver bowl by Mrs. Maxwell Berry of Fulton
County as an expression from her home auxili-
ary.
Mrs. Henry Tift’s lovely home and gardens
were the scene of a tea given by the Auxiliary
on Wednesday afternoon.
Following business of Thursday the follow-
ing slate selected by the nominating committee
was elected:
President — Mrs. L. W. Williams, Savannah.
President-Elect — Mrs. J. R. S. Mays, Macon.
May, 1950
219
First Vice-President — Mrs. Ralph Fowler,
Marietta.
Second Vice-President — Mrs. John W. Turner,
Atlanta.
Third Vice-President — Mrs. Paul Russell,
Albany.
Recording Secretary — Mrs. Leo Smith, Way-
cross.
Corresponding Secretary — Mrs. C. R. A. Red-
mond, Savannah.
Treasurer — Mrs. Robert C. Major, Augusta.
Historian — Mrs. Robert Crichton, Milledge-
ville.
Parliamentarian — Mrs. Bruce Schaefer, Toc-
coa.
Mrs. Ralph Chaney, Augusta, pinned the
President’s pin on Mrs. J. Harry Rogers, ex-
pressing sincere appreciation for her excellent
year of service.
Faye H. Clifton, Chm. Editorial Committee
(Mrs. Ben H. Clifton)
(Continued from Page 211)
(C. MacKenzie Brown, M.D.)
10. Shumacker, H. B., and Abramson, D. I.: Posttrauma-
tic Vasomotor Disorders, Surg., Gynec. & Obst. 88:417-434
(April) 1949.
11. Faust, F. L. : Repeated Sympathetic Blocks: Their
Limitation and Value, Anesthesiology 7:161-175 (March)
1946.
12. Steinbrocker, A. : Arthritis, Clinical and Medical Ser-
vice 4th Division, New York University, Bellevue Hospital.
Read before National Anesthesiology Congress, (Sept. 10)
1947.
13. Bageant, W. E., and Rapee, L. A.: Treatment of
Pulmonary Embolus by Stellate Block, Anesthesiology 8:500-
505 (Sept.) 1947.
14. Volpitto, P. P., and Risteen, W. A.: The Use of
Stellate Ganglion Block in Cerebral Vascular Occlusion,
Anesthesiology 4:403-408 (July) 1943.
15. Mandl. F. : Paravertebral Block, New York, Grune and
Stratton, 1947, p. 91.
16. White, J. C.: Technique of Paravertebral Alcohol
Injection, Surg., Gynec. & Obst. 71:334-354, 1940.
17. Stubbs, D., and Murphy, J. P. : The Treatment of
Intractable Pain, New York State J. Med. 87:2094-2097
(Oct.) 1947.
18. Rovenstine, E. A., and Wertheim, H. M. : Therapeutic
Nerve Block, J.A.M.A. 117:1599-1603 (Dec. 6) 1941.
DISCUSSION
DR. A. H. BUNCE (Atlanta) : Mr. President and
gentlemen, I wish to make just a few remarks about
the paper by Dr. David Robinson on bursitis, from the
standpoint of a medical man.
Many years ago Dr. J. W. Landham called my
attention to the benefits to be derived from x-ray treat-
ment in acute bursitis. I knew very little about the
differential diagnosis of painful shoulders at that time;
I don’t know much more now.
In our practice the No. 2 ailment is rheumatism and
arthritis, painful joints and muscles over the body.
Painful shoulder is fairly frequent. Sometimes it is
impossible, not infrequently is it impossible, to tell
what is causing the painful shoulder.
However, we have found that if we do make an
accurate diagnosis of an acute bursitis, beautiful results
frequently are obtained by x-ray therapy, but not
always. The longer the thing has existed, the less satis-
factory is the treatment.
I state now that I am indebted to Dr. Landham for
calling my attention to this treatment in a very dis-
tressing condition.
First, try to make an accurate diagnosis. Second, in
those patients having acute bursitis, x-ray treatment
certainly should be tried, because all too frequently
unfortunately, all of our treatments fail.
DR. ROBERT DRANE (Savannah) : Like Dr.
Phillips, my endeavors are limited to a rather narrow
field, and I am poorly qualified to discuss the surgical
papers. 1 appreciate the courtesy extended me in
sending them, and 1 read the papers with interest. I
see no reason to take issue with what the essayists
have said. They have covered their subjects well.
Dr. Robinson's paper I agree with for the most part.
In my experience 1 have had more patients with a
left-side involvement than a right-sided involvement. I
have always wondered about this, because most of them
were right-handed men and a few women.
The method of treatment is much the same. I have
gradually gotten into the habit of treating a patient
four times within a week. If he comes on Monday I
treat him anteriorly, and posteriorly the next day, skip
a day, then anteriorly, and the next day posteriorly. I
find I get much quicker results in relieving the pain —
and that is the main reason why the patient comes.
I have had just as good results with a potential of
120 or 130 kilovolts rather than 200. The higher volt-
age is a little safer and there is less chance of skin
damage. We give 125 r to thin patients and 150 r to
heavier patients. We give each area two treatments
anteriorly and posteriorly. If the machine is well cali-
brated, and if you intelligently administer the dose, I
don’t think you will have any side reaction. If I do
not get results in this series of four treatments, I
discontinue them and tell the patient I don't think
he will be improved by further treatment.
DR. C. MacKENZIE BROWN (closing) : In the
paper on “Therapeutic Nerve Blocks,” I devoted just
one sentence to the subject of bursitis of the shoulder
joint. There have been volumes written on the subject.
In January of this year an article appeared in
the Anesthesiology Journal, reviewing the literature
on the various methods of treatment of this condition.
The conclusion of Dr. E. A. Rovenstine, who himself
had 100 cases to report, was described. More satisfac-
tory treatment was obtained by suprascapular nerve
block. If a patient does not respond within 48 hours
after a course of radiation therapy, the method should
be considered a failure. Only an occasional case of
chronic bursitis is cured by roentgen therapy. Com-
paring the latter with physical therapy almost identical
results are obtained.
This is a simple maneuver. The suprascapular nerve
is located in the suprascapular notch. This is as far
behind the clavicle as the coracoid process is in front
of the clavicle. You can feel the coracoid process on
yourself — feel how far it is in front the clavicle.
After arriving in Albany one of my first cases of
bursitis was in the hospital administrator, an ex-football
player. In this case the suprascapular nerve was
blocked. Sixteen months have passed and his bursitis
has not returned.
Since then other athletes, including baseball players,
liave had procaine block of the sensory pathway to
the shoulder-joint. For athletic or nonathletic indi-
viduals, suprascapular nerve block in the treatment of
bursitis in the shoulder joint has been highly successful.
A.M.A. PUBLISHES STORY OF
CORTISONE AND ACTH
The first full and comprehensive report by Dr.
Philip S. Hench and his collaborators at the Mayo
Clinic, Rochester, Minn., on their original work with
cortisone and ACTH is published by the American
Medical As=ociation in the April issue of Archives
of Internal Medicine.
The article also contains a review of other pertinent
experimentation on these and allied substances.
Co-authors with Dr. Hench are Edward C. Kendall,
Ph.D., and Drs. Charles H. Slocumb and Howard F.
Polley.
Studies which led to the use of the hormones and
their effects in arthritis, rheumatic fever, lupus erythe-
matosus disseminatus, psoriasis, tuberculosis, chronic
idcerative colitis, gout and allergic conditions are dis-
cussed.
220
The Journal of the Medical Association of Georgia
NEWS ITEMS
(Continued from Page 217)
part in the program. Dr. Samuel E. Andrew. Waycross,
superintendent of the Atlantic Coast Line Hospital,
Dr. Lovick W. Pierce, Waycross, and Dr. W. S. Cook,
Albany, attended the meeting.
* * *
Dr. J. M. Barnett, Albany physician, was recently
re-elected to a four-year term as medical member of
the Dougherty County Board of Health by Dougherty
Superior Court’s Grand Jury. Dr. Barnett, regarded
as an international expert on malaria, its prevention
and treatment, long has served as the County Board
of Health's medical member.
* * *
T! ie Bibb County Medical Society held its regular
business meeting at the Georgia State Health Depart-
ment Building, Macon, April 4. Dr. Henry H. Tift,
secretary- treasurer.
*)• •ft
Dr. Frank K. Boland, Atlanta physician and surgeon
and recent author of “The Story of Crawford Long—
The First Anesthetic", was one of the guest speakers
at the Crawford W. Long Day observance held at the
University of Georgia, Athens, March 30. Dr. Boland
participated in the ceremony at Oconee Cemetery,
where Dr. Long is buried, when a wreath was placed
on Dr. Long’s grave.
* * *
The Brooks County Medical Society declared in a
statement issued to the press that President Truman's
scheme for “Socialized Medicine” would deny medical
care to many Americans who need it most and who
are least able to pay for it. Members also emphasized
that compulsory health insurance legislation proposed
in Washington would “leave out in the cold of medical
neglect” the indigent tuberculous, the insane, the
nervous, veterans, ministers, and religious workers,
domestic and farm labor, railroad workers, employees
of cities, counties and states, and the needy indigent.
“Tuberculosis is still a major problem in Georgia and
the nation,” the statement continued. “The insane
often must go to jails to await room in an asylum.
Yet these tragic people could not look to the Truman
Plan for a haven.” The American Medical Association
estimates, using government VA figures as a basis, that
1.500.000 additional federal employees would be needed
if the Truman health plan is enacted. “Under non-
profit for hospital and other medical costs, the price
for a family of four would be less than the cost of
a package of cigarettes a day”, the statement con-
cluded.
* * *
Dr. R. L. Carter, Thomaston physician, recently spoke
to the Pike County Lions Club at Molena, going into
detail on the new Upson County-Thomaston Hospital
now under construction in Thomaston. By the use of
a slide projector, Dr. Carter showed photographs, as
well as blueprints and diagrams which sketched all
details of the new $1,200,000 building. One hundred
beds are planned for the hospital.
* * *
The Cerebral Palsy Societv of Georgia held its second
conference in East Point. March 28. Hightlight of the
meeting was a demonstration of a cerebral palsy clinic
by Dr. Harriet Gillette, medical director at Aidmore
Children’s Convalescent Hospital, Atlanta, and cerebral
palsy consultant. Dr. Gillette will confer with members
of the cerebral palsy chapter at Macon regarding plans
for the establishment of a clinic and training center.
* * *
The Crawford W. Long Memorial Hospital held its
regular monthly dinner meeting of the staff in the
dining room of the hospital, Atlanta, April 11. Pro-
gram: “Two Bone Fractures of the Forearm", Dr.
William Bondurant; “Morton’s Neuroma of the Toe ”.
Dr. R. L. Yeargan, Jr. Pediatric section: ‘‘Mortality
Statistics", Dr. Edwin Webb. Medical section: “Eosino-
phile Count in Myocardial Infarction", Dr. \rthur
Moseley. General practitioners: Dr. Harry Ridley,
program chairman. Surgical section: “Some Problems
of Proctology”, Dr. Edgar Boling.
* * *
The Crawford W. Long Memorial Hospital, through
Dr. Wadley R. Glenn, Medical Director, announces
the appointment of Dr. 1.. J. Miller as director of
anesthesia, beginning April 15. Dr. .Miller is already
well known to the members of the visiting staff and
the hospital personnel, having done a great part of his
work here during the past four years. There will he no
changes in the present personnel. Miss Regina Noon
will retain her position as chief nurse anesthetist
and Mrs. Alice B. Martin will retain her position as
operating room supervisor.
* * *
The Crippled Children’s division of the State De-
partment of Welfare held an orthopedic clinic at the
John D. Archbold Memorial Hospital, Thomasville,
March 31. Dr. Fred Hodgson, Atlanta, who is in
charge of the Crippled Children’s work throughout the
state, was among the orthopedists conducting the clinic.
Others included Dr. Fred Murphy, Atlanta orthopedist,
who will be in Thomasville in July for permanent resi-
dence. and Dr. Dunlap, who is orthopedist for Thomas-
ville and Thomas County. Dr. Charles Watt, Thomas-
ville surgeon, stated that it is the hope of the medical
men of this district to establish a local Crippled
Children’s treatment center. This district covers 22
counties.
* * *
Dr. Mayhew Derryberry, Washington, D. C.. director
of health education for the United States Public Health
Service, presided over the second Leadership Confer-
ence in Health Education held at the Hotel DeSoto,
March 29-31. The conference was sponsored by the
Chatham-Savannah Health Department and Chatham
County public schools. Thirty-six local cooperating
groups and agencies, together with numerous health
education officials from throughout the State par-
ticipated in the meetings. The purpose of the con-
ference was to study accomplishments of the recom-
mendations from the first conference which were put
inlo effect in the county and city health programs.
* * *
Dr. Richard E. Felder, formerly associated with
the Clark-Holder Clinic, LaGrange, has accepted a
position as instructor in psychiatry in the clinical
department of Emory University School of Medicine,
Atlanta. The clinical department is located at Grady
Memorial Hospital. Dr. Felder has been serving as
resident physician in internal medicine at Grady
Memorial Hospital since July 1, 1949 and will com-
plete his residency in July of this year, when he will
begin the duties of his new position. He graduated
from Emory University School of Medicine, Atlanta,
in 1944 and went into the Army Medical Corps in
1946. Following basic training he was assigned to
the 319th Station Hospital at Bremerhaven. Germany.
He served as chief of staff the last year he was in
Bremerhaven.
* * *
Dr. Austin P. Fortney and Dr. James Freeman, two
of Sylvania’s young physicians, were recently presented
certificates for outstanding services rendered the Medi-
cal Hospital at Fort Jackson during 1949, while mem-
bers of the hospital staff. Lt. Col. S. E. Donhouser,
commanding officer of Savannah military sub-district,
prt'fnted the certificates in the presence of their fam-
ilies and the Rev. P. E. Miller. He stated that these
were the first awards of that type that he had issued
during his time as commander.
* * *
Georgia colleges will get $12,547 for heart disease
research out of $220,000 grants-in-aid the American
Heart Association recently announced. Two of the
May, 1950
221
grants are to the Emory University School of Medicine,
Atlanta. One is $4,725 for the study of physiology of
the kidney by Dr. Walter H. Cargill. The other is
$5,250 for studying the physiology of circulation by
Dr. James V. Warren. A grant of $2,572 was made
the Medical College of Georgia, Augusta, for phar-
macologic studies by Dr. Raymond P. Ahlquist. The
association previously had allotted $8,000 for an in-
vestigation into the treatment of rheumatic fever. This
project is being carried on at the Cardiac Clinic at
Grady Memorial Hospital, Atlanta. The new grant
makes a total of $400,000 voted by the American
Heart Association for research during the 1950-51
academic vear.
* * *
The Georgia Department of Public Health, Atlanta,
recently announced that eight Georgia medical officials
havt been certified by the American Board of Preven-
tive Medicine and Public Health. Newly certified
doctors include: Guy G. Lunsford, Atlanta, director of
the division of local health organizations of the State
Department; R. W. McGee, Atlanta, director of the
Fulton County Health Department; T. O. Vinson,
Decatur, director of the DeKalb County Health Depart-
ment; J. A. Thrash, Columbus, director of the Muscogee
County Health Department; Abe J. Davis, Augusta,
director of the Richmond County Health Department;
Floyd Payne. Rome, director of Battey Tuberculosis
Hospital, and Guy V. Rice, Atlanta, director of the
division of maternal and child health of the Georgia
Department of Public Health.
* * *
Georgia observes Doctors’ Day today. That kindly
and lovable character, the family doctor, is in the
limelight today.
This is ‘‘Doctors’ Day” in Georgia. Every state has
its annual day on which it pays tribute to the man
who administers to those with sick and broken bodies.
Georgia has set aside March 30 as Doctors' Day.
Why March 30?
Because that is the date on which Crawford William-
son Long, in Jefferson, Ga., administered ether to a
patient before removing a tumor from the neck. That
was in 1842, and it was the first recorded use of an
anaesthetic in surgery.
Long’s statue now stands in Statuary Hall in the
Capitol, Washington, D. C.
Born at Danielsville, Georgia, Nov. 1, 1815, he
graduated at Franklin College, Ga., and secured his
medical education at Transylvania University and the
University of Pennsylvania. He subsequently spent 18
months in New York City Hospital observing and
performing surgical operations. In 1841 he returned to
Jefferson, Georgia, to open his practice.
While there is no special observance in Valdosta of
Doctors’ Day, it is felt that citizens will want to pay
tribute in their own silent way by reflecting on the
boon to humanity that results from the practice of
medicine under America’s system of free enterprise.
It is probably appropriate here to recall the descrip-
tion, with a truly Scotch flavor, of William McLure,
physician who practiced in Scotland, taken from “A
Doctor of the Old School”:
“The sight of him put courage into sinking hearts.
But this was not by the grace of his appearance, or
the advantage of a good bedside manner.
“A tall, gaunt, loosely-made man, without an ounce
of superfluous flesh on his body, his face burned a
dark brick color by constant exposure to the weather;
red hair and beard turning grey, honest blue eyes
that looked you ever in the face, huge hands with wrist-
bones like the shank of a ham, and a voice that
hurled his salutations across two fields, he suggested
the morgue rather than the drawing room.
“But what a clever hand it was in operation, as
delicate as a woman’s; and what a kindly voice it was
in the humble room where the shepherd’s wife was
weeping by her man's bedside . . . that ugly scar that
cut into his right eye-brow and gave him such a sinister
expression was got one night when his horse slipped on
the ice and laid him insensible eight miles from home.
His limp marked the big snowstorms in the Fifties, when
his horse missed the road and they rolled together
in a drift. McLure escaped with a broken leg and the
fracture of three ribs, but he never walked like other
men again.
"But they were honorable scars, and for such risk
of life men get the Victoria Cross in other fields.
McLure got nothing but the secret affection of the
Glen which knew that none had ever done one-tenth
as much for it as this ungainly, twisted, battered figure.
“Many a face softened at the sight of him limping
to his home.” — From the editorial page of Valdosta
Daily Times March 30, 1950.
* * *
1 lie Georgia Medical Society held its regular
meeting at 612 Drayton Street, Savannah, April 11.
Program: “Polyps of the Lower Bowel”, Dr. John G.
Zirkle. Discussion led by Dr. Lee Howard, Jr. Dr. Sam
Youngblood, Jr., secretary.
* * *
The Fulton County Medical Society held its dinner
meeting at the Academy of Medicine, Atlanta, May 4.
Program: Dr. J. D. Martin, Jr., moderator. “Chronic
Subdural Hematoma”, Dr. Robert F. Mabon; “A New
Surgical Procedure in Treatment of Scoliosis”, Dr. Paul
L. Reith, and “Some Aspects of Chest Tomography,”
Dr. Ted Leigh.
* * *
The Habersham County Medical Society held its
monthly meeting at the home of Dr. J. L. Walker,
Clarkesville, March 9. Dr. Harry Rogers, Atlanta
surgeon, was guest speaker. He delivered an interesting
and informative lecture on cancer. Members present
were Drs. J. L. Walker, B. J. Roberts and George T.
Nicholson. Guests included Dr. Rogers, Dr. L. G.
Neal, Jr., Cleveland; Dr. Ben Nalley, Helen; Drs.
Wm. H. Good, Jr., Arthur G. Singer, Jr., E. F. Chaffin,
Clias. M. Henry, C. L. Ayers, Robert E. Shiflet, and
W. B. Schaefer, all of Toccoa. The April meeting was
held at the home of Dr. Joe J. Arrendale, Cornelia.
Dr. W. J. Murphy, Atlanta, of the Department of
Epidemiology of the Georgia Department of Public
Health, was guest speaker. He spoke on “New Ap-
proaches in the Spread and Control of Contagious
Di seases.”
* * *
Dr. A. O. Linch, Atlanta, president of the Fulton
County Medical Society, and Dr. Steve Garrett, Atlanta,
president of the Georgia Dental Association, were
among the first persons tested at the opening of the
main station of the Greater Atlanta Screentest for
Health April 11. Dr. T. F. Abercrombie, Atlanta,
former head of the Georgia Department of Public
Health, also attended the opening and called the test-
ing program “one of the greatest advancements in safe-
guarding the public’s health.”
* * *
Major Tom F. Little, formerly Tifton physician, was
recently named as the First Calvary division surgeon,
with his new assignment at Camp Drake, headquarters
of the First Calvary Division. Tokyo, Japan. Major
Little, who arrived in the Far East Command in
September 1949, enlisted in the military service August
1941. He has attended Medical Field Service School,
Army School of Radiology, and Command and General
Stag School while in the Army. He graduated from
Tulane University of Louisiana School of Medicine,
New Orleans, La. During World War II, Major Little
served in the European theater and received credit
campaigns in Morocco, North Africa, Sicily, Normandy,
Northern France, the Ardiennes and Middle Europe.
He holds the Bronze Star with Oak Leaf Cluster, Dis-
tinguished Unit Citation with Oak Leaf Cluster, Belgium
Fourre Guerre and the French Crois de Guerre.
222
The Journal of the Medical Association of Georgia
Dr. Guy G. Lunsford, Atlanta, a veteran official of
the Georgia Department of Public Health, recently
resigned as head of the division of local health organi-
zation. Dr. Lunsford will join the Veterans’ Administra-
tion as a medical officer in the insurance division. He
will be succeeded by Dr. S. C. Rutland, now medical
director of the west-central region with headquarters
in Macon. Dr. Rutland was formerly county medical
officer for Crisp and Jenkins counties.
* * *
Dr. Harry Lange, Atlanta pediatrician, recently at-
tended the area meeting of the American Academy of
Pediatrics held in Philadelphia.
* * *
Dr. Charles P. Marvin, Atlanta, has completed the
requirements for certification to the American Board
of Surgery. He has been approved by the Cedentials
Committee and is certified as of March 31, 1950.
* * *
Drs. Joseph C. Massee, Dan Burge and Charles E.
Brown, Atlanta, announce the removal of their offices
to 21 Eighth Street, N. E., Atlanta.
* * *
Dr. Jay McLean, Savannah, of the Savannah Tumor
Clinic, addressed the members of the Men’s Club of
St. Michael’s Episcopal Church, Savannah, March 28.
His subject was “Cancer and Its Cure.” Dr. McLean
said “The picture is not as bleak and dark as many
believe." and urged his hearers to take steps to see
that they and members of their families “Elect not to
die of cancer.”
* * *
Medical Arts Building of Columbus, Inc., Columbus,
was occupied on March 27. The T-shaped two-story
white brick building is owned and operated by a
a corporation formed by the following Columbus physi-
cians: Drs. A. N. Berry, H. J. Bickerstaff. C. C. Butler,
W. G. Love, Jr., G. J. Dillard, J. B. Thompson, Bert
Tillery and Luther H. Wolff. The new structure on
the corner of Thiteenth Avenue and Thirteenth Street
cost approximately $200,000 and includes eight suites
of six rooms each, with more than 50 public rooms.
The air conditioned building was planned to include
facilities for dental, x-ray, and pathologic installations
as well as for physicians’ offices. From 13 to 15 physi-
cians will occupy the building.
* * *
The National Association of Manufacturers held a
dinner meeting at the Atlanta division of the Univer-
sity of Georgia, Atlanta. March 22. The Geogia Indus-
trial Dinner was sponsored by the Associated Industries
of Georgia, the Cotton Manufacturers Association of
Georgia and the National Association of Manufacturers.
Religious, academic, political and personal freedom
inevitably will be lost also if medicine and business
are state controlled, an Atlanta medical leader asserted.
Dr. A. O. Linch, president of the Fulton County Medical
Society, declared that American medicine, “under free
practice and without compulsion, has accomplished
results for which it need not apologize.” Speaking for
the dental profession. Dr. Steve A. Garrett, president
of the Georgia Dental Association, pointed out that
judging from the example in socialized England.
“Dentists” are likely to be even more tightly shackled
than doctors if the two professions were to be socia-
lized.” Dr. Edgar D. Shanks, Atlanta, secretary-treasurer
of the Medical Association of Georgia, and Dr. C. L.
Chandler, Jr., president of the Northern Dental Society,
also endorsed the meeting. Claude A. Putnam, presi-
dent of the NAM, and its managing director, attended
the meeting. Norman Elsas, president of the Fulton
Bag and Cotton Mills, and an NAM director, pre-
sided.
* * *
The Ninth District Medical Society held its meeting
in Commerce, April 12. with 37 physicians attending.
Scientific program: “The Doctor, the Public and the
Government”, Dr. Alex B. Russell. Winder; “Some
Problems in the Obstruction of the Neck of the Urinary
Bladder”, Dr. Rafe Banks, Jr., Atlanta; “The Use
and the Mis-use of Quindine and Digitalis”, Dr. J. B.
Neighbors, Jr., Athens; “The Bedside Diagnosis of
Acute Cardiac Arrhythmias”, Dr. Bruce Logue, Atlanta.
Officers elected were Dr. J. L. Walker, Clarkesville,
president; Dr. C. J. Roper, Jasper, vice-president; Dr.
Hartwell Joiner, Gainesville, secretary-treasurer. The
next meeting of the Ninth District Medical Society will
be held in Gainesville next September.
* * *
Dr. Elton S. Osbone, Jr., Savannahian with the
United States Public Health Service, was recently
promoted to assistant chief in chronic diseases and
his headquarters will be transfered from Atlanta to
the national office in Washington. A son of Dr. and
Mrs. Elton S. Osborne of Savannah, young Dr. Osborne
has been very successful in bis career with the U. S.
Public Health Service, having rendered valuable service
with the federal department during and since the war.
He was at one time sent to Greece on a special mission.
Dr. Osborne is a graduate of the LIniversity of Georgia
School of Medicine, Augusta, and has had special
courses at Johns Hopkins in Baltimore and in New'
Orleans.
* * *
Dr. James E. Paullin, Atlanta, was presented the
Alfred Stengel Award for his work in the advancement
of medical education and for outstanding service and
loyalty to the American College of Physicians at the
recent convention of the College in Boston. Dr.
Paullin has served as president of the American
Medical Association, the Medical Association of Georgia
and the Fulton County Medical Society.
* * *
Dr. David Henrv Poer, Atlanta surgeon, was elected
secretary of the Southern Surgeons’ Association at a
meeting recently held in Charleston. S. C. Other officers
elected were Dr. Clarence E. Gardner. Duke University
physician. Durham, president: Dr. W. H. Prioleau,
Charleston, vice-president, and Dr. George T. Wood,
High Point, N. C.. treasurer.
* * *
The Randolph-Terrell Medical Society members were
horored at the annual Doctors’ Day dinner, given by
the Woman’s Auxiliary to flip Randolnh-Terrell Society,
at the Standley Oxford Clubhouse in Dawson. Dr. J. T.
Arnold, Parrott phvsician, who has practiced medVme
for 50 years, was honor guest and was introduced by
Dr. Steve P. Kenyon. Dawson, past president of the
Medical Association of Georgia. “How appropriate
and fitting on this Doctors’ Day that we, his fellow
phvsicians, nay tribute and honor to this man who
has given 50 years of his life in unselfish service
to his fellowman,” Dr. Kenyon said. “Few men have
been more faithful to organized medicine than Dr.
Arnold. ... It is an honor to be a member of an
Association which claims Dr. Arnold as one of its
members. He exemplifies to the highest degree the
noble traditions that have made the American general
practitioner loved, respected and admired throughout
the world.” Dr. Kenyon said. In behalf of the Randolph-
Terrell Medical Societv- the honor guest was pre-
sented an engraved desk set. The principal address
of the evening was made by Eck Patterson, of Cuthbert.
who spoke humorously and informatively of the mediacl
profession from horse and buggy days to present. He
pointed out that there were three doctors present. Dr.
Arnold. Dr. T. F. Harper and Dr. F. S. Rogers, who
began their medical practice in the horse and buggy
era.
* * *
Dr. C. Purcell Roberts, Atlanta physician, was
inducted as a fellow of the American College of
Physicians at the recent meeting held in Boston, Mass.
* * *
Dr. O. W. Roberts, Sr., one of Carrollton's best and
most beloved and respected physicians, who has made
May. 1950
225
a lifetime work of serving the needs of those in pain,
was listed on the editorial page of the Georgian, which
is Carrollton’s newspaper, under the heading ‘’Georgian
Spotlight", March 24. Like other doctors of Carrollton
and Carroll County, Dr. Roberts has devoted his life
to serving his fellowman, and the best monument which
could possibly be erected in his honor would be the
high health standards of Carrollton and Carroll County.
Dr. Roberts has played a vital part in the constant
effort to improve health and hospital facilities. He is
another of the many who can take pride in the new
Tanner Memorial Hospital, for not only did he take
a huge part in getting the hospital built; he also is
playing a vital role in keeping it operating so efficiently.
He was honored by being named vice-president and
vice-ehief-of-staff of the hospital, but it was an honor
well deserved for a man well grounded in the funda-
mentals of medicine and steeped in the honorable
traditions of the profession which he chose for his life's
wrork.
* * *
The Sa\annah Tuberculosis and Health Association
officers entertained at a dinner in honor of Carl Fox,
newly appointed executive secretary of the Georgia
Tuberculosis Association, anti Frank W. Webster, execu-
tive secretary of the North Carolina Association. March
16. The dinner preceded the annual meeting of the
Savannah Tuberculosis Association which was held in
the Georgian Room of the Hotel DeSoto, Savannah.
Dr. C. A. Henderson, Savannah, city-county health
officer, conducted Mr. Fox on a tour of the Health
Department and the Tuberculosis Sanitorium while
the new executive secretary was in Savannah.
* * *
The Savannah Tumor Clinic, 612 Drayton Street,
Savannah, unveiled a plaque in the laboratory as a
testimonial to the cooperation of Savannah Post No.
135, American Legion, in equipping the laboratory
and aiding with its maintenance and operation, on
April 16. Frank 0. Wahlstrom, chairman of the board
of the clinic, was the principal speaker. Persons prom-
inently identified with the clinic and the work of the
American Cancer Society in Savannah, as well as repre-
sentatives of Savannah Post No. 135 were present.
Formal acceptance of the gift was made by Thomas
Oxnard, president of the clinic. Drs. M. M. Schneider
and Harry M. Kandel attended as members of Post
No. 135, American Legion. Dr. Lee Howard is direc-
tor of the clinic and chairman of the committee of
the Georgia Medical Society having medical charge
of the project. Dr. Jay Howard is radiation therapy
director.
* * *
The Second District Medical Society held its spring
meeting at the American Legion home, Camilla, April
13. The meeting was called to order by the president.
Dr. J. C. Brim, Pelham. Minutes of the previous meet-
ing were read and approved, also the financial state-
ment. Dr. Brim appointed a committee to nominate
officers for the coming year and to select a site for
the next meeting. He then read a letter from the
Better Health Conference concerning a meeting in
Albany at which they asked that the Second District
Medical Society be represented, and the following
were appointed to represent the society: Drs. Paul
Russell, Albany; Carl Pittman, Jr., Tifton ; John Tucker,
Bainbridge, and M. W. Williams, Camilla. The matter
of financial help to the small counties entertaining the
District Society was again discussed. Dr. Carl Pitt-
man, Sr. moved that the treasurer be empowered to
discuss and to help any society that might need it.
The motion was seconded and passed unanimously.
There being no further business, the scientific program
was turned over to the Georgia Heart Association, the
sponsors. ’'The Recognition of Correctable Congenital
Cardiac Defects”, Dr. J. Willis Hurst, Atlanta; “Modern
Treatment of Angina Pectoris and Coronary Throm-
bosis", Dr. Thomas L. Ross, Jr., Macon, and “The
Bedside Diagnosis and Treatment of the Cardiac
Arryhthmias,” Arthur Knight. The three above-named
papers were discussed from the floor and many questions
were asked the visiting physicians, who graciously dis-
cussed all questions. This was one of the most enlighten-
ing and entertaining programs which has ever been pre-
sented to the society. Following the scientific program
a so< iai hour was held and a barbecue dinner served.
During the dinner the nominating committee announced
its nominees who were unanimously elected. They are
Dr. Robert M. Joiner, Moultrie, president; Dr. Milton
B. Bowman, Albany, vice-president, and Dr. Frank
A. Little, Thomasville, secretary-treasurer. Albany was
selected as the site for the October meeting. Dr.
Frank A. Little, secretary-treasurer.
* * *
The Seventh District Medical Society held its meet-
ing at the Sequoyah Country Club, Calhoun, April 5.
Members were guests of the Gordon County Medical
Society. Program: Invocation by the Rev. C. W.
Pruitt; Address of Welcome by Dr. J. E. Billings, Cal-
houn; Report of minutes, report of committees, report
of councilor, and introduction of new members. Scientific
program: “The Judd Memorial Cancer Clinic — A Dis-
cussion of Cancer of Cervix,” Dr. D. Llovd Wood,
Dalton. Discussion by Drs. J. T. McCall. Jr., Rome, and
Alfred Colquitt, Jr., Marietta; "The Treatment of
Apoplexy”. Dr. Walter E. Boehm, Chattanooga, Tenn.
Discussion by Drs. William Harbin, Rome, and W. U.
Hyden, Trion; “Lower Nephron Nephrosis”, Dr. W. B.
McGuire, Chattanooga, Tenn. Discussion by Drs. R. F.
Spanier, Cedartown, and T. A. Cochran, Ringgold;
“Bronchiectasis and Its Treatment”, Dr. Osier A.
Abbott, Atlanta. Discussion by Dr. Rufus Payne, Rome
and Dr. Wilbur Hall, Calhoun. Officers are Dr. Sam
H. Howell, Cartersville, president; Dr. Lee H. Battle,
Jr., Rome, vice-president; Dr. S. B. Kitchens, La-
Fayette, secretary-treasurer, and Dr. D. Lloyd Wood,
Dalton, councilor. Committee on arrangements were
Drs. R. D. Walter, C. K. Richards and L. R. Lang,
all of Calhoun.
The Woman s Auxiliary to the Seventh District Medi-
cal Society held its meeting at the Sequoyah Country
Club, Calhoun, April 5. Welcome bv Mrs. J. E.
Billings, Calhoun; Response by Mrs. William T. Gist,
Summerville; Reading of minutes; reports from County
Vuxiliaries, new7 business and election of officers. “A
Discussion of Cancer”, Dr. D. Lloyd Wood, Dalton.
Officers are Mrs. William U. Hvden. Trion, District
Manager, and Mrs. J. J. Allen, Trion, secretary.
* * *
The Regional Better Health Conference in South-
west Georgia held its first conference at Radium Springs
Casino, near Albany, April 25. Dr. Steve P. Kenyon,
Dawson, former president of the Medical Association of
Georgia and Dr. 0. F. Whitman, Albany, Regional
Med'cal Director, were the featured speakers at the
morning session. Twenty-eight counties were included
in the conference, and community leaders attended.
Participating in the discussion were selected community
leaders and consultants from the Georgia Department
of Public Health, among whom was Dr. T. F. Sellers,
Atlanta, director of the Georgia Department of Public
Health. All county representatives were given an oppor-
tunity to discuss their local health problems. Following
the luncheon, Mrs R. K. Winston, Tifton, who is
chairman of the Executive Committee of the Better
Health Conference of Georgia, addressed the confer-
ence. Participating in the afternoon discussion on "How
to Get Community Action for Better Health” were
representatives of the Community Councils of Worth,
Tift. Sumter, Colquitt, Dougherty and Thomas counties.
Mrs. Paul Russell, Albany, is chairman of the Southwest
Regional Committee and planned the conference.
* * *
The Thomas County Medical Society sponsored a
seminar at Archbold Memorial Hospital. Thomasville,
22 1
The Journal of the Medical Association of Georgia
March 29, ami is the first of its kind in the Thomas-
ville area. Some 100 Georgia and Florida doctors at-
tended the seminar. Dr. Mervin B. Wine of Thomas-
ville, presided over the sessions. Dr. Philip K. Bondy
of Emory University, Dr. Corbett Thigpen of Augusta,
Dr. J. Mason Baird and Dr. William G. Hamm of
Atlanta were the featured speakers.
* * *
Dr. A. Bruce Gill, Philadelphia, professor emeritus
of orthopedic surgery, University of Pennsylvania
School of Medicine, conducted a clinical pathological
conference which was attended by the staffs of Univer-
sity Hospital, Oliver General Hospital, and the Len-
wood. Augusta, March 14 and 15. He was in Augusta
as the guest of the Georgia Medical College and Dr.
Peter B. Wright, professor of orthopedic surgery at
the medical college. Dr. Gill is regarded as one of
the nation’s outstanding orthopedic surgeons having
made most of his splendid reputation in his work
dealing with the pathology of the hip joint.
* * *
Veterans Administration Hospital. Augusta, held a
conference and seminar on neuropsychiatry in which
five Atlanta physicians participated, March 30-April 1.
The conference was held in the Veterans Administration
Hospital. Augusta. Noted specialists from New York,
Boston and Washington were on the program. The
meeting was open to private NP specialists and all
others interested in the subject. Atlantans on the
program included Dr. Frank B. Brewer, Southern area
medical director for VA; Dr. Raymond S. Crispell,
VA’s Southeastern chief of neuropsychiatry; Dr. Estelle
P. Boynton, of the mental hygiene clinic at VA’s Geor-
gia Regional Office; Dr. William Kauffman, chief
of the psychiatric service at Lawson VA Hospital, and
Di. Charles R. F. Beall, examining psychiatrist at the
regional office. The session was one of the most ex-
tended medical seminars devoted primarily to neurology
which has been held in the South.
* * *
Dr. Hoke Wainmock, Augusta, a professor in cancer
research at the Medical College of Georgia, recently
addressed the Junior Chamber of Commerce, Augusta,
on “Cancer Research.” Cancer is a greater killer of
American children than polio, according to Dr. Warn-
mock. He described methods used for early detection
of cancer. He told of precautions which could be taken
to guard partially against developing cancerous con-
ditions.
OBITUARY
Dr. John Lee Campbell, aged 78, life-time resident
of Ben Hill, died at his home April 16, 1950. Dr.
Campbell was born in Ben Hill. Ife graduated from
Atlanta Medical College, Atlanta, in 1896. and returned
to Ben Hill, where he had practiced medicine for over
50 years. Active in church and civic work, he was a
member of the Owl Rock Methodist Church, the Ben
Hill Civic Club and several medical societies. Surviving
are his daughter, Mrs. E. L. Rhodes, Bremen ; a son,
W. Lee Campbell. Ben Hill : three sisters, two brothers,
and four grandchildren. Funeral sendees were held
at the Owl Rock Methodist Church with the Rev. Jack
Speer, the Rev. D. H. Maxey and the Rev. Henry T.
Smith officiating. Burial was in the churchvard, Ben
Hill.
* * *
Dr. Lewis Ryley Casteel, aged 82, widely known
Wilkes County physician, died April 2, 1950, at his
W ashington home following a long illness. Dr. Casteel
was born in Union County, Georgia, the son of the
late Jones Casteel and Mrs. Rachel Byers Casteel. He
giaduated from Vanderbilt University School of Medi-
cine, Nashville, Ttnn. in 1893 and did post-graduate
work in Baltimore tr.d in 1906 did further graduate
work at the Atlanta College of Physicians and Surgeons,
Atlanta. He first practiced medicine in Cherokee Coun-
ty, N. C. an 1 in Oklahoma. He moved to Washington,
Ga., in 1910 and had conducted general medical prac-
tice since. He was an honorary member of the Wilkes
County Medical Society, the Medical Association of
Georgia, and the American Medical Association, chair-
man of the trustees of Mary Willis Memorial Library,
active Mason and associate teacher of the Jesse Mercer
Men’s Bible class at the First Baptist Church, W ashing-
ton. At the 100th anniversary of the Medical Associa-
tion of Georgia annual session held in Savannah, 1949,
Dr. Casteel was awarded a Certificate of Distinction
and a gold lapel button for his 56 years of distinguished
service in the medical profession. He is survived by
his wife, Mrs. Low Hollenshead Casteel; four daugh-
ters, Mrs. Albert Young, Washington; Mrs. S. A. Moore,
Murphy, N. C.; Mrs. J. E. Jones, Mt. Holly, N. C., and
Mrs. John McGehee. Cedartown; three sons, Radcliffe
Casteel. Knoxville, Tenn.; R. G. Casteel, Lavonia; B.
W. Casteel. Metasville; a brother. Dr. Van D. Casteel,
Copper Hill, Tenn.; 12 grandchildren and two great-
grandchildren. Funeral services were held at the First
Baptist Church, with the Rev. J. R. Kirkland officiating,
ami with the Rev. John Bushy and the Rev. Owen
Hoffman assisting. Burial was in Rehoboth churchyard.
* * *
Dr. Charles Howard Daniel, aged 50, College Park
physician and surgeon, died at his home, 801 West
Rugby Avenue, College Park, April 17, 1950. A native
of Senoia. Dr. Daniel graduated from Emory University
School of Medicine, Atlanta, in 1926. He interned at
Grady Memorial and Georgia Baptist Hospitals. He
started the practice of medicine in College Park in
lu29, where he remained until his death. He was a
member of the Fulton County Medical Society, the
Medical Association of Georgia and the American
Medical Association. Active in community life of
College Park. Dr. Daniel was onetime director of the
Atlanta Boys Club, a member of the Civitan Club, a
.Mason, and a Shriner. He was a leading layman of the
College Park Methodist Church, having served as
chairman of the building committee and superintendent
of the Sunday School. He also served as a steward
in the church. Surviving are his wife, Mrs. Charles
Howard Daniel; two daughters. Miss Dorothy Ruth
Daniel, Miss Sarah Susan Daniel; a sister, Mrs. Allen
B. Cole, Claremont, Cal.; and a brother, Frank P.
Daniel, Senoia. Funeral services were held at the
College Park Methodist Church with the Rev. R. J.
Kerr, the Rev. J. W. Veatch and the Rev. R. C.
Cleckler officiating. As escort the members of the
Board of Stewards of the College Park Methodist
Church. Burial was in Senoia Cemeterv.
* * *
Dr. Roscoe Hinson Enzor, Sr., Smithville, aged 62,
died at the Americus and Sumter County Hospital,
Americus, following a long illness April 12, 1950. Dr.
Enzor graduated from the Atlanta College of Physicians
and Surgeons, Atlanta, in 1911, now Emory University
School of Medicine. Dr. Enzor wTas a prominent physi-
cian and surgeon of Smithville and Lee County for
the past 17 years. He was a former mayor of Smithville,
having served for five terms. He was health officer of
Lee County and a director of the Farmers & Merchants
Bank of Smithville. He was a member of the Smith-
ville Baptist Church, serving as deacon and clerk. He
was a past master of the Smithville Masonic Lodge No.
250 aiid at his death was treasurer of the group. He
was an honorary member of the Sumter County Medical
Society, the Medical Assotiation of Georgia and the
American Medical Association. He is survived by his
wife, Mrs. Lulah Finnell Enzor; one son, Roscoe
Enzor, Jr.. Atlanta; two daughters. Mrs. A. K. Liv-
ingston, Mobile, Ala., and Mrs. Charles T. Dietrich,
Smyrna, Delaware, and two grandchildren. Also four
brothers and two sisters. Funeral services were held
at the Smithville Baptist Church, with the Rev. Alec
Thompson, pastor, officiating, assisted by the Rev. Joe
H. Bridges, of the Dawson Street Methodist Church,
Thornasville. Burial was in Smithville Cemetery.
May, 1950
225
Dr. Marion McHenry Hull, aged 78, Atlanta physician
and co-founder of the Atlanta Bible Institute and
former member of the Committee of 100 Fundamental-
ists, died of a heart attack while teaching a Bible Class
at the Institute March 28, 1950. Dr. Hull, a native
of Athens, was one of the nation’s most widely known
religious figures as well as a leading Atlanta physician.
He received his medical degree from Georgetown Uni-
versity School of Medicine, Washington, D. C. Follow-
ing his internship at Bellevue Hospital, New York,
he- came to Atlanta, first as a staff member of the old
Presbyterian Hospital and later a member of the advis-
ory staff of Crawford W. Long Memorial Hospital. At
the time of his death he was chairman of the Board
of Trustees as well as one of the Bible Institute’s
leading instructors. He had written several religious
hooks and pamphlets and at the time of his death was
working on an interlinear translation of the New
Testament from Greek into English. His religious work
led, following the death of William Jennings Bryan,
to his appointment as a member of the Committee
of 100 Fundamentalists, composed of leading religious
figures throughout the world. He was a charter member
of the North Avenue Presbyterian Church and was a
member of the Board of Elders. He was an honorary
member of the Fulton County Medical Society, the
Medical Association of Georgia and the American
Medical Association. Surviving are his wife, the
former Vara Curry, Marysville, S. C.; a daughter,
Mrs. S. L. Morris, Atlanta; two sons, Thomas C. Hull
and Richard L. Hull, both of Atlanta; a brother, three
sisters, and several grandchildren. Funeral services were
held at Spring Hill, with the Rev. Richard Orme Flinn,
Jr., officiating. Burial was (private) in West View
Cemetery, Atlanta.
EMORY POSTGRADUATE MEDICAL CLINICS
Sponsored by the Medical Alumni Association of
Emory University
May 31, June 1 and 2, 1950
Procram
Grady Memorial Hospital— Wednesday, May 31, 1950
Surgical Procram
(1)
9:00 a.m.
Bleeding in the Last Trimester of
Pregnancy — Dr. John S. Fish.
(2)
9:30 a.m.
Gastrointestinal Hemorrhage — Dr. Ira
A. Ferguson.
(3)
10:00 a.m.
Significance of Thyroid Adenoma —
Dr. D. Henry Poer.
(4)
10:30 a.m.
Cholelithiasis — Dr. V. Duncan Shep-
ard.
(5)
? 1 :00 a m.
Appendiceal Peritonitis — Dr. A. Eu-
gene Hauck.
(6)
11:30 a.m.
Open.
Medical Program
(A) 9:30 to 10:30 a.m. The Diagnosis of Obscure
Fevers — Dr. Paul B. Beeson.
(Bl 10:30 to 11:30 a.m. Lymphoma and Hematologic
Problems: Diagnostic and
Therapeutic Techniques. Dr.
Charles M. Huguley, Dr. Mil-
ton H. Freedmon, Dr. Byron
J. Hoffman.
12:00 to 1:00 p.m. THE WILLIAM SIMPSON ELKIN
LECTURE. Guest speaker: Dr. W.
C. Sealy, Assistant Professor of
Surgery, Duke University. “Surgi-
cal Treatment of Congenital
Anomalies of Heart and Great
Vessels.”
1:00 to 2:00 p.m. Lunch — Grady Memorial Hospital
as guests of the University.
Surgical Procram
(7) 2:15 p.m. Gastrointestinal Carcinoma — Dr. John
S. Atwater, Dr. George R. IJidlicka,
Dr. Charles S. Jones.
<C>
(D)
1:00 to 2:00 p.m.
(8,' 3.45 p.m. Hyperthyroidism — Dr. Philip K. Bun-
dy, Dr. John T. Akin, Dr. Charles
M. Huguley.
Medical Program
2:15 to 3:00 p.m. Recent Advances in tiie Diag-
nosis and Treatment of Syphi-
lis Dr. Albert Heyman, Dr.
Walter H. Sheldon.
3:15 to 4:15 p.m. A Study of Cerebral /flood
Flow and Its Clinical Implica-
tions— Dr. John L. Patterson,
Dr. Albert Heyman.
Grady Memorial Hospital Thursday, June 1, 1950
Surgical Program
(9) 9:00 a.m. Cancer of the Prostate — Dr. M. K
Bailey.
(10) 9:30 a.m. Prolonged Labor — Have Ocytocics a
Place in Management ?- Dr. John R.
McCain.
(11) 10:00 a.m. Local Care of Burns — Dr. Frank F.
Kanthak.
(12) 10:30 a.m. Surgery of Pain — Dr. Homer S. Swan-
son.
(13) 11:00 a.m. Significance of Solitary Breast Tumor
— Dr. Wadley R. Glenn.
(14) 11:30 a.m. Abdominal Surgery of the Newborn
— Dr. Charles E. Holloway.
12:00 to 1:00 p.m. DR. WILLIAM CHESTER
WARREN. SR., MEMORIAL
LECTURESHIP. Guest speak-
er: Dr. G. E. Burch, Profes-
sor of Medicine, Louisiana
State University, “Aspects of
V enous Pressure.”
Lunch — Grady Memorial
Hospital as guests of the
University.
Surgical Program
2:15 p.m. Ulcerative Colitis Dr. Lon W. Grove,
Dr. T. Sterling Claiborne, Dr. Joseph
H. Hilsman.
3:45 p.m. Toxemia in Pregnancy — Dr. Rudolph
A. Bartholomew, Dr. Charles B. Up-
shaw, Dr. R. K. Hancock.
Medical Program
2:15 to 3:00 p.m. Visit to Laboratories with a
Discussion of Research in
Progress — Dr. Arthur J. Mer-
rill, Dr. Philip K. Bondy, Dr.
Paul B. Beeson.
3:15 to 4:15 p.m. Infectious Diseases: Aids in
Diagnosis and Treatment -7-
Dr. William F. Friedewald,
Dr. Max Michael, Jr.
Emory University Hospital — Friday, June 2, 1950
Surgical Program
9:00 a.m. Complications of Splenectomy — Dr.
John D. Martin, Jr.
9:30 a.m. Thoracic Emergencies — Dr. Osier A.
Abbott.
Cancer of Lip and Tongue — Dr. J.
Elliott Scarborough.
Congenital Dislocation of the Hip — -
Dr. Robert P. Kelly.
Conservative Pelvic Surgery — - Dr.
John H. Ridley.
Sinusitis — Dr. Lester A. Brown.
Medical Procram
9:30 to 10:20 a.m. The Physiology of the Adren-
al Pituitary Axis and its
Clinical Applications — Dr.
Philip K. Bondy, Dr. Hugh
G. Mosley.
(J) 10:30 to 11:30 a.m. Use and Results of Cortisone
Therapy (Movie) — Dr. Ver-
non E. Powell.
(15)
(16)
(G)
(H)
(17)
9:00
a.m.
118)
9:30
a.m.
(19)
10:00
a.m.
1 20)
10:30
a.m.
(21)
11:00
a.m.
(22)
11:30
a.m.
(I)
9:30 1
to 10
226
The Journal of the Medical Association of Georgia
12:00 to 1:00 p.m. Guest speaker: Dr. Arthur P.
Richardson. Professor of Phar-
macology, Emory University,
“ Recent Advances in Drugs,
Affecting the Autonomic
Nerves.”
1:00 to 2:00 p.m. Lunch — Rohinson Memorial
Dining Room, Alumni Memo-
ial Building, as guests of the
University.
Surgical Program
(23) 2:15 p.m. Symposium on Backache — Dr. Edgar
F. Fincher, Dr. Paul L. Rieth.
(24) 3:45 p.m. Peripheral Vascular Disease — Dr.
Carter Smith, Dr. Cleve Ward, Dr.
William H. Proctor, Jr.
Medical Program
(K) 2:15 to 3:00 p.m. Cardiac Catherization and Its
Clinical Application — Physi-
ology Laboratory.
(L) 3:15 to 4:15 p.m. Cine-Angiocardiography and
its Clinical Application (Mo-
vie)— Dr. H. Stephen Weens.
7:30 p.m. Annual Banquet of the Emory Uni-
versity Medical Alumni Association
at the Capital City Club. Ladies in-
vited. Formal dress optional.
REGISTRATION AT THE ONE HUNDREDTH ANNUAL SESSION OF THE
MEDICAL ASSOCIATION OF GEORGIA, MACON
A
Abbott, Osier A., Emory University
Abercrombie. T. F., Atlanta
Adams. J. Fred, Montezuma
Agee, M. P., Augusta
\iken, W. W., Lyons
Aldrich, F. N., Macon
Alexander, George H., Forsyth
Allen, Eustace A., Atlanta
Allen, II. D., Jr., Milledgeville
Allison, Gordon G., Atlanta
Anderson, Carl L., Macon
Anderson, J. C., Macon
Anderson. Robert T., Atlanta
Anderson, Samuel A.. Atlanta
Anderson, W. W„ Atlanta
Arnold, J. T„ Parrott
Arnold, M. F.. Hawkinsville
Arp, C. R., Atlanta
Arrendale, Joe J., Cornelia
Atkins. Harold C., Macon
Atwater, John S., Atlanta
Ayers, C. L., Toccoa
Avers, Sanford E., Atlanta
B
Bailey, Thomas E„ Augusta
Bancker, E. A., Atlanta
Barnett, J. M„ Albany
Barner. John L., Athens
Bashinski, Benjamin, Macon
Bates, W. B., Waycross
Barton, W. L., Macon
Battle, Lee H., Jr., Rome
Baxley, Harry B.. Donalsonville
Baxley, W. C„ Blakely
Baxley, W. W., Macon
Bazemore, W. L., Macon
Beasley, B. T.. Atlanta
Belcher. F. S„ Monticello
Bell, John A., Jr., Dublin
Bell. Rudolph. Thomasville
Bellhouse. Helen W.. Atlanta
Bennett, Robert L.. Warm Springs
Benson, H. Baslev. Atlanta
Benson. Wm. H.. Marietta
Benton, C. C„ Macon
Berg. Joseph L., Albany
Billinghurst, George A., Macon
Bishop. Everett L.. Atlanta
Bloise. F. T.. Dublin
Blum, Leo J. Jr.. Warner Robins
Boland. Chas. G.. Atlanta
Boland. Frank K.. Atlanta
Bond, Dr. D. T.. Danielsville
Bonner. Wm. H., Athens
Born. W. H.. McRae
Boswell. W. C„ Macon
Rovd. Hartwell. Atlanta
Boyette, L. S., Ellaville
Bradley, D. M., Waycross
Brawner, James N.. Jr., Atlanta
Brim, J. C., Pelham
Broaddriek, G. L., Dalton
Brown, F. Bert. Savannah
Brown, George W., Griffin
Brown, J. B.. Jr., Baxley
Brown, Lester A., Atlanta
Brown, R. G.. Swainsbroo
Brown. Roland A., Atlanta
Brown, Robert L., Atlanta
Bryan, Wm. W., Atlanta
Bunce, Allen H., Atlanta
Buckner. Frank, Albany
Burdine, W. E.. Blue Ridge
Burleigh. Bruce D., Marietta
Bu'sey. T. J., Fayetteville
Bush. Albert R.. Hawkinsville
Bush, Hollowav, Macon
Bvne. J. M.. Tr., Waynesboro
C
Campbell, .T. I .. Jr., Valdosta
Carter, .T. C., Scott
Carter. R. L„ Thnmaston
Carv. R. Frank. Macon
Calloway. Enoch. LaCrange
Calhoun. F. P„ Tr., Atlanta
Carson. Willard P . Chatsworth
Cason, Hu Mi B Wnrr<mton
Cafhcart. Don E„ Atlanta
Chamber®. T. W. LaGrange
Chanev. RMnE H Augusta
Cheshire. H. I .. Tlmma-viUo
Chesnuti. T. EL. M;]]erLrpville
Cheves. H. T .. Union Point
Clirisman, W. W.. Macon
Clark. .Tamps T Atlanta
Claxton. E. B Dublin
Clifton. Ben H.. Atlanta
Cluxlon. Harlev F.. Jr Savannah
Cobb. T'tus R.. Tr.. Dublin
Cnfer, Olin S. Atlanta
C oker, Gradv NT.. C anton
Cole, A. A.. Macon
Coleman. Fre<! T Dublin
Coleman. D. K.. Vienna
Coleman. Reese C. Tr.. Atlanta
Coleman. Y. B Jonesboro
Collier, Thos. J. Atlanta
Collier. T. W.. Brunswick
Collins. Braswell F. Wavcross
Collins. R. A.. Tr.. Montezuma
Collinsworth, P. T .. Atlanta
Cook, Ellison R. Savannah
Com. Ernest. Macon
Crawford. H. C.. Atlanta
Crawlev, Walter C„ Marietta
Crichton. Robert R„ Milledgeville
Cross, John B., Atlanta
Crowdis, James H., Jr., Blakely
Cruise, Joe S., Atlanta
D
Dallas, R. E., Thomaston
Dancy, William R., Savannah
Daniel, J. W., Sr., Savannah
Daniel, Walter W., Atlanta
Davis, Abe J., Augusta
Davis, E. B., Byromville
Davis, Shelley, Atlanta
Davis, W'. Ben. College Park
Dean. H. B., Unadilla
DeFreese, S. J.. Monroe
Denny, R. L.. Carrollton
Derrick. H. C., Sr., Oglethorpe
DeVaughn, N. M„ Augusta
Dillard, G. J., Columbus
Dodd, William A., Dublin
Dorough, W. S., Atlanta
Dowman, Charles E., Atlanta
Dowman, Cordelia K., Atlanta
Drane, Robert, Savannah
Duggan, A. D., Washington
DuPree, George W., Gordon
DuPree, John T„ Macon
Durham. W. P„ Abbeville
DuVall, W'. B., Atlanta
E
Eberhart. Charles E„ Atlanta
Edenfield. R. W„ Macon
Elliott, W. G., Cu'hbert
Ellis, John. Atlanta
Ellison, Robert G.. Augusta
Equen, Murdock. Atlanta
Erwin, G. Y„ Athens
Evans, Albert L., Atlanta
F
Farmer, C. Hall, Macon
Fenn, Henry R.. Americus
Ferrell, R. G., Macon
Ferrell. T. J.. Waycross
Fisher. Albert, Jr., Monticello
Fitts, John B.. Atlanta
Fletcher. I. Elizabeth, Statesboro
Floyd, Chas. S.. Loganvil'e
Floyd, Waldo E., Statesboro
Foster, G. R., Jr., McDonough
Foster, H. A., I.aGrange
Fowler, A. H., Marietta
Fowler, Major, Atlanta
Fowler. R. W„ Marietta
Freeh. H. C.. Savannah
Freedman. Milton H., Atlanta
Fulghum. Charles B., Milledgeville
Fuller, George W„ Atlanta
Funke, John. Atlanta
G
Gallemore, J. L., Perry
May, 1950
227
Galloway, William H., Atlanta
Galvin, W. H., Emory University
Garner, John P., Atlanta
Garrard, J. L., Rome
Gatewood, T. Schley, Americus
Gershon. Nathan, Atlanta
Gibson. Wallace M., Milledgeville
Gilbert, R. 0., Greenville
Gillette, Harriet E., Atlanta
Goldstein, Jay, Warner Robins
Golsan, Willard R., Macon
Goodman, L. J., Macon
Goodwyn, Thos. P., Atlanta
Goodyear, Win. E., Atlanta
Goolsby, R. Cullen, Jr., Macon
Goss, Woodrow, Richland
Gower, W. J., Thomaston
Green, Charles G., Waynesboro
Greene, Ed H., Atlanta
Griffin, E. L., Atlanta
Griffin, L. H., Claxton
Griggs, Harvey E., Conyers
Gross, 0. S., Vidalia
Grubbs, J. H., Molena
H
Hall, S. H., Macon
Hall, Thomas M., II, Milledgeville
Hall, W. D., Calhoun
Hallum, Alton, Atlanta
Hamm, W. G., Atlanta
Hammond, G. W., Newnan
Hammond, R. L., Jackson
Hancock, S. L., Cairo
Hardman, Billy S., Gainesville
Harper, Sage, Douglas
Harrell, H. P., Augusta
Harris, B. W., Sea Island
Harrold, Thomas, Macon
Hatcher, Milford B., Macon
Hazlehurst, W. D., Macon
Head, M. M., Zebulon
Hendrick, A. G., Perry
Hendrix, A. M., Canton
Hendry, Katherine M., Blackshear
Hendry, Wm. A., Blackshear
Henry, C. G., Augusta
Hensley, E. A., Gibson
Herault, Pierre C., LaGrange
Hicks, Thomas J., McCayesville
Hicks, W. G., Jackson
Iliisman, J. H., Atlanta
Hock, Charles W., Augusta
Hodges, Chas. A., Dublin
Hodgson, Fred G., Atlanta
Holliman, Henry D., Atlanta
Horton, B. E., Atlanta
Holton, C. F., Savannah
Houser, F. M., Macon
Hubert, M. A., Athens
Huguley, Chas. M., Jr., Emory
University
Huson, W. J., Covington
J
Jacobs, John L., Atlanta
James, David F., Emory University
James, L. P., Macon
Jairatt, W. D., Macon
Jernigan, C. S., Sparta
Jernigan, H. W., Atlanta
Jernigan, Sterling, Atlanta
Johnson, A. M., Valdosta
Johnson, McClaren, Atlanta
Johnson, Roy J., Jr., Fitzgerald
Joiner, Horace G., Douglas
Jones, Alex P., Griffin
Jones. H. T., West Point
Jones, John P., Macon
Jones, R. E., Tifton
Jordan, William K., Macon
K
Kanthak, F. F., Atlanta
Karpat. Robert, Dublin
Kay, James B., Byron
Keen, O. F., Macon
Kelley, D. C., Lawrenceville
Kellum, J . Morgan, Thomaston
Kemper, Clilton G., Atlanta
Kennedy, F. L)., Baxley
Kenyon, Steve P., Dawson
King, J. Dudley, Atlanta
King, James T., Atlanta
King, J. L., Sr., Macon
King, John T., Thomasville
King, Ruskin, Savannah
Kirkland, Spencer A., Atlanta
Kiser, Ellen Finley, Atlanta
Kiser, William, Jr., Atlanta
Kite, J. H., Atlanta
Klemann, Gilbert L., Augusta
Height, Arthur, Waycross
Krantz, S., Chamblee
L
Lancaster, E. M., Shady Dale
Landham, J. W., Atlanta
Lane, George M., Forsyth
Lang, G. H., Savannah
Lange, J. Harry, Atlanta
I aniei, L L, Soperton
Lee, H. G., Millen
Leigh, Ted F., Atlanta
Lennard, 0. D., Sandersville
Leonard, W. P., Atlanta
LeRoy, Albert G., Thomson
Leslie, John T., Decatur
Lester, Wm. M., Atlanta
Lewis, John R., Louisville
Lewis, John R., Jr., Atlanta
Lewis, W. E., Macon
Linch, A. O., Atlanta
Little, A. G., Valdosta
Logue, Bruce, Atlanta
Long, H. W., Eastman
Long, Leonard, Atlanta
Looper, Ben Keith, Canton
Lott, Oscar H., Savannah
Lovell, W. W., Atlanta
Lowe, W. R., Midville
Lowance, M. I., Atlanta
Lucas, Paul W., Tifton
M
Mallory, M. L., Vienna
Maloy, C. J., McRae
Mann, D. S., Albany
Mann, F. R., McRae
Marshall, A. S., Fort Valley
Martin, J. D., Jr., Atlanta
Martin, John M., Augusta
Martin, Robert B., Cuthbert
Martin, Walter D., Augusta
Martin, W. 0., Jr., Atlanta
Mass, Max, Macon
Massenburg, G. Y., Macon
Massey, W. F., Chester
Maxwell, Edgar J., Jr., Athens
Mays, J. R. S., Macon
McAllister, Robert W., Macon
McArthur, Charles E., Cordele
McCarver, W. C., Vidette
McClelland, Spence, Atlanta
McCoy, John F„ Moultrie
McCoy, W. R., Folkston
McDaniel, J. G., Atlanta
McDaniel, J. Albany
McDonald, E. M., Winder
McDonald, Harold, Atlanta
McDonald, Lewis H., Atlanta
McDougall, J. Calhoun, Atlanta
McElroy, J. I)., Atlanta
McFarlane, J. W., Macon
McGeary, W. C., Madison
McGee, H. 11., Savannah
McG uire, T. H., Houston, Texas
McLaughlin, C. K., Macon
McLean, Jay, Savannah
McMath, W. B., Americus
McMillan, E. C., Jr., Macon
McMillan, J. G., College Park
Meaders, H. D., Newnan
Meeks, Calvin S., Douglas
Mendenhall, W. A., Chamblee
Mercer, J. E., Vidalia
Meriwether, W. W., Macon
Middlebrooks, T. W., Union Point
Milford, Hubert, Hartwell
Miller, Linus J., Atlanta
Minchew, B. H., Waycross
Mitchell, William E., Atlanta
Mobley, Walter E., Macon
Molyneaux, Evan W., Hogansville
Montgomery, R. C., Butler
Moore, Henry M., Thomasville
Morrison, Howard J., Savannah
Morton, John B., Thomasville
Muecke, H. W., Waycross
Mulkey, A. P., Millen
Mullins, D. F., Jr., Athens
Murphy, W. J., Atlanta
Murray, George S., Columbus
Muse, L. H., Atlanta
N
Neal, Jules C., Jr., Macon
Neal, L. G., Jr., Cleveland
Neely, F. L., Atlanta
Neili, F. K., Albany
Neuberg. S. Charlotte, Macon
Newman, W. A., Macon
Newsom, N. J., Sandersville
Newton, R. G., Macon
Nippert, P. H., Atlanta
Norris, Jack C., Atlanta
Nunez, M Fernan, Dublin
0
Oliver, J. A., Douglas
O'Neal, John B., Ill, Elberton
O’Neal, Phyllis J., Elberton
Osborne, V. W., Atlanta
Osteen, W'. 1... Savannah
Owensby, N. M., Atlanta
P
Palmer, Clarence B., Covington
Palmer, J. W., Ailey
Parkerson, Sidney T., McRae
Patrick, E. V., Carrollton
Patton, Sam, Macon
Payne, Rufus, Rome
Peacock, T. G., Milledgeville
Pendergrass, R. C., Americus
Peterson, T. A., Savannah
Phillips, A. M., Macon
Poer, David Henry, Atlanta
Poliakoff, S. R., Atlanta
Porch, Leon D., Macon
Powell, Fincher C., Decatur
Prince, Charles L., Savannah
Priviteri, Charles A., Chamblee
Pruce, Arthur M., Atlanta
Pruitt, M. C., Atlanta
Puett, W. W., Norcross
228
The Journal of the Medical Association of Georgia
Fumpelly, R. A., Jesup
Pursley, Norman B., Milledgeville
R
Kaiford, Morgan, Atlanta
Rankin, Joseph L., Atlanta
Rawls, Lewis L., Macon
Rayle, A. A., Atlanta
Reavis. W. F.. Waycross
Redfearn, J. A., Albany
Reese, D. S., Carrollton
Reeve, Tom, Carrollton
ReiHer, R. M., Macon
Revell, W. J., Louisville
Reynolds, H. M., Cairo
Rhyne, W. P., Albany
Richardson, C. H., Macon
Richardson, C. H., Jr., Macon
Richardson. Rhea W., Macon
Ricketson. G. M.. Douglas
Ridgeway, Robert E.. Royston
Ridley, C. L., Sr., Macon
Ridley, Charles L., Jr.. Macon
Ridley, John H.. Atlanta
Rieth. Paul L., Atlanta
Roberson, Phil E., Albany
Roberts, M. Hines, Atlanta
Robinson, David, Savannah
Robinson. John H., 111. Americus
Robinson, R. L., Atlanta
Rogers, Harry, Atlanta
Rogers, J. V., Cairo
Rogers, James V., Jr., Emory
University
Roper, E. A., Jasper
Rosen, E. F., Savannah
Rosen, Samuel F., Savannah
Roughlin, L. C., Atlanta
Rubin, S. N., Gordon
Rudder, Fred F., Atlanta
Rumble, Charles T., Macon
Russell, Alex B., Winder
Russell, Paul T., Albany
S
Sage, Dan Y., Atlanta
Saggus, J. G., Harlem
Sams, J. R., Covington
Sapp, C. J., Rome
Sappington, T. A., Thomaston
Savage, C. P., Montezuma
Saye, E. B., Thomasville
Scardino, Peter L., Savannah
Schaefer, W. B„ Toccoa
Schroder, J. Spalding, Atlanta
Seaman, H. A., Waycross
Sellers, T. F., Atlanta
Selman, W. A., Atlanta
Semans, James H., Atlanta
Seymour, Glenn E., Albany
Shanks, Edgar D., Atlanta
Sharp, C. K., Arlington
Sharpe, W. W., Alma
Shepard, Duncan, Atlanta
Shepard, W. O., Bluffton
Shuman, Vilda, Waycross
Siegel, Alvin E., Macon
Sikes, Walter A., Milledgeville
Simmons, J. W., Brunswick
Simonton, Fred H., Chickamauga
Simpson, Addison W., Jr., Washington
Simpson, John A., Athens
Skobba. Joseph S., Atlanta
Sinaha, T. G., Griffin
Smith, George B., Rome
Smith, Harold, Savannah
Smith, Leighton A., Quitman
Smith, Leo, Waycross
Smith, Richard L., Cochran
Smith, W. P., Sr., Bowdon
Smith, W. P., Decatur
Stamps, Edward R., waycross
Standifer, J, G., Blakely
Stapleton, J. W., Dublin
Stewart. J. Benltam, tviacon
Stoner, W . P., Sylvester
Stump, R. L., Valdosta
Suarez, Raymond, Macon
Swanson, llomer, Atlanta
Swilling, Evelyn, Macon
T
Tankersley, R. M., Atlanta
1 aylor, R. L., Davisboro
Taylor, William J., Atlanta
1 homas, David R., Augusta
Thompson, E. A., Emory University
Thompson, U. R., Macon
t hwaite, Walter G., Quitman
lidmore, J. L., Atlanta
I itt, Henry H., Macon
Trincher, Irvin H., Emory
University
Turner, Edwin W., East Point
turner, John W., Atlanta
Turner, W. W., Nashville
Tyler, Herbert D., Thomaston
U
Upshaw, C. B., Atlanta
Upchurch, W. E„ Atlanta
V
Vinson, Frank, Fort Valley
Vinson, Thos. O., Decatur
Vinton, Luther M., Atlanta
W
Wagnon, Geo. N., Atlanta
Walker, D. D., Macon
Walker, Exum, Atlanta
Wall, C. K., Thomasville
Waller, Robert D., Milledgeville
Ware, D. B., Fitzgerald
Ware, Ford, Macon
Wasden, C. N., Macon
Wasden, Howell A., Jr., Pavo
Watson, E. R., Macon
Weaver, H. G., Macon
West, Edward M., Atlanta
Whatley, E. C., Reynolds
Whitehead, C. Mark, LaGrange
W ilkes, W'. A., Augusta
Williams, C. Roy, Wadley
Williams. David C., Sr., Milledgeville
Williams, Hiram J., Cordele
Williams. J. Weldon, Jr., Lavonia
Williams, L. W., Savannah
Williams. P. L., Cordele
Williams, W. A., Macon
Willis, T. V., Brunswick
Wilson. Richard, Atlanta
Winston, Richard K., Tifton
Wolff, Luther N., Columbus
W ood, D. Lloyd, Dalton
Woods, 0. C., Milledgeville
Wootten, L. 0., Cordele
Work, S. D., Jr., Macon
Wright, Peter B., Augusta
Y
Yampolsky, Joseph, Atlanta
Yarbrough, Y. H., Milledgeville
\ oumans, H. D., Loyns
VISITORS
B
Baldwin, Robert E., Cbamblee
Baird. Warren A.. Toledo, Ohio
Barksdale, John H., Dublin
Barnes, Walter, Jr., Atlanta
Bazemore, J. M., Augusta
Beard, J. S., Edison
Bender, John R., Winston-Salem, N.C.
Blumberg, C. N., Augusta
Blumherg, Joe M., Augusta
Browning, Zack C., Atlanta
Burns, E. C., Jr., Augusta
C
Calk, Guy L., Augusta
Carswell. Bowdre L., 20th Medical
Gr., Shaw AFB, S. C.
Cason, W'm. M., Atlanta
Clements, C. A., Daisy, Tenn.
Clements, J. L., Jr.. Emory University
Counts, Russell L., Branford, Fla.
Coyle, J. A., Dublin
D
Daniel, Orman, Jeffersonville
Davis, Marvin L., Atlanta
Drummond. C. S., Winston-Salem, N.C.
Dyer, C. W., Macon
F
Finesinger, Jacob E., Baltimore, Md.
Flanagan. J. C., Atlanta
Freeman, M., Dublin
G
Gafford. A. V., Cbamblee
Gilliland, Mary, Atlanta
Gordon, Joseph B., Fort Benning
Greenblatt, Robert, Augusta
Gude, A. V., Chamblee
Gustin, Ronald M., Athens
H
Hall. S. P., Scottsboro, Ala.
Harris, Marvin M., Ph.D., Macon
Harrison. J. H., Wrightsville
Ilarsha, James M., Chamblee
Hopkins, E. C., Augusta
Houston, W. H„ Jacksonville, Fla.
Howard, John C., Chamblee
I
Irons, Ernest E., Chicago. 111.
J
Jarrell. Harold, Macon
Jordan, T. C., Barnesville
K
Kay. James B., Jr., Augusta
Kelly, G. Lombard, Augusta
King, J. L., Jr., Atlanta
Kisselee, Paul J., Jr., Ft. Benning
L
Levy, Jack H., Augusta
Lin, Hui-Ching Yen, Macon
M
Marvin, Chas. P., Atlanta
Matthews, W. Eugene, Augusta
Mayfield, George, Atlanta
McGinty, Howard C., Huntington,
W. Va.
Meissner, Tom 0. W., Chamblee
Moffett, J. D., Jr., Atlanta
Moon, Jack B., Harlem
(Continued on Page XVI)
The Journal of the Medical Association of Georgia
XV
/ PULMONARY EDEMA
/ | AND PAROXYSMAL
C* ^ J CARDIAC DYSPNEA
"The development of pulmonary-
edema at night may in certain cases
be prevented and in addition effec-
tively treated by intramuscular . . .
administration of aminophyllin in
dosages of 0.5 Gm."1
The diuretic action of Searle Amino-
phyllin frees the tissues of excessive
fluid; its myocardial stimulating ac-
tion improves the efficiency of heart
contractions.
G. D. Searle & Co., Chicago 80, 111.
seariZ AMINOPHYLLIN
ORAL... PARENTERAL... RECTAL DOSAGE FORMS
*Contains at least 80% of anhydrous theophylline.
SEARLE RESEARCH IN THE SERVICE OF MEDICINE
1. Barach, A. L.: Edema of the Lungs, Am. Pract. 3: 27
(Sept.) 1948.
*
Please mention this Journal when writing advertisers.
XVI
The Journal of the Medical Association of Georcia
REGISTRATION
(Continued from Page 228)
Mullins, James N., Atlanta
N
New, James S., Augusta
Nieburgs, H. E., Augusta
0
Olnick, Herbert, Decatur
P
Parker, W. H„ Daylona Beach. Fla.
Parks, Orville A., Augusta
Pitts, B. Marlin. Montevallo, Ala.
Pound, W. D., Eat onton
R
Ramey, C. W., McCalla, Ala.
Rey, Chas. J., Jr., Macon
Rinker, J. Robert, Augusta
Rivers, Thomas M., New Y'ork, N. Y.
Roberts, Ralph D., Macon
Roberts, R. E., Macon
Roche, W. P., Jr., Chamblee
Romeo, Charles J., Jr., Dublin
Rumble, Lester, Jr., Atlanta
S
Sams, W. C., Savannah
Sharpley, John G., Savannah
Schmidt, Henry L., Jr., Augusta
Smith, Claude A., Stockbridge
Smith, Wm. P.. Jr., Macon
Stinson, F. C., Talbotton
Strickland, M. A., Chamblee
Sullivan, A. W„ Chamblee
T
Tate, Allen D., Jr., Macon
Thigpen, Corbett, Augusta
Thomas, W. M. H., Macon
Torpin, R., Augusta
Turner, August B., Atlanta
V
Valencia, Naciouceno, Augusta
Volpitto, Perry P., Augusta
Waddell, N. N„ Anderson, S. C.
Wammock, Hoke, Augusta
Watkins, W. M„ Macon
Webb, W. M., Ft. Benning
Weens, H. S., Emory University
Williams, P. L„ Jr., Cordele
Willis, Augusta E., Chamblee
Wood, James A., Macon
Woodward, Louie Frances, Augusta
Wylie, M. H.. Augusta
Y
Yeomans, Neal F., Augusta
Y oung, Geo. G., Chattanooga, Tenn.
Youngblood, V. H., Concord, N. C.
WANTED — Young man, general practi-
tioner, in West Middle Georgia, Georgia
License required. Will guarantee $6500.00
first year, possible to make $10,000 to
$12,000. Write or contact MAG, 478
Peachtree St., N. E., Atlanta, Ga.
LONG established hospital for immediate
sale in South Georgia — Surgeon in
charge retiring. Well equipped and fully
accredited by College of Surgeons. Nurses
home and doctors’ apartments joining hos-
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of Georgia, 478 Peachtree St., N. E., At-
lanta, Ga.
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Please mention this Journal when writing advertisers.
THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia. June, 1950 No. 6
MEDICAL SERVICES IN THE
DEPARTMENT OF DEFENSE
Richard L. Meiling, M.D.
Director of Medical Services, Office of the
Secretary of Defense
Washington, D. C.
It is always a pleasure to return to
Georgia — and especially so when I can
join my medical colleagues to discuss our
mutual interests in national defense. Of
all the things which I might say to you
tonight, probably the most important is
this matter of mutual understanding and
effort between military and civilian physi-
cians on defense problems.
Today the conflicting philosophies of
nations, in combination with the headlong
rush of science, have forced this country,
against its natural wishes, to arm itself
against the threat of an aggressor. Such
threats we have faced and mastered in the
past. The challenge to our national security
today has assumed a new character.
Should our nation again be attacked, the
battle may well be carried to our own
cities and towns rather than being contained
on some distant shore. The nation will
look, not alone to the military forces, but
to the medical profession of our country
for a broad and effective medical defense
program — one which will meet the needs
of the entire population, military and
civilian. For this reason, the present and
future plans for medical services in the
Armed Forces are your business as much
Remarks before the Medical Association of Georgia, Macon,
April 19, 1950.
as they are mine — a joint responsibility
shared by every physician in our country.
For many of our military medical prob-
lems, we have little or no precedent. Be-
cause of this, we have gone to the medical
profession as a whole for guidance and
assistance, since the job before us requires
the finest talent the nation can muster-
The Office of Medical Services, and the
Department of Defense health policies
which it has developed, are the product
of the thinking of dozens of the best pro-
fessional men of this country.
The American medical profession re-
peatedly recommended to the President,
the Congress and the Department of De-
fense the development of civilian medical
advice and direction over the medical ser-
vices of the armed forces.
You are all familiar with the work of
the Council on National Emergency Medi-
cal Service of the American Medical Asso-
ciation. No one person had more to do
with the establishment and work of this
Council than your own beloved Dr. James
Paullin. In June 1948 the House of Dele-
gates of the American Medical Association
adopted a resolution calling for the estab-
lishment of “a permanent ‘Civilian Medi-
cal Advisory Board’ ” of civilian doctors
of medicine responsible for developing
policies, procedures and programs for the
medical and hospital services throughout
the Armed Forces. Full thought and con-
sideration were given by the medical pro-
fession to the consolidation or joint utiliza-
tion of military medical facilities by all
the Armed Forces, with due emphasis on
the medical support of the combat forces,
230
The Journal of the Medical Association of Georcia
and to the resulting reduction of non-mili-
tary medical problems. These measures
were designed to alleviate shortages of
professional medical personnel and to give
the greatest possible support to the fighting
forces.
Each of these recommendations from the
medical profession has been proven worthy
and hence has been accepted.
The ad visory body was established in
November 1948 when the Secretary of
Defense, the late James Forrestal, appoint-
ed the Armed Forces Medical Advisory
Committee. This committee, under the
chairmanship of Mr. Charles P. Cooper,
is composed of outstanding civilian physi-
cians and dentists who advise the Secre-
tary of Defense on broad military health
policies.
The Secretary of Defense, on March 1.
1949, instructed the Secretaries of the
Army, Navy and Air Force to take a!
possible measures to reduce the non-mili-
tary medical workload and to improve the
utilization of professional manpower
throughout the Armed Forces.
The first step toward consolidation of
hospital facilities was a Department of
Defense policy for joint inter-service use
of military hospitals. This was followed
in March 1949 by a policy of joint staffing
of selected hospitals, to further conserve
specialized medical talent.
In May, 1949, on the recommendation
of the Armed Forces Medical Advisory
Committee, Secretary of Defense Louis
Johnson established a Medical Services
Division, which later was redesignated the
Office of Medical Services. This step like-
wise was welcomed by the American medi-
cal profession which, in July 1949 and
January 1950, through the House of Dele-
gates of the American Medical Associa-
tion, forwarded letters to the Secretary of
Defense commending the establishment of
the Office of Medical Services and the ap-
pointment of the civilian director of Medi-
cal Services on the Secretary of Defense
staff.
In short, the present medical organiza-
tions and policies at the level of the Secre-
tary of Defense conform to the actual
recommendations of the American medical
profession. They constitute the results of
the best medical thinking in this country.
We in the Department of Defense con-
sider this important. We realize that our
true mobilization strength lies with the
civilian physicans of our nation. In World
War II approximately 95 per cent of the
medical officers serving with the Army and
Army Air Forces were civilian medical
men in uniform. Some 86 per cent of the
Navy’s medical staff likewise were civilians
on wartime duty. The splendid record of
the greatest and most successful medical
team in history bespeaks more than words
of mine the far-reaching advances made in
medical and health fields. The civilian-
military medical officers certainly have
earned a place at the conference table when
medical plans for national defense are
being formulated.
You probably are interested in the cur-
rent economy program of the Department
of Defense and its effect on the military
medical services. In a nutshell, it amounts
to this: “How can we place the greatest
number of tanks, ships and planes in ser-
vice and stay within the discipline of a
vigorous national economy?” The military
medical services must assume their fair
share of these economy efforts, so long as
the high quality of medical care which the
American people expect for their uni-
formed forces is not impaired. On the
basis of this principle, we have been able
to achieve many economies and we look
forward to more.
But in providing medical services for
June, 1950
23 1
the vast needs of the Armed Forces, econ-
omy of dollars alone is neither the goal
nor the solution. We had to pursue
economy in five forms — economy of dol-
lars, of facilities, of talent, of effort and
of time. There is no inexhaustible supply
of any of these items. Unless each is care-
fully used we cannot hope to meet our
obligations to the military forces.
In many instances the dollar economies
have come as a by-product of introducing
modern, sensible business practices. For
example, if you were to ask me today for
the cost of health services in the Armed
Forces, I cannot tell you — nor can anyone
else. This is the result of budgeting and
accounting methods in which the funds
necessary for medical and related care
have been dispersed throughout many
branches of the three military departments,
with only a small part of the money labeled
for the “Medical Services.”
Therefore, the budgeting system is being
revised — modernized if you will! During
the next fiscal year we will know for the
first time just how much money our mili-
tary establishment needs and spends for
the health programs.
The physical facilities which the mili-
tary medical services now have are the
most generous which the nation has ever
provided in time of peace. We propose
to use them wisely. Using them jointly,
as I mentioned a moment ago, is exceed-
ingly important and has proved very satis-
factory in operation. It is only a matter
of education before even the “diehards”
will accept it. The facilities for transpor-
tation of patients have been carefully
studied also. The Department of Defense
last September adopted the policy of using
air transportation as the standard method
of transporting patients, both in this coun-
try and for patients returning from over-
seas. This results in saving dollars and
scarce medical personnel; it simplifies the
logistics of military operations by utilizing
planes which otherwise would be returning
empty, in most instances, to their home
bases; and it improves the care of our
patients by their rapid movement to the
best qualified medical facility.
Joint staffing in the Army, Navy and
Air Force hospitals with specialists and
consultants who are in short supply will
make possible a better professional service
to patients of all three services with the
talent available and with the least drain on
the national medical resources.
Our medical reserve program during the
past three years has been far from satis-
factory, either to the reservist or the mili-
tary forces. Recognizing this, the Armed
Forces Medical Advisory Committee estab-
lished a special task force of reserve officers
to investigate the problem thoroughly,
hearing testimony from dozens of informed
individuals and organizations, military and
civilian. The Task Group's proposals for
improving the medical reserve were adopted
by the committee and now are in the hands
of the Civilian Components Policy Board,
which coordinates reserve affairs for the
Office of the Secretary of Defense. I sin-
cerely hope that this study will produce
a major improvement in the medical re-
serve program, for no mobilization plan
can be successful in a democracy such as
ours except through a sound reserve pro-
gram.
We are seeking economy of effort by
concentrating on the work for which the
military medical services hold prime re-
sponsibility. It means, for example, devo-
tion to the requirements of the combat
arms, with other activities taking a secon-
dary role. It means, in research, concen-
tration of our efforts upon the research for
which we have the principal obligation.
We cannot afford to duplicate the research
work of other federal agencies or private
institutions, or, for that matter, of the
The Journal of the Medical Association of Georgia
232
friendly nations with which we are allied
under the Atlantic Pact. In the scientific
race which characterizes the military ef-
forts of nearly all nations today, the lim-
ited number of trained research workers
and the amount of equipment available for
certain investigation demands that we co-
operate with others and apportion the work
according to the mission which is assigned
to each. To do this the Research and De-
velopment Board and the Office of Medical
Services review the research plans of the
military medical services regularly.
The need for conserving time brings us
to a critical part of our defense problem.
Should we be attacked again it would be
necessary to mobilize much faster than
ever before, and probably under conditions
of considerable disruption. For this rea-
son, our plans must be up-to-date from day
to day, particularly among the medical ser-
vices, for the demands which would be
made upon us overshadow any of our pre-
vious experience.
When I say “us” I mean you and me
and every physician in the country. Our
nation looks to the medical profession in
time of national emergency, just as our
patients and their families turn to us indi-
vidually in time of need. Therefore it is
only right and proper that we should join
hands in preparing our defenses. As long
as our Armed Forces have the advice, the
participation and the support of physicians
throughout the land, I feel confident that
this country will lie medically ready for
any emergency which arises.
HEALTHGRAM
The increase in facilities for distribution of necessary
food, the more widely spread knowledge of the principles
of healthful living, better understanding of good housing
and the leveling off of income, with few rich and few
poor, have been, and will continue to be, important
factors in the prevention of incidence of and death from
tuberculosis. Unless a world-wide catastrophe interferes,
it seems clear that social factors will continue to favor
reduction rather than increase of tuberculosis. W. G.
Smillie, M.D., New England J. Med., Jan. 12, 1950.
INTRAMEDULLARY NAILING OF
FRACTURES OF LONG BONES
J. C. Patterson, M.D.
Cuthbert
This method of fixation of fractures by
driving a large pin down the medullary
canal has a great many advantages in se-
lected cases over the old methods. It is an
internal splint which holds the fracture in
perfect position, yet allows the muscle pull
to keep up continuous impaction of the frag-
ments and thus stimulates union.
Although Leslie V. Rush, of Meridian,
Mississippi, first used pins in the medullary
cavity to hold fractures and published his
first paper in Bone and Joint Surgery in
1937 and in Annals of Surgery in 1939,
most writers on this subject have given
credit to Kuntscher, of Kiel, Germany, who
published his classic paper in 1940. He and
a number of surgeons in Germany, Hun-
gary, and Sweden used this method quite
extensively, and probably too indiscrim-
inately, during World War II.
For some reason Rush’s work seemed not
to have been well known, and due to lack
of communication between the central pow-
ers and the rest of the world little was
known of this method in this country.
It took the recapture of one of our sol-
diers in whose femur a Kuntscher pin had
been placed to introduce American surgeons
to this procedure, and the general public
was made aware of this method of treatment
by an article in Time Magazine showing
photographs of the x-ray of the above men-
tioned soldier. Since that time there has
been a number of articles written with case
reports published both here and abroad, the
This or essentially the same paper with slight modification
has been presented before the Seaboard Airline R. R. Sur-
geons’ Meeting, Havana, Cuba, and before other smaller
groups in the past few months, all with the hope the
profession would enlarge its activities regarding the use of
the Rush pin and further perfect the technic for improved
surgical care for fractures.
June, 1950
233
Fig:, la. Fracture. Case 1.
Fig. lb. Immediately after reduction and insertion of Rush
pin. Case 1.
Fig. lc. Six weeks after insertion of pin. Walks without
support. Case 1.
writers most prominently known being:
Anders Westerborn, of Sweden; Endre
Kedri, Budapest, Hungary; Fowler and Ri-
ordan, of Nashville, Tennessee; Hanson and
Street, of Mississippi; and Leslie V. Rush,
of Meridian, Mississippi. Most of these
men have confined the use of the nail to
fractures of the femur; however, Rush has
used the nail in fractures of almost all the
hones of the body.
There are three types of nails: the ‘V’
type, a very rigid type of nail used by
Kuntscher; the diamond-shaped rigid bar
of Street; and the round, more flexible nail
invented by Rush. I had the pleasure of
visiting and observing Dr. Rush use his nail.
In my work I have used only the Rush nail
and technic. All of these nails are made of
18.8 stainless steel.
At first Kuntscher drove his nail in rather
blindly through the greater trochanter, re-
ducing the fracture, and threading the nail
into the lower fragment by the use of the
fluoroscope. He has since abandoned this
method, and now he makes an incision over
and exposes the site of the fracture. He
then inserts a guide wire retrograde through
the medullary canal of the proximal frag-
ment. This wire is pushed through the
cancellous portion of the hone until it is
exposed just beneath the skin. A small in-
cision is then made over the wire and the
‘V’-shaped nail threaded over the wire and
driven down, threaded into the distal frag-
ment, then driven all the way.
The Rush method is as follows: first
The Journal of the Medical Association of Georgia
23 I
Fig. 2a. Fracture. Case 2.
Fig. 2b. Immediately after reduction. Case 2. Note this and
Fig. 2c, which is a different view, but films were made at
same examination. Case 2.
Fig. 2c. Note comment under Fig. 2b. Case 2.
Fig. 3a. Fracture. Case 3.
Fig. 3b. After insertion of pin. Case 3.
Fig. 3c. Six weeks after insertion of pin. Case 3.
choose the light size and length nail by
measuring it on an x-ray film of the well
leg, remembering that x-ray magnifies the
size of the canal about 1 mm. Next a two
or three inch incision is made over and down
to the greater trochanter; then either inside
the trochanter or just beneath, it does not
matter, a hole is bored with a large brace
June, 1950
235
Fig. 4a. Shows loose plate with distraction, 6 months old.
Case 4.
Fig. 4b. Plate was removed and pin inserted. Case 4.
and bit through the cortex of the bone down
toward the medullary cavity. Then a Rush
nail, which has a sled runner point and may
he bent easily, if necessary, is inserted into
the hole and driven until one can feel that
it is in the medullary canal. Another in-
cision is made over the site of the fracture,
the fracture is reduced, and is held by an
assistant with hone forceps while the nail
is driven down and threaded into the distal
fragment under direct vision, the pin is then
driven until about two inches above the
joint. Wounds are closed and no other
apparatus is necessary to restrain the limb.
The patient is allowed out of bed in a few
days, up on crutches and out of the hospital
in less than two weeks, allowing movement
of the knee almost immediately, and one
can usually bear weight on it in six weeks.
This is in marked contrast to the usual pa-
tient— from six to eight weeks in traction,
six to eight weeks longer in a spica cast, a
stiff knee, and several weeks before one is
able to walk without a cane. After firm
union is determined by x-ray, usually sev-
eral months, the nail is removed.
The indications for the use of the nail
Fig. 4c. This and Fig. 4d show results after treatment with
Rush pin. Case 4.
Fig. 4d. Note comment under Fig. 4c. Case 4.
are rather limited. The ideal type of frac-
ture for its use is a transverse fracture of
the upper two-thirds of the femur, hut it
must he one inch below the trochanter. I
have used this nail only in fresh fractures
and in a few old ununited fractures, hut
the indications of its use as given by men
of wider experience are: first, femoral short-
ening; second, malunion of fractures; third,
ununited fractures; fourth, fractures which
do not reduce satisfactorily with traction,
which should he operated on in any event;
fifth, double fractures of the shaft of the
femur; sixth, fracture in which early mobil-
ization is essential, such as fractures com-
plicated by joint injuries.
Contraindications: First, long spiral frac-
tures; second, comminuted fractures; third,
large butterfly type fractures.
These three types of fractures are contra-
indicated because the pull of the strong
muscles of the thigh will have a tendency
to telescope the fragments and thus produce
shortening unless one uses traction at the
same time; fourth, some men consider com-
pound fractures a contraindication because
of the danger of infection, while others ar-
gue that chemotherapy obviates danger of
236
The Journal of the Medical Association of Georgia
Fig. 5a. Malunion of tibia. Case 5.
Fig. 5b. Bone was freshened and pin inserted. Case 5.
Fig. 5c. Note results after six weeks elapsed. Case 5.
Fig. 5d. Note results after approximately eight months had
elapsed. Case 5.
infection; fifth, in children under sixteen in
whom the epiphyses are not closed this
method should not he used.
Advantages : No external fixation is nec-
essary in fractures of the tibia in which
eversion of the foot will occur unless a cast
is applied to the leg; second, the adjacent
joints can he kept mobile, preventing limi-
tation of motion; that is, the stiff knee which
is so common with the old method of treat-
ment; third, early ambulation, thereby re-
ducing hospital cost and nursing service;
fourth, there is no muscular atrophy and no
joint stiffness; therefore no rehabilitation is
necessary. This method eliminates the detri-
mental factors of traction or distraction at
the site of the fracture, but maintains
through muscular action constant pressure
on the ends of the fragments, which stimu-
lates healing.
One must consider the theoretical dangers
of this method such as, the effect caused by
a foreign body closed in a medullary space:
first, as to sequestration and development of
callous. Unless there is an infection no
sequestration or fistula will develop. Since
the advent of chemotherapy very few infec-
tions, if any, have been reported. Rush
claims that he has not had an infection in
twelve years from work of this type. X-ray
films show that ossification of the ends of the
fragments is perfect. Second, the danger of
fat embolism. It is claimed that there is less
danger of fat embolism from the use of the
pin than from the original fracture, although
Kuntscher reported two cases of fat em-
bolism. Third, the effect of operation on the
marrow as a blood forming organ. Kedri,
June, 1950
257
by doing blood examinations every five days
from the day of the fracture until six months
afterwards, stated that the hemoglobin and
red cell count increased from ten to thirty
per cent, indicating that it actually stimu-
lated the blood forming organs. Fourth,
the possibility and sequences of infection.
In Europe, early in the use of the pin where
it was indiscriminately used there was some
infection. Kedri reported four out of 82
cases. These were in compound wounds,
but none since the advent of penicillin, and
I have known of none in this country.
Conclusions: Because of the short stay in
bed, the simple after-treatment, the reduced
pain, the lack of stiff joints, the short hos-
pital stay and early return to work, I feel
that this is the best method available today
of treating the type of fractures in which
it is indicated.
REFERENCES
1. Rush, L. V., and Rush, H. L. : A Reconstruction Opera-
tion for Comminuted Fractures of the Upper Third of- the
Ulna, Am. J. Surg., New Series vol. 38, 2: 332-333 (Nov.)
1937.
2. Rush, L. V., and Rush, H. L. : Technique of Longi-
tudinal Pin Fixation of Certain Fractures of the Femur, J.
Bone and Joint Surg. 21: 619-626 (July) 1939.
3. Kuntscher, G. : Intramedullary Nailing: Experimental
Study, Klin. Wchnschr 19: 6-10 (Jan. 6) 1940.
4. Street, Hansen, and Brewer: The Medullary Nail,
Presentation of a New Type and Report of a Case, Arch.
Surg. 55: 424-432 (Oct.) 1947.
5. Westerborn, A Marrow Nailing of Recent Fractures,
Pseudarthrosis and Bone Plastic. Experiences in 100 Cases,
Ann. Surg. 127: 577-591 (April) 1948.
6. Bohler, L. : Medullary Nailing of Kuntscher, First Eng-
lish Edition, Baltimore, Williams and Wilkins Company,
1948.
7. Fowler, S. Benjamin, and Riordan, Daniel C. : Internal
Fixation of the Femur with the Kuntscher Intramedullary
Nail. South. M. J. 42 : 545 (July) 1949.
HEALTHGRAMS
Tuberculin tests are an assential part of preventive
services to children, both to indicate whether infection
has occurred and to direct attention to sources of infec-
tion. The inereasing interest in BCG vaccine may
lead before long to its wide use in minimizing the
probability of the development of clinical tuberculosis.
Henry E. Meleney, M.D., The Milbank Memorial Fund
Quarterly, July, 1949.
* * *
If the public health man knows all there is to
know about tuberculosis, its cause and prevention,
its epidemiology, case finding, contact finding, and
supervision, its health education and community organi-
zation aspects, its hospital and rehabilitation phases,
its economic reactions, its need for statesmanship and
legislation, its challenges in unanswerable questions
and the need for research, that person knows the bulk
of what there is to know about public health. The
rest of public health is largely application of the same
procedures in other fields with changes of emphasis
according to the special neculiarities of that field.
William P. Shepard, M. D., Nat. Tuberc. A. Bull.,
Oct., 1949.
AMBULATORY TREATMENT OF
SYPHILIS WITH AUREOMYCIN
C. H. Chen, M.D.,
R. B. Dienst, Pii.D.,
and
R. B. Greenblatt, M.D.
A ugusta
Reports on the oral administration of
aureomycin in the treatment of various
stages of syphilis have appeared during the
past two years.1 3 All investigators have ob-
tained satisfactory results with the anti-
biotic given every four to six hours day and
night (q4h to q6h ) for 11-25 days. The pur-
pose of this study was to see if the one to two
night doses could be omitted without impair-
ing the desired clinical results. The success
of this regimen will make this form of ther-
apy more convenient and fully ambulatory.
For this study two patients with primary
chancre, one with a negative and one with a
positive Kahn test, were selected. Each pa-
tient was given one gram of aureomycin in
the form of four 250 mg. capsules four times
daily at four hour intervals (q.i.d.) for two
weeks. Their case histories are briefly out-
lined as follows:
REPORT OF CASES
Case 1. A Negro male, aged 21 years, came to the
clinic with the chief complaint of having had a painless
ulcer on the penis for six days. The patient denied having
had syphilis previously, and a blood Kahn test per-
formed three weeks previously was negative. Local exam-
inations revealed a well circumscribed, elevated and
indurated ulcer measuring 1.5 cm. in diameter in the
right inguinal region. Darkfield examination of the
ulcer was positive for T. pallidum. Kahn, Ducrey, Frei
and Donovan body4 skin tests were performed and when
read were found to be negative.
Oral aureomycin treatment as outlined was begun im-
mediately. Within four days the ulcer healed completely.
No drug reactions were noticed. Blood Kahn tests done
after one, two, four and five months were all negative.
The patient remained in perfect health during a follow
up period of five months.
Case 2. A Negro male, aged 17 years, complained of
a penile ulcer of “few days” duration. There was some
tenderness but no pain. Four years ago he had an attack
Received for publication March 23, 1950 from the Univer-
sity of Georgia School of Medicine, Augusta, Georgia. Aided
by a grant from the State of Georgia Department of Public
Health.
The aureomycin capsules used in this study were furnished
by Lederle Laboratories, Inc.
238
The Journal of the Medical Association of Ceorcia
of gonorrheal urethritis, but had never had syphilis. His
blood Kahn tests had been negative. On examination, a
typical hard and indurated chancre of 1.5 cm. in diameter
was seen on the right side of the coronal sulcus. There
was no enlargement of inguinal lymph nodes, nor was
there any other abnormal finding. Darkfield examination
and Kahn test were both positive, while Ducrey, Frei,
and Donovan body skin tests were negative.
A two-week course of aureomycin was given. On the
second day tenderness disappeared, but the lesion was
only slightly improved. On the tenth day a darkfield
examination was made and no treponema were found.
The patient then complained of nausea, some vomiting,
profuse salivation, headache, diarrhea, and insomnia.
There was also a slight elevation of body temperature.
Benadryl 50 mg. three times a day and phenobarhital
0.03 gm., p.r.n., were prescribed. All complaints were
completely alleviated the next day except diarrhea which
lasted throughout the aureomycin therapy. Complete
healing of the ulcer took place three weeks later. A
blood Kahn test done four months after the completion
of therapy was negative. No skin eruptions or other
lesions suggestive of secondary syphilis developed during
the four months of follow up period.
Discussion
From the results obtained in these two
cases, it appears that aureomycin is effec-
tive against primary chancres when admin-
istered in the daytime hours only. The heal-
ing of the ulcer in the second case was de-
layed, probably due to the presence of phi-
mosis. The fact that the darkfield examina-
tion was negative long before the lesion
completely healed indicated that the cause
of delayed healing was probbaly mechan-
ical.
The belief that a supermultiple dosage
schedule for crystalline penicillin G is nec-
essary has been questioned by Southworth
and Debbs. " They obtained equally good
clinical results whether every 12 hours or
the conventional every three hours schedule
was employed. Since aureomycin is slowly
excreted,'1 there is less indication for this
antibiotic to be given throughout the night.
The results from this study attest to this
reasoning. Although other forms of syphilis
have not been treated with our proposed
four-times-a-day schedule, it is our belief
that satisfactory results might be obtained.
Summary
Two cases of primary chancre were suc-
cessfully treated with aureomycin given in
1 gram doses four times daily (q.i.d.) for 2
weeks. Since this schedule does not involve
the administration of medicine at night, it is
considered more convenient than other
schedules thus far reported and is probably
the first suitable ambulatory treatment for
syphilis. The same method of aureomycin
administration is recommended for a trial
in other forms of syphilis.
REFERENCES
1. O’Leary, P. A., and Kierland, R. B. : The Oral Admin-
istration of Aureomycin (Duomycin) and its Effects on
Treponema Pallidum in Man, Proc. Staff Meet., Mavo Clin.
23:574-578 (Dec. 8) 1948.
2. O’Leary, P. A., and Kierland, R. B. : The Oral Use of
Aureomycin in the Treatment of Late Cutaneous Syphilis,
Proc. Staff Meet., Mayo Clinic 24: 302-306 (May 25 1 1949.
3. Rodriquez, J. ; Plotke, F. ; Weinstein, S., and Harris,
W. W. : Aureomycin and its Effect in Early Stages of
Syphilis: A Preliminary Report, J.A.M.A. 141: 771-772 (Nov.
12) 1949.
4. Chen, C. H. ; Dienst, R. B., and Greenblatt, R. B. : Skin
Reaction of Patients to Donovania Granulomatis, Am. J.
Syph., Gonor. & Ven. Dis. 33: 60-64 (Jan.) 1948.
5. Southward, J. L., and Debbs, C. H. : Prolonged Interval
Dosage of Aqueous Penicillin in Surgical Infections, South.
M. J. 42: 981-983 (Nov.) 1949.
6. Herrell, W. E., and Heilman, F. R. : Aureomycin,
Studies on Absorption, Diffusion and Excretion, Proc. Staff
Meet., Mayo Clinic 24: 157-166 (March 30) 1949.
NURSE MIDWIFE SERVICE IN
WALTON COUNTY GEORGIA
Ernest Thompson, M.D.
Walton County Health Commissioner
Monroe
Nurse midwife service is a new venture
in Public Health in Georgia, and in fact in
the nation. Because it is new and because
it is necessarily closely allied to the prac-
ticing physician, the program committee
thought it appropriate to have a paper on
nurse midwife service read at this meeting.
My discussion begins with a definition of
the term nurse midwife. A nurse midwife
is a graduate nurse who has had postgrad-
uate training in the management and de-
livery of normal obstetric cases. By this
training she is qualified to deliver normal
cases and is capable of early recognition of
complications which demand the services of
a physician.
I shall try to give in a short space a de-
scription of the organization and operation
of the program, and to discuss briefly the
need for such a service; the relations of
the Health Department with the public, the
June, 1950
259
doctors, and the hospital; and the possible
future of the service.
Since January 1, 1938 Walton County
has had a Health Department under the di-
rection of a full-time Health Commissioner
who is a Doctor of Medicine. Since Janu-
ary 1947 the County Health Department has
employed two nurse midwives whose pri-
mary duty is to attend deliveries of patients
qualifying for nurse midwife service.
These deliveries are all done at the hos-
pital. The nurse midwives do not attend
home deliveries. The patients are hospital-
ized for three days, longer if complications
require it. The total cost to the patient is a
hospital charge of $15.00. This is the same
as the fee charged by lay midwives.
To be eligible for this service the patient
must be a resident of Walton County, the
case must present no serious complications,
the patient must be investigated by the local
Department of Public Welfare, an admis-
sion card must be signed by a Walton Coun-
ty physician, and the patient must attend
the Health Department’s maternity clinic
for prenatal care.
The Health Commissioner is responsible
for prenatal care but does not attend deliv-
eries. Every doctor in the county stands
ready to assist in emergencies.
The nurse midwives perform another
very valuable service. They are called
when doctors’ private obstetric patients come
to the hospital in labor. They examine the
patient, observe the course of labor, notify
the doctor at the proper time, and assist the
doctor with the delivery. Obviously they
represent a valuable addition to the hospital
personnel and constitute a great time saver
for the doctor.
The nurse midwives are regular employ-
ees of the County Health Department which
is responsible to the County Board of
Health. The State Department of Public
Health stands in the same relation to this
service as to other Health Department serv-
ices; they furnish financial participation.
They are concerned in the formulation of
policies governing the program. They as-
sure themselves and us that the nurse mid-
wives employed are capable and that the
whole program maintains a high standard
of performance. They observe the work at
frequent intervals and are ready at all time
with expert assistance in any of its many
phases. They require regular, detailed re-
ports.
The foregoing describes in brief the nurse
midwife service as operated by the Health
Department in Walton County. The need
for such a service in Walton County and
over much of the State is attested by un-
deniable facts. Lay midwives, or “granny
women”, are disappearing from the scene
in Georgia. There are now 1600 lay mid-
wives in the State. One thousand of these
are from 50 to 70 years of age. More than
300 are above 70. Less than 250 are below
50.
Ten years ago Walton County had 16
registered midwives; we now have seven.
Two of these are 48 years of age; one is 58;
three are respectively 63, 64, and 69, and
one is 70.
Midwife patients are not disappearing
however. A large number of our mothers
still must of economic necessity seek the
services of midwives. There are of course
a small number who employ midwives
from choice rather than necessity.
It is true also that the quality of obstetric
care in our State is improving. This im-
provement in quality (which carries with it
an increase in quantity of service per pa-
tient) entails an increase in doctors’ fees,
and more and more is coming to mean a
hospital bill in addition to a doctor bill.
This is as it should be; and I, and all
health workers, encourage the employment
of a good physician, adequate pre- and post-
240
The Journal of the Medical Association of Georgia
natal care, and hospital delivery if a good
hospital lie reasonably available. Further-
more we affirm that such service costs mon-
ey and is worth what it costs. However,
those who cannot pay for such service con-
stitute a problem; and because human life
is important the problem cannot be ignored.
Nurse midwife service is an attempt to
solve this problem.
There are five separate groups involved
in the operation of this program, these being
the State Department of Public Health, the
Walton County Health Department, the
practicing physicians of Walton County, the
Walton County Hospital, and the public
whom we serve. Obviously the enterprise
had to be carefully planned and plans care-
fully followed through in order to do a
good job and preserve harmony between
the various groups.
Before the work was started every phase
of it was considered and so far as possible
everything was put in writing and received
the mutual approval of the groups involved.
On one occasion the members of the Walton
County Medical Society sat up until mid-
night, hearing the reading of six pages of
policies, two pages of questionnaire to in-
dividual doctors concerning their personal
preferences in their own obstetric practices,
and twenty pages of standing orders for
nurse midwives. We tried to anticipate and
plan for all situations: even whether or not
the nurse midwives would live in the
nurses' home at the hospital. ( Incidentally
it was decided that they would not).
This careful planning was not wasted
effort. The program has operated for two
and half years with one amendment to the
policy on admission of patients to the serv-
ice, and one alteration of administration of
the same policy. Both these changes were
initiated by the physicians of the county.
Furthermore, all parties concerned, includ-
ing the people of the county, agree that we
are performing a worth while service and
are doing it in the right way.
A few remarks on admission policies may
be of interest. In the first place I point out
that pre- and postnatal care at the Health
Department's maternity clinic, is available
to residents of Walton County without re-
gard to financial status. This service was
established in the early days of the Health
Department to take care of patients of lay
midwives. By far the greater number of
women seen in this clinic are midwife pa-
tients, but quite a number come to us for
prenatal care and go to their doctor for
delivery, and this on order of the doctor
himself.
When we established delivery service by
nurse midwives, then of course the patient's
financial status became a consideration. In
the beginning it was agreed that patients
whom we considered eligible and who pre-
sented no serious complications, would be
sent with an admission card to the doctor
whom she named as her family physician.
If the doctor signed the card and returned
it to us the patient was admitted to the
service. If he refused to sign the card the
patient was denied the service.
After the program had been in operation
for seventeen months the doctors proposed
to amend admission policies to require in-
vestigation of applicants by the Welfare
Department. This was done. Now the pa-
tient goes to the doctor with a summary of
her financial condition as drawn up by the
Welfare Department and a recommendation
for acceptance or rejection signed by the
Welfare Director. The doctor is not bound
by the Welfare Director’s recommendation.
He still may accept or reject the patient as
he sees fit.
Our admission policies are satisfactory
I believe, except for a few people on the
ragged edge of eligibility, who could per-
haps stretch a point and employ a doctor.
June, 1950
241
but cannot be persuaded to do so. When
these people are denied the service they
employ “granny women'’ and have their
babies at home. Since we cannot send them
to doctors I feel that we should admit them
to nurse midwife service. Some of the doc-
tors agree with me on this and some do not.
It will not be done until the doctors are
agreed on it.
Any such program as this succeeds or
fails accordingly as the local Health Depart-
ment succeeds or fails to establish and main-
tain cordial relations with the practicing
physicians and the hospital. I say, with no
modesty whatever, that we have succeeded
in this and will continue to succeed.
In the first place our nurse midwives are
well prepared: their work earns the respect
of the doctors and of the hospital manage-
ment and personnel. And they are on the
job. One of them is on call 24 hours a day,
holidays, Sundays, every day. There has
not been a time since the program started
when a nurse midwife could not be found
in a very few minutes.
In the second place, the nurse midwives,
and I, and the whole Health Department,
walk the straight and narrow path of doing
our own job and preserving strict neutrality
in dealing with the several members of the
profession. We make no attempt to operate
the hospital or to manage any doctor’s prac-
tice. This is not to say we never make a
suggestion. We do make suggestions and
they are always well received and given due
consideration. We are in competition with
lay midwives but we are not in competition
with doctors. We send patients to doctors
whenever we have the opportunity.
In the third place, our doctors are easy
to get along with. A more cordial and co-
operative group of doctors would be impos-
sible to find. If they harbor the least ill
will toward the service or consider it in any
way a threat to their practice, I have been
unable to discover it.
In the matter of cooperating with the
nurse midwives and assisting them with
their patients, the doctors have gone beyond
what could reasonably be expected. They
have done literally everything from pre-
scribing a sedative to performing a cesarean
section, and have made no charge for such
services. In several instances they have per-
formed sterilizing operations on nurse mid-
wife patients whose general health did not
permit further childbearing. These opera-
tions were also done without charge.
We receive the same fine cooperation
from the hospital. They always deal very
cordially with us and very generously with
the patients.
Nurse midwife service is proving popular
with the public. In 1947 nurse midwives
attended a total of 64 births, in 1948 they
attended 80 births, through July 31 this
year they attended 76 births. All their de-
liveries are hospital deliveries, and I be-
lieve the percentage of hospitalization of
obstetric cases is considerably higher in
Walton County than in most rural Georgia
counties.
Several things together have produced a
remarkable increase in the percentage of
hospital deliveries in this county over the
past decade. In 1939, 5.2 per cent of the
patients delivered in the county went to
the hospital. The percentage has steadily
increased until in 1948, 78.2 per cent of
deliveries in the county were hospital de-
liveries.
I know there are those who argue elo-
quently in favor of home deliveries. But
there is no doubt in my mind that our high
percentage of hospital deliveries, making
prompt and effective medical care possible,
has spared us several maternal deaths.
It is interesting too to record, for the past
several years, the percentage of births in
the county that were attended by physicians.
242
The Journal of the Medical Association of Georgia
Beginning in 1942 and continuing through
1948 the percentages are as follows: 64.1;
65.5; 68.9; 68.0; 72.7; 70.8; and 69.3.
Also the percentage of deliveries by lay
midwives was 35.9 in 1942 and 14.9 in
1948. Obviously the nurse midwife has
taken business from the lay midwife, not
from the doctor.
In conclusion, I submit that the nurse
midwife program in Walton County is no
longer experimental, but has proved to be
a satisfactory solution to the problem of
maternal care for the very low income
group. This service and the medical pro-
fession are working together to elevate the
standard of obstetric care in the county.
It is a program of essential service on which
doctors and local public officials can agree;
it could doubtless serve as well in many
communities in the State as it does here.
I believe that any such program should be
administered by a Doctor of Medicine who
has a sympathetic understanding of the
problems of practicing physicians.
A CASE OF POST VACCINAL
ENCEPHALITIS TREATED WITH
CHLOROMYCETIN
David S. Mann, M.D.
Frank E. Thomas, M.D.
Albany
A case of post-vaccinal encephalitis with
recovery is presented. It is believed this
case may be of interest because chloromy-
cetinR seemed to be of definite benefit for
this rare condition. It is also probably of
some interest that this child developed en-
cephalitis in spite of being vaccinated when
he was slightly less than one year old.
REPORT OF CASE
R. L., a white male approximately one year old. was
first seen in the hospital emergency room Feb. 12, 1950.
He had had a smallpox vaccination of the right arm
nine days previously. The preceding day he had been
somewhat fretful. On the morning of February 12 his
temperature was 100° F., but he did not seem particu-
larly ill. His vaccination had “taken"’ well, had gone
through the usual stages, and was then at approximately
the height of reaction. During the day his temperature
and malaise gradually increased. A generalized con-
vulsion suddenly overtook him, and the parents imme-
diately brought him to the hospital.
He had just completed a generalized convulsion, wit-
nessed by emergency room attendants, and was still
“twitchy" when first seen by one of us. Rectal tempera-
ture was over 105° F. There was moderate hut definite
stiffness of the neck. The vaccination was at the height
of reaction, and was of a more adult-type reaction
than is usually seen at this age. An umbilicated pustule
about 1 cm. in diameter was surrounded by an irregular,
dark, reddish zone of thickened skin approximately 0.5
cm. wide. There was no redness or swelling of the arm,
and no lymph nodes were palpable. Reflexes were active,
equal, and not unusual. The examination otherwise re-
vealed normal findings.
The patient was admitted to the hospital and the
usual temperature-reducing measures instituted. Sub-
cutaneous fluids were given, mainly because of the
hyperpyrexia, as there was no dehydration clinically.
Sodium luminalR was given for sedation, and penicillin
and a liquid sulfadiazine preparation were started.
Blood work showed a red cell count of 5,330.000; a
white cell count of 21,700 with 59 per cent polymor-
phonuclear leukocytes, 40 per cent lymphocytes, and
1 per cent monocytes. The urinalysis was normal.
The temperature was lowered somewhat, hut remained
high, the first hospital day. The child vomited almost
all food and fluids the first day. There was another gen-
eralized convulsion the first night. On the morning of
the second day a lumbar puncture was done. This re-
vealed clear fluid under a pressure of 310 mm. of
water. There was no evidence of block in the cerebro-
spinal canal. Cell count on this fluid revealed only 2
cells per cubic mm. Protein and sugar tests were not
done through error. Culture later proved negative.
At this time one of us ( F.E.T. ) , suggested the use of
chloromycetin,R on the theory that, being a virus infec-
tion, post-vaccinal encephalitis might respond to it.
Accordingly, 100 mg. of the drug was ordered every
four hours, five times daily (This was approximately 50
mgm. /kilogram of body weight, as the child weighed
about 22 pounds). The first dose was given at 4 P. M.
of the second hospital day. Sulfadiazine was discon-
tinued. Penicillin. 400.000 units twice daily, w'as con-
tinued, to prevent any secondary infection.
Improvement was rapid. Within thirty-six hours after
the first dose of chloromycetinR the temperature had
dropped to normal, and it remained normal thenceforth
(See temperature chart). Likewise the vomiting, nuchal
stiffness, increased irritability, and fretfullness cleared
swiftly, all having disappeared by the fifth hospital day.
On the fourth day it was discovered the child had been
receiving 250 mg. of chloromycetinR each dose, instead
of 100 mg. as ordered. This was corrected at this time.
Thus for the first two days the patient had received a
dosage of 125 mg. kilogram. There was a mild diarrhea
on the fifth day, which cleared rapidly with minimal
June, 1950
243
treatment. It is possible this was a mild gastro-intestinal
disturbance due to chloromycetin.R but this was not
thought to be the case. Even if true, the reaction was
mild and followed extra large dosage.
A fine rash, having the appearance of a mild drug or
allergic rash, was present over body and thighs the fifth
hospital day; it had almost disappeared the next day,
when the patient was discharged.
Lumbar puncture was repeated on the fifth day but
was not entirely satisfactory. However, the fluid was
definitely no longer under increased pressure, as it ran
out very slowly through a 20 gauge needle.
On the sixth hospital day, the day before his first
birthday, the patient was discharged as cured. There
were no positive physical findings at this time, and a
dry scab was all that remained of the vaccination. Total
dosage of chloromycetinR in the hospital was 3.6 Gm.
One dozen 100 mg. capsules were given him on dis-
charge, to be taken five times daily at home. Thus, the
total chloromycetinR dosage was 4.8 Gm.
The child was re-examined one month later; all find-
ings were normal.
Summary and Conclusions
A case of post-vaccinal encephalitis in a
white hoy slightly less than one year of age
is presented. Though very ill at first, re-
covery was prompt after the administra-
tion of chloromycetinR in a dosage of 125
mg./ kilogram daily, reduced to 50 mg. /kilo-
gram after 48 hours. The temperature be-
came normal 36 hours after the first dose
of the drug, and remained normal. Penicil-
lin and supportive treatment were also given.
It is our opinion that chloromycetinR was
of definite benefit in this one case of post-
vaccinal encephalitis. Because of the rarity
of this condition, it is impossible for a series
to be obtained. Thus scientific evaluation of
the effectiveness of treatment with chloro-
mycetinR or other chemotherapeutic agents
will have to depend on the tabulation of
isolated reports such as this, and the com-
parison of results with previous percentages
of mortality and morbidity.
HEALTHGRAM
In one large American city, the reporting of cases
of tuberculosis has been compulsory for more than
half a century. Yet, despite this long history of
experience in the field, about 40 per cent of the
tuberculosis deaths in the past six years were never
reported as living cases of tuberculosis. And this is
not alone the experience of this particular city. The
American Public Health Association reported in 1947
that in 66 communities 30 to 89 per cent of the
tuberculosis deaths were unreported as living cases.
Cedric Northrop, M. D., Robert J. Anderson, M. D.,
and Herbert I. Sauer, B.A., Pub. Health Rep., Aug. 5,
1949.
CARCINOMA OF THE STOMACH
T. C. Davison, M.D.
A. H. Letton, M.D.
Atlanta
We are accustomed to living in a world
filled with disasters — wars, earthquakes,
train, auto and airplane wrecks — yet we are
not complacent about them. They are a con-
stant source of menace to ourselves and our
minds. The world reacted with horror a few
years ago when it was learned that the
atomic bomb at Hiroshima killed 78,150
persons1. We all shuddered at the death
toll of 512 at Texas City a few years ago.'
Yet in contrast we are rather complacent
about the 189,811 who died from cancer in
1947 in the United States.' Every city in
the country checked their hotels and revised
their fire laws following the holocaust of
the Winecoff Hotel, which claimed 121
lives' a few years ago in Atlanta. But no
one got too worried, except a few doctors,
about the 25,9674 victims of cancer of the
stomach in 1947 in the United States alone.
Why? There are two reasons: the first is
that cancer slips as a thief in the night,
killing and moving on; while disaster comes
on suddenly claiming all its victims at once.
Cancer is not seen by the majority of people
and goes unnoticed. Secondly, there is little
the layman feels he can do about cancer. He
thinks that it is the next fellow and not
himself who will develop it; he feels doing
something about cancer is the doctor’s job.
What are we physicians going to do about
it? What can we do? There are two things
which can be done: the first, is to find the
cancer sooner; the second, is to remove it
more radically. Let us consider ways that
we can bring these about.
There has been considerable publicity in
Read by Dr. Letton before the Tenth District Medical
Society, Monroe, Aug. 18, 1949.
244
The Journal of the Medical Association of Georcia
the lay press recently about cancer, and we
doubt that it would be too wise to push this
much harder than at present because of
the great mental unrest it causes in so many
of our unstable individuals. Thus, we are
going to have about the same difficulty in
the future in seeing people earlier because
they are so reluctant to see about little
things. In a large series0 of patients with
cancer of the stomach, it was noted that an
average of six months elapsed between the
time the patient’s first symptoms appeared
and his visit to the physician. This is almost
incredible, but what is more unbelievable
is that an average of five months elapsed
between the time of the first visit to the
physician and his operation. This is the
physician’s fault and it is this five-month
period which we can reduce, and which we
must reduce. This five month period is di-
rectly the result of and an indication of the
vague symptoms of early cancer of the
stomach. The majority of the time, we have
been too prone to give the patient some
tablets or powders and a diet for his indi-
gestion, and ask him to return in three
weeks — if at that time he is still having
trouble, then we have changed his medicine,
etc. Such is the routine pattern of mild
dyspepsia — playing along for an average
of five months, letting cancer grow larger
day by day, while we should have done an
x-ray examination by a qualified roentgen-
ologist when the usual simple treatment
didn’t have the desired effect. This, of
course, is going to bring about many exam-
inations which won’t find malignancy, still
it won't be a waste for it will usually point
to some other disease, even if it doesn’t it
will rid the patient’s fears and help him to
have more confidence in his physician — for
now that he knows that he is being looked
after. Everyone appreciates a physician
being thorough.
In order to be complete, let us speak
briefly of the symptoms of malignancy of
the stomach. The typical textbook picture
actually is the picture of far advanced can-
cer of the stomach. Early malignancy of
the stomach has no pathognomonic sympto-
matology— it varies directly with the loca-
tion of the lesion and with its size and type.
It may be epigastric discomfort, belching,
a feeling of fullness in the upper abdomen,
new idiosyncrasies to certain foods, or just
the inability to eat rich, heavy meals where
once such could be tolerated. These symp-
toms are due to some obstruction or con-
striction in the gastric lumen — the lack of
pliability of the stomach due to malignant
infiltration preventing proper movement of
the stomach contents. Another early symp-
tom may be fatigue, loss of endurance, or
pallor. All of these are caused by anemia
which is due to either one or a combination
of the following: the lack of Castle’s intrin-
sic factor for maturation of red cells due to
involvement of the stomach by the malig-
nancy or due to actual blood loss from the
tumor. The symptoms of gastric ulcers may
also be the symptoms of gastric carcinoma,
for you must remember the large percentage
of gastric ulcers that are malignant, and
the even larger percentage that are pre-
malignant.
X-ray examination should include a
fluoroscopic view of the stomach. This ac-
tually is more important than the pictures
themselves, for here the actions of the stom-
ach, the peristaltic waves can be watched.
Pliability of the stomach may be determined
and small defects may be pressed and made
to fill out where they otherwise may go un-
seen. A good fluoroscopic examination by
an expert is unsurpassed.
The concensus of opinion is that the over-
whelming majority of gastric (not duo-
denal) ulcers that are over 2.5 cm. (1 inch)
in diameter have undergone malignant de-
generation or have been caused by a cancer.
June, 1950
245
In a series of 869 cases reported by Wal-
ters," 14.5 per cent of gastric ulcers smaller
than 2.5 cm. in diameter (1 out of 7) are
malignant and 22 per cent, practically one
quarter, have already spread to the regional
lymph nodes. This is about the same odds
as Russian roulette.
The gastric analysis may or may not be
of value: 59 per cent show achlorhydria,
with no acid in the stomach, while 25 per
cent have a decreased amount of stomach
acid." Thus 84 per cent have lower than
normal, the rest have normal or an increased
amount of acid. In the past two years we
have found quite helpful the application of
Papanicolaou’s technic in examining smears
of gastric contents. When one finds malig-
nant cells then we know we are dealing
with cancer; but, of course, where none are
found we have no assurance that we did not
overlook them. Its similar to a fishing trip;
when we catch fish we know that there were
fish in the lake but when we don't its no sign
that there were no fish there.
In all of these methods of diagnosis we
have mentioned none is 100 per cent, but
to make our diagnosis a little more sure we
ask Dr. John Atwater, in our office, to use a
gastroscope with which the stomach can be
visualized without too much difficulty. This
again is not 100 per cent, but combining it
with our other methods it makes our results
more accurate.
Then to find cancer earlier, let us re-
member cancer may be in any patient over
40 years (and some under) of age, and let
us not treat gastric ulcers with expectancy
(we believe they should all be treated sur-
gically. If not they should be carefully
watched with x-ray and gastroscopy). Thus,
we can reduce that average five-month pe-
riod between the first visit to the physician
and the operation considerably, i.e., getting
the lesions earlier and resulting in more
cures.
Earlier we mentioned another method
that would reduce the mortality, which was
to remove the ulcers and cancers more radi-
cally. By this, we mean to do complete
gastrectomy in each instance, and we do
mean to go well around the area and to
remove the regional lymph nodes. Even
though these nodes are not enlarged they
may harbor only a few malignant cells
which if left in would ruin the chance of
the cure. The only way to cure cancer of
the stomach is to completely remove it
surgically.
To demonstrate some of the complications
in diagnosis, in treatment and in after treat-
ment, let us show you the case of Mr.
W. C. H. — this is not a composite picture,
i.e., one made up of several different pa-
tients; but this did all actually happen in
one person:
Mr. W. C. H. was 72 years old when he came to us
three years ago. When he was 48 years old. 22 years ago,
one of us (T. C. D. ) operated on him for a gastric ulcer.
Upon looking up his old record, we find the ulcer was on
the les er curvature, and a posterior gastroenterostomy
was done because of pyloric stenosis. Since then he has
had mild chronic dyspepsia which was relieved by
alkalies. Six months prior to his visit to us he began
feeling weak; this had progressed markedly so that his
activities are by now quite limited.
Physical examination was negative except for an
emaciated, underweight white male aged 72, who showed
grade 1 arteriosclerosis of his retina, and a small hemor-
rhoid. The mucous membranes were quite pale. His
red blood count was 2,830.000 and his hemoglobin 49
per cent. He was hospitalized and given 2,000 cc. of
whole blood which brought his hemoglobin up to 90
per cent, with the help of liver injections, and iron and
vitamins orally.
His gastric analysis showed 52 degrees of free and 64
degrees of combined acid with positive blood in all
specimens. X-ray examinations revealed a fungating
tumor on the lesser curvature of the stomach where the
old ulcer had been 20 years ago. We next had Dr.
Atwater gastroscope the gentleman, who demonstrated a
large fungating cancer with some normal gastric mucosa
proximal to it on the lesser curvature, which suggested
that this lesion might be operable.
We were able to perform a complete gastrectomy
after cutting the gastrocolic ligament near the colon and
cutting the old gastrojejunostomy and doing a new
jejunojeunostomy. We then cut away the mesogastrium
near the coeliac axis, for an enlarged node was located
along the course of the left gastric artery. The duodenum
was cut about 1 cm. distal to the pyloris and turned in.
The vagi nerves were next cut, so that the stomach could
be pulled down and an esophagojejunostomy performed,
using two rows of sutures. Next, a jejunojej unostomy
was performed to make the bile by-pass the esophagoje-
junostomy. The new routing of the intestinal tract and
its anastomosis are shown in Fig. 1.
The patient’s postoperative course was uneventful; he
went home on the twelfth postoperative day. One week
246
The Journal of the Medical Association of Georgia
^-Levine Tu3T
Fig. 1. Sketch showing the anastomoses following complete
gastrectomy.
later he had a chill and high fever, and an x-ray of his
chest at this time suggested a subphrenic abscess in spite
of his smooth postoperative course. He was given large
doses of penicillin and the next day his temperature did
not go over 100° F., but the following day it jumped to
104°. The malaria smear showed many parasites and
a course of atabrine promptly controlled his troubles.
His further recovery was uneventful except for a perni-
cious type of anemia which gradually developed, which
was corrected by ventriculin with iron. One donor, upon
questioning, confessed that he had contracted malaria
while in the Pacific during World War II; this probably
was the source of the malaria since the patient had never
had it prior to this time.
The patient gained back his usual weight and re-
turned to his usual occupation, and gradually was able
to eat three meals a day which he enjoyed. Two years
later he died from an unrelated disease and autopsy
revealed no evidence of any cancer of the stomach.
The pathologic examination of the operative specimen
revealed that the nodes near the stomach along the left
gastric artery were involved while those nearer the
coeliac axis were not — it was thus felt that this radical
procedure removed all the malignant cells since the
nodes "upstream" were involved and the nodes farther
“downstream" were not. and thus gave this gentleman
two years of useful, trouble-free life when a lesser
procedure would have failed. This may have offered even
more life had not some other diseases interrupted his
course.
It is thus our feeling that one should remove the
regional lymph-nodes when dealing with cancer of the
stomach, just as one does when dealing with cancer of
the breast.
Summary
1. A brief review of the problem of can-
cer of the stomach has been presented.
2. Suggestions as to management of dys-
pepsia, so as to cut down on the five-month
average period from the first visit to the
physician to operation, have been made.
Remember cancer first — don’t treat gastric
ulcers expectantly.
3. A more radical gastrectomy should he
performed to he sure and get all of the
cancer cells.
4. An interesting case of cancer of the
stomach on whom a total gastrectomy was
performed was presented.
5. A cancer patient in whom malaria
was found, probably acquired malaria by
way of transfusion, was reported.
REFERENCES
1- 3. Information Please, Doubleday & Company, Inc., and
Garden City Publishing Company, Inc., 1948.
2- 4. National Summaries of Vital Statistics Report for
1947.
5. Georgia Cancer Bulletin, 1948.
6. Walters, Gray and Priestly: Carcinoma of the Stomach.
Philadelphia, W. B. Saunders Company, 1943, p. 212.
7. Walters, Gray and Priestly: Carcinoma of the Stomach,
Philadelphia, W. B. Saunders Company, 1943, p. 75.
MIND, MATTER AND THE DOCTOR
H. B. Jenkins, M.D.
Donalsonville
Mr. President, members of the Second
District Medical Society and visitors. For
four months I have been congratulating
myself on receiving an invitation to talk to
you today. I wish to thank and to congratu-
late the young men of your program com-
mittee and to assure them that an invitation
to appear before this society is considered
equally as important as would he an invita-
tion to appear before the New York Acad-
emy of Medicine or before the Royal Col-
lege of Surgeons.
Having been requested to talk on medi-
cine, a subject has been selected about which
all of us know very little. It is mind, matter
and the doctor, with emphasis on the impor-
tance of the doctor learning more about the
minds of his patients and applying this
knowledge in the practice of his profession.
No paper pertaining to psychiatry is re-
Address delivered before Second District Medical Society
at Tifton, October 13, 1949.
June, 1950
217
called as having been read before this so-
ciety during the past twenty years. The im-
portance of the subject is shown in the re-
jection by the draft boards of 1,850,000
young men for mental disorders during
World War II, or 38 per cent of all rejec-
tions. In addition there were approximately
one million admissions to Army hospitals
for mental disorders during World War II,
with 50 per cent of those admitted occur-
ring within 30 days after induction and 85
per cent within the first six months of Army
service. Only a small percentage were ad*
mitted for mental disorders due to battle
stress or battle fatigue, and of the small
percentage admitted more than half were
returned to duty. If we can place any faith
in psychiatric practice in the Army these
appalling statistics emphasize our failure in
helping to develop healthy minds in our
patients. Are we going to dismiss these
figures with the assertion that personality
adjustments are not important in civilian
life and that those mental disorders were
due to the interruption in our serene mode
of living? That would be the easy way hut
a visit among the patients in our State hos-
pitals will convince us that we have a tre-
mendous problem in the prevention of men-
tal disorders in our people in peace time as
well as in war time.
Before getting too deeply involved in the
subject of mind, matter and the doctor, a
story, which some of you have heard, will
be told about mind, matter and the man.
While serving as President of the United
States, Mr. William Howard Taft was said
to have weighed an average of 317 pounds
— a lot of matter for one man. On an occa-
sion of a gathering of Republican men and
women in New York City, Mr. Taft was the
honored guest and Mr. Chauncey Depew
was the toastmaster. In introducing Mr.
Taft to the distinguished gathering, Mr. De-
pew addressed the group as follows: “La-
dies and gentlemen, we have with us a man
who is pregnant with the ideals of Ameri-
can citizenship, a man who is pregnant with
the thoughts of better international relation-
ship, a man who is pregnant with those fac-
tors which tend toward community better-
ment, a man who is pregnant with the doc-
trine of State Rights for all states — ladies
and gentlemen, the President of the United
States.” In acknowledging this introduction,
Mr. Taft demonstrated an active mind with
his large amount of matter. With an obese
abdomen supported by a pair of large
hands, he replied: “My fellow Americans,
Mr. Depew has referred repeatedly to my
pregnancy. I have decided that if it is a
boy I will name him Theodore, if it is a girl
I will name her Columbia, but if it is gas
and I have very good reasons to believe it is
I will call it Chauncey Depew .”
As to specific mental disorders, we may
easily recognize the psychoses due to old
age, arteriosclerosis and other circulatory
changes, infectious diseases, metabolic dis-
eases, trauma, alcohol, drugs and other exo-
genous poisons, newgrowths or other or-
ganic changes in the nervous system, but we
must remind ourselves that only a very
small per cent of these readily recognized
psychoses were concerned with the rejec-
tion of nearly two million young men for
government services during World War II.
The psychoses from infectious diseases like
syphilis and epidemic encephalitis are de-
creasing rapidly because of the progress
we have made in developing preventive and
curative measures for the basic disease. The
psychoses from the metabolic diseases like
pellagra and beri-beri are likewise decreas-
ing as a result of medical progress. The
psychoses from drugs, alcohol and other
exogenous poisons are more or less static
in number. The psychoses from arterioscle-
rosis, other circulatory changes and senility
are increasing because people are living
218
The Journal of the Medical Association of Georgia
longer. The psychoses from newgrowths or
from other organic changes in the nervous
system, comparatively speaking, are not a
major problem.
What about the psychoses and psychoneu-
roses which disqualified so many of our
young men for Army service? They still
exist as major problems and help fill the
beds in our state hospitals with the dementia
praecox, the manic depressive, the para-
noia, the psychopathic personality and the
mentally deficient. Through the applica-
tion of eugenic laws the number of mentally
deficient is being reduced but we are doing
too little for the young people in their
twenties and thirties who are being diag-
nosed as manic depressives, dementia prae-
cox, paranoias, psychopathic personalities
and psychoneurotics. These may not be
readily recognized and many etiologic fac-
tors are mentioned by different psychia-
trists, but we are failing in our duties if we
make no efforts to learn and observe the
signs and symptoms of these diseases among
our patients and to give these patients the
help which they need. Otherwise we should
designate ourselves as specialists in the
diagnosis and treatment of organic diseases.
We do know that environmental factors play
a dominant role in the causation of mental
disorders in the young. Where young peo-
ple are brought up in good surroundings,
with good families and good social contacts
and without problems of personality adjust-
ments, mental disorders seldom develop. As
general practitioners we have other duties
besides catching babies, giving shots to
people who don’t like to take medicine by
mouth or congratulating our patients who
diagnose their own cases of appendicitis,
gallbladder disease or biliousness. When
a doctor and a patient confer in an office
there are two people in that office, both
equally important, and the mind of the
patient and his mental development are just
as important as the body and its physical
development.
Psychiatrists and psychologists have sal-
vaged many people and in doing so have
accomplished feats which were just as spec-
tacular, just as brilliant and just as impor-
tant as those of the surgeon who removed a
brain tumor or who corrected a congenital
defect of the heart. Because we note that
some people with physical handicaps will
follow vocations which require greater train-
ing and use of those parts of the body which
are physically defective, we must not think
like the student who asked a psychology
professor if the professor majored in psy-
chology because he had a weak mind.
Some of us older practitioners were
taught little about psychiatry and psychol-
ogy in medical school. I do recall the fol-
lowing story pertaining to psychiatry from
medical school days. A young man as a
patient in a hospital for the mentally sick
appeared before a parole board and was
asked a number of important questions. His
answer to what he would do when he re-
ceived his parole was “that he would go
down town, buy a sling shot, find some rocks,
come back and shoot all the windows out of
the hospital buildings.” After repeated re-
jections of his application for parole he wras
convinced that he would have to give a
different answer to this important question.
His final brilliant answer was that “he
would go down town, buy a quart of good
whiskey, rent a U-drive-it and find a good
looking girl to go riding with him. They
would drink a little, pet a little, smooch a
little and in the process of admiring and
stroking her beautiful legs, her shapely
knees and her soft thighs, he would discover
her pretty elastic garters. Then, he would
jerk off the garters, make a sling shot and
rush back to the hospital to shoot all the
windows out of the buildings.” But time
passes on and progress is being made in our
June, 1950
249
medical schools. Today our medical students
are being taught psychiatry and psychology
in a systematic manner, but there is much to
he done before psychiatry attains the place
in the curriculum of our medical schools that
it should have if our graduates are to receive
comparable training in the prevention and
cure of diseases of the mind along with the
superb training they are receiving in the
prevention and cure of diseases of the body.
I trust that the members of this society
will show such interest in the problem of
mental disorders that our program com-
mittees will consider inviting speakers who
know something about psychology and psy-
chiatry to address the society on this sub-
ject at least once every year. Thank you.
STAB HEART REPAIR
Report of Case
Cecil B. Elliott, M.D.
Cedartown
A penetrating wound in the cardiac re-
gion with evidence of intrapericardial pres-
sure requires immediate surgical interven-
tion. Successful treatment in the medical
centers has been reported for a number of
years and with the advent of available
whole blood supply and positive pressure
gas anesthetic equipment, more and more
cases are being reported from the small
town and country hospitals. During the last
war, small groups with essential equipment
were able to meet such exigencies with on
the spot surgery. This experience in many
instances is now being carried to the civilian
emergency which dictates immediate sur-
gical repair, no matter how small the hos-
pital or clinic.
The immediate dangers in stab wounds
of the heart or hemorrhage and heart tam-
ponade. These may be very rapid in onset
accompanied by signs and symptoms of
shock with cyanosis and marked respiratory
distress. If operation is not done at once,
death may result in a short time, depending
upon the size and location of the heart
wound. Sudden intrapericardial pressure
causes a drop in arterial pressure and an
increase in venous pressure.
Although it is necessary to prepare the
patient hurriedly, it should he done care-
fully to avoid wound infection. Since the
pleura is frequently injured, a positive pres-
sure gas anesthetic should he used. One of
the immediate dangers of the operation is
further injury to the heart muscle while at-
tempting to place sutures. The coronary
vessels, if not injured, should be carefully
avoided when placing sutures. Whole blood
transfusion is indicated as soon as the heart
wound is closed.
REPORT OF CASE
Case 1. A well developed well nourished male, aged
32, entered the hospital with a penetrating, sucking
wound of the anterior left chest in the second l.C.S.
Pulse imperceptible, B.P. 0/0, respiration 37 with
marked respiratory distress. Emergency steps were taken
to prohibit the ingress of air through the chest wall
by sealing it with vaseline gauze. Hie skin was cold
and clammy; neck veins were markedly distended and
no cardiac sounds were detected. Preparation for opera-
tion was begun and, in the interim, a flat plate of chest
was made which revealed a large globular heart shadow.
Available blood from the bank was cross-matched.
The patient was prepared and draped in the routine
manner. A local anesthetic was used in the initial steps
of the operation, while the endotracheal intubation was
being done. Ether, under partial positive pressure, was
administered so that the patient was sufficiently anes-
thetized when heart action was resumed. Positive pres-
sure was maintained while the chest remained open.
A semicircular incision was made from the second to
fifth ribs with the curve overlapping the sternal margin
and then extended through all structures to the cartilage.
A flap of skin, muscle and fascia was dissected up to ex-
pose the underlying cartilage and ribs of the thoracic
cage. A third and fourth two-inch rib resection, includ-
ing the sternal attachment, was done. The mammary
vessels were carefully clamped and ligated and a trans-
pleural approach was made by enlarging vertically the
original opening in the pleura. The pericardium was
markedly distended and motionless. The pericardial
wound was located and enlarged to six centimeters, thus
exposing a penetrating wound two centimeters in length
in the left ventricle. The tamponade was removed by
suction and moist sponging. The heart wound was
easily found from the spurting blood because heart action
immediately became vigorous as soon as intrapericardial
pressure was released. Blood transfusion was begun. The
area was sprayed with 2 cc. of 5 per cent novocaine
solution and the forefinger of left hand was placed
over the wound. Four interrupted triple zero nylon
sutures were placed through the rent under the fore-
finger. They were then held under tension, as the finger
was removed, and tied separately. The pericardium
250
The Journal of the Medical Association of Georgia
was irrigated with warm, normal saline solution and
closed with triple zero nylon. A stab wound was made
in the posterior axillary line of the sixth I.C.S., a
No. 16 soft rubber catheter placed, the lung was rein-
flated and the chest closed tightly in layers.
The patient was placed in Fowler's position and the
catheter connected to a trap to prevent positive pressure
accumulation. Continuous oxygen was given for four
days. He received 1000 cc. of whole blood to replace
the blood loss and for six days was maintained on peni-
cillin, quinidine and alpha-tocopherol. He was dis-
charged from hospital on the eighteenth postoperative
day.
SOME OBSTRUCTIVE LESIONS IN THE
NEWBORN
J. Dudley King, M.D.
Atlanta
Obstructive lesions of the gastrointesti-
nal tract in infants are of considerable in-
terest to the pediatrician, the surgeon and the
radiologist. Prompt diagnosis is essential
in some of these lesions and, even then, the
prognosis too often is poor.
During the ten-month period from April
1, 1949 to February 1, 1950 the following
cases were seen in the X-ray Department of
the Crawford W. Long Memorial Hospital.
There were four cases of esophageal atresia,
eight cases of pyloric stenosis, and one case
each of the following: duodenal obstruction,
atresia of the ileum, obstruction due to
meconium, and imperforate anus.
Esophageal atresia may be recognized
during the first few hours of life by excess
mucus and prompt regurgitation of the first
attempted feedings. The following case his-
tories are of interest.
REPORT OF CASES
Case 1. This premature male infant weighed 4 lb. 6
oz. at birth. He was admitted ten hours after delivery
at a nearby town, and a clinical diagnosis of esophageal
atresia was made. Radiographs showed the site of
atresia to be high, at the level of T-3. Air was present
in the intestinal loops, indicating that a fistula was
present between the lower esophageal segment and the
tracheobronchial tree. This is the most common type of
esophageal atresia; that is, a blind pouch above and a
fistulous communication with the lower esophageal seg-
ment and the tracheobronchial tree. About 70 per cent
of the esophageal atresias are of this variety.
An esophageal anastamosis and fistulectomy was done
30 hours after admission. The immediate postoperative
cour-e was good, but the baby developed atelectasis and
died 48 hours postoperatively.
Case 2. This was a normal delivery, but the baby was
a typical mongolian. Excess mucus and vomiting at the
first feeding led to the clinical diagnosis. Fluoroscopy
and radiography with the injection of lipiodol into the
esophagus revealed a high atresia of the esophagus with
a fistula connecting the esophagus and trachea above the
site of the atresia. Air was again present in the intes-
tinal loops indicating that there was a communication
below the site of the atresia between the lower esopha-
geal segment and the tracheal bronchial tree. This type
of atresia is less common, for a fistula was present both
above and below the site of atresia.
Case 3. This premature infant was admitted about
three hours after birth at a nearby town. Her weight was
4 lb. 11 oz. An esophageal atresia was demonstrated at
the level of T-2. At operation a wide defect was shown
between the two esophageal segments. The upper seg-
ment actually did not enter the chest. A fistula was
closed between the lower segment and the bifurcation
of the trachea. The next day the upper segment was
exteriorized and a gastrostomy done. The baby is doing
well now and weighs about 6 lb. Another operation is
planned when the baby is 18 months old. The stomach
will be mobilized and brought up through the chest to
the neck if possible. If this is not possible, then a tube
will be grafted and an anastamosis established under
the skin of the anterior chest wall.
Hypertrophic pyloric stenosis is not, in
the strict sense, an obstructive lesion in the
newborn. It manifests itself a few weeks
after birth, but since it is a congenital lesion,
it is included here. In specimens obtained
from infants a week or ten days of age, the
mucosa and submucosa of the pylorous are
essentially normal. After this time the forc-
ing of curds through the small opening
brings about edema of the mucosa and a
slight increase in the leukocytic infiltration
of this layer. This mechanical irritation
therefore produces thickening of the mu-
cosa, which further reduces the already
small size of the pyloric lumen. It is for
this reason that infants do not exhibit signs
of obstruction until they are about two weeks
of age in spite of the fact that the hypertro-
phied muscle has been present since birth.
The radiologist, in attempting to demon-
strate hyperterophic pyloric stenosis, at-
tempts to obtain radiographs with the py-
loric canal outlined by barium. If this is
done, the so-called “string sign” is pro-
duced. This sign is considered to be pathog-
nomonic by many observers. The elongated
canal may be two or more centimeters in
length. The normal canal is less than one
centimeter in length.
June, 1950
251
Certainly radiographic examinations are
not necessary in typical cases. Radiographs
are reassuring confirmatory evidence, how-
ever, and the demonstration of a normal
pyloric canal practically excludes hypertro-
phic pyloric stenosis as the possible cause of
vomiting.
Obstruction in the duodenum may be due
to atresia, stenosis or malrotation of the
midgut with or without peritoneal bands
across the lower part of the descending duo-
denum. Our case was due to malrotation.
In the majority of these cases the cecum
lies just below the distal half of the stom-
ach, and peritoneal bands cross from the
cecum or ascending colon and attach to the
posterolateral abdominal wall. Thus these
bands cross the duodenum and cause ob-
struction. When the bands are absent, the
cecum may lie over the second or third
portions of the duodenum and cause ob-
struction by external pressure. In our case
no bands were demonstrated across the duo-
denum, but there was a volvulus of the
midgut which is a fairly common complica-
tion in these cases.
The case of atresia in the ileum was some-
what unusual. The baby developed abdom-
inal distention two days after birth and
vomited feedings. Radiographs showed
small irregular calcific shadows scattered
in several areas of the abdomen. The small
calcific shadows appeared to be intralum-
enal. In the right lower quadrant of the
abdomen circular calcific shadows were
present which appeared to outline the lumen
of the bowel in that area. No gas could be
demonstrated in the large bowel.
At operation numerous adhesions were
found. The abdomen was entered with con-
siderable difficulty because of these dense
adhesions. An atresic segment of gut was
found in the ileum and 50 cm. of small
bowel was resected and re-anastamosis was
done. Microscopic examination of the
atresic segment showed a hemangioma
with extensive calcification in the wall of the
bowel. The immediate postoperative course
was good but an uncontrollable diarrhea
developed later. This diarrhea continued
and the baby died 6 weeks after operation.
At postmortem examination 50 cm. of small
bowel and 42 cm. of large bowel were pres-
ent. This together with the 50 cm. of small
bowel resected is less than one-half the
usual length of the gastro-intestinal tract
for an infant of this age.
It is felt that this was responsible for the
uncontrollable diarrhea. The immediate
cause of death was bronchopneumonia.
Approximtaely three-fourths of patients
with ano-rectal anomalies have complete
obstruction and are therefore seen in the
first few days of life. Usually the obstetri-
cian notes an imperforate anus if this is
present. This was the case in our patient.
Wagensteen and Rice in 1929 first de-
scribed the ingenious way we now all use
to investigate the position of the blind rectal
pouch. The baby is inverted and an opaque
object is placed on the dimple of skin where
the anal opening should be. Lateral radio-
graphs are better than anteroposterior radio-
graphs for locating the position of the pouch.
It is well to remember that 18 to 24 hours
may be required before the gas can be pro-
pelled through the sticky meconium to the
rectum. An examination prior to that time,
showing no gas in the rectum, is not re-
liable; and has, in many#cases, led the
surgeon to make unnecessary abdominal
approach to re-establish continuity.
HEALTHGRAM
Tuberculosis is not a simple health problem like the
removal of tonsils or the repair of a broken leg. It is a
complex, long-time ailment almost always resulting in
a special way of living. Tuberculosis involves many
things besides hospital, medical, and nursing care. It
has many requirements on the social welfare side and
these needs are often of long duration. The tuberculosis
problem is one of prehospital and posthospital care with
all that they mean. Moreover, it is a problem of the
care of the patient’s family as well as of the patient.
Ruth Taylor, Nat. Tuberc. A. Bull., Oct., 1949.
252
The Journal of the Medical Association of Georgia
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
June, 1950
THE CHALLENGE . . . PUBLIC RELATIONS
(This editorial, ivritten by V. 0. Foster, Executive
Secretary for the Tennessee State Medical Association
and published in its May 1950 journal, applies to Georgia
as well. Read it, please.-— Ed.)
The special session of the House of Delegates
called for May 13 will go down as a momentous
one in the history of the Tennessee State Medical
Association. Momentous because a decision will
be made on projecting and financing a strong and
positive Public Relations Program.
As a result of the changes in the administra-
tive and executive functions of the headquarters
office which came about during the annual meet-
ing in Memphis, it might be assumed that the
Executive Secretary is now in a position to
execute a strong Public Relations program.
Although Public Relations is one of his new
responsibilities, the lack of personnel, assistance,
and time will prevent his giving the necessary
attention to such an all-important phase of the
Association's activities. Routine administrative
duties such as director of finance, the business
management of the Journal, services to the vari-
ous boards, councils, and committees of the As-
sociation. the handling of the multitudinous de-
tails of The Tennessee Plan, routine office man-
agement, public service demands, and publicity
simply means that the Public Relations program
cannot possibly be more than an incidental and
totally inadequate consideration of the Executive
Secretary.
The Executive Secretary conceives of the head-
quarters office as having two all-inclusive pur-
poses: (1) services to the profession and (2)
services to the public. Every activity of the
executive office falls clearly into one of these
service fields. If a creditable job is to be done
in both fields, adequate personnel, facilities, and
funds are necessary. It is in the area of “services
to the public” where a sound and effective Public
Relations program can make the greatest contri-
bution to the Association.
With the addition of a new staff member work-
ing in the special field of services to the public
and with the Executive Secretary free to render
necessary and vital services to the profession, a
reasonable amount of success could be expected
in both fields.
Each of these services would complement and
reinforce each other. Obviously these two fields
of service must have a high degree of coordina-
tion and administrative control. Such coordina-
tion will avoid the serious errors of working at
cross-purposes, duplications, and waste of the
time of personnel, facilities, and funds.
Such a dual program must be service, not pub-
licity. It must be performance, not propaganda.
It will stand or fall eventually upon whether or
not a solid record of achievement is accom-
plished.
Rased on a backlog of experience in other
states, it can he said that medical Public Rela-
tions— good Public Relations — falls into two
percentages:
Eighty per cent depends upon the relations
between the doctor and the patient. Twenty
per cent depends upon the presentation of the
medical profession to the public. These two are,
however, inseparable and interdependent.
It must lie pointed out that the medical pro-
fession now enjoys, and has long enjoyed, a
highly favorable public acceptance and ap-
proval of its major service — the service of ren-
dering medical care of the highest quality. The
public has no quarrel with the medical profes-
sion over the superior scientific quality of its
service. In fact, the technical superiority of
medical science has done much to place a damper
on open criticism of other aspects of medical
practice — the social, economic, and even politi-
cal aspects.
It is in the fields of medical economics, medi-
cal sociology, and medical politics (statesman-
ship) where more effective leadership needs to
be demonstrated.
The medical profession, because of inade-
quate public information about its accomplish-
ments, and because there are enemies of the pro-
fession who would destroy it for their own selfish
purposes, feels that it must submit its own case
to the bar of public opinion. The case must be
effectively presented. There is no individual nor
group of individuals who can escape the search-
ing light of public opinion. Eventually public
opinion crystallizes and represents itself in politi-
cal, economic, and social action. If these actions
are favorable, all is well. To the degree that they
are unfavorable, there is an inevitable decline in
public approval and approbation.
The present effort to destroy the private prac-
tice of medicine is a threatening example of the
length to which unfavorable segments of the
public will go in order to bring about certain
changes which they desire. Of course, the estab-
lishment of political medicine would not be in the
public interest and the public would pay a dear
price for its realization. It is crystal clear that
the medical profession, as a defender of the
public interest, must do its part to preserve and
to extend the free enterprise system. This sys-
tem has been the atmosphere in which not only
June, 1950
253
medicine, but the whole economy has given
America the highest standard of living in the
world.
There are problems in the field of distribution
of medical care, there are problems in the field
of cost of medical care, and there are problems
related to the availability of medical care. All
these problems are challenging opportunities for
increasing the services of the profession to the
public. They are important aspects of a Public
Relations program.
There is no profession that can lay claim to
loftier ideals, to more humanitarian purposes,
and to greater dedication to the public welfare
than can the profession of medicine. The intelli-
gence, the courage, the devotion to duty, to say
nothing of the superior scientific accomplish-
ments of men of medicine, have earned an over-
whelming amount of public acceptance and ap-
proval.
It is not enough, however, to “be good and
do good.” Publicizing these virtues is a part of
the Public Relations equation. The accomplish-
ments of medicine must be known by the public.
The public is looking to the profession for the
solution of many of its medical care problems.
The profession can solve these problems and
solve them in voluntary, cooperative ways. There
is still time. Unless they are thus solved, it is
apparent that the public will look to a bureau-
cratic arm of the federal government for such
solutions.
The aim and purpose of a good Public Rela-
tions program should be to conserve and create
a high degree of favorable public opinion toward
the profession and its members.
Public Relations is not new, but an apprecia-
tion of its value is relatively new. The Great
Physician understood and utilized effective Public
Relations techniques, else how would you inter-
pret this line of Holy Writ:
“Let your light so shine before men, that
they, seeing your good works ...
Or how would you interpret Lincoln's observa-
tion when he said:
“Public sentiment (opinion ) is every-
thing. With public sentiment nothing can
fail; without it, nothing can succeed; con-
sequently he who molds public sentiment
goes deeper than he who enacts statutes.
UNITED STATES PHARMACOPEIA
One of the most important decennial meetings
of the United States Pharmacopeial Convention
was the recent meeting in Washington, D. C.
Preceding the convention was a conference, at
which time a series of simultaneous meetings
was held on scientific subjects of pharmacopeial
interest. These included reviews of the status of
pharmacopeial standards for protein hydroly-
sates, antibiotics, water for pharmaceutic uses,
volatile oils, vegetable drugs and dermatologic
preparations and other topics.
The convention considered and adopted with
some modification the recommendations of the
Committee on Constitution and By-Laws, which
was appointed at the 1940 convention meeting.
This committee reported at a special meeting in
1942, at which time the proposed by-laws were
adopted, but tbe constitution was held over until
the 1950 meeting. The changes in the constitu-
tion were extensive but reflected the attempts of
those who are interested in the United States
Pharmacopeia to insure continued progress of
this organization.
At this convention officers and members of the
Committee of Revision for the 1950-1960 conven-
tion were elected. The president is Dr. Allen H.
Bunce of Atlanta, Georgia. Dr. Bunce, who had
been chairman of the Committee on Constitution
and By-Laws, succeeded Dr. Carey Eggleston.
Adley B. Nichols and W. Paul Briggs were re-
elected secretary and treasurer, respectively. The
vice president is Dr. Theodore G. Klumpp. The
Board of Trustees, which includes two represen-
tatives from medicine, two from pharmacy and
two at large, consists of Robert L. Swain, editor,
Drug Topics and Drug Trade Neivs; P. H. Cos-
tello, secretary, National Association of Boards
of Pharmacy; Ernest Little of the College of
Pharmacy, Rutgers Lhiiversity; Carson P. Frai-
ley, executive vice president, American Drug
Manufacturers Association; Arthur C. DeGraff,
professor of therapeutics, New \ork University
College of Medicine, and Austin Smith, editor of
The Journal of the American Medical Associa-
tion. Swain, Costello and Little were members
of the preceding Board of Trustees; the others
are newly elected. Lloyd C. Miller was introduced
as the director of the Committee of Revision for
1950-1960. He succeeded Dr. E. Fullerton Cook,
who for five decades has worked closely with
the United States Pharmacopeia. Dr. Cook gave
untiring service during his time as director of
the Committee of Revision and was eulogized on
several occasions at the convention.
The United States Pharmacopeia is an official
compendium under the provisions of the Federal
Food, Drug and Cosmetic Act and is of outstand-
ing importance in the establishment of drug stand-
ards for the enforcement of this act. Thus it
has tremendous influence in industrial and other
circles and is of great importance in the protec-
tion of the health of the people. Furthermore, it
is internationally known and has been officially
recognized in a number of Latin American coun-
tries. Those who have an opportunity to serve
the Pharmacopeia and its interests have a right
to cherish this opportunity. Because of the nature
of the Pharmacopeia and what it represents, those
who are responsible for its affairs cannot think
of personal interest; they must always have in
mind the interest of the Pharmacopeia. The newly
elected officers and members of the Committee
25 1
The Journal of the Medical Association of Georgia
of Revision for the 1950-1960 United States
Pharmacopeial Convention should have the con-
tinued support of the medical, pharmacal and
allied organizations in their work. — Editorial The
Journal of the American Medical Association,
May 27, 1950.
ENJOY YOURSELF: IT IS LATER THAN
YOU THINK
It was several years ago: I was ill at the time.
Dr. Edgar D. Shanks, editor of The Journal of the
Medical Association of Georgia, asked me to
write an article from the point of view of a pa-
tient. I wrote the article “I Became a Patient'5
which was published in The Journal.
Recently 1 have been ill again and among the
books brought to me to read was “A Chinese
Garden”. It is a short story by Dr. Frederic
Loomis, and gives the probable origin of the
current expression “Enjoy yourself, it is later
than you think”. This story is to the point and
furnishes food for thought. As I read it I was
reminded of a resolution on the death of a
doctor friend of mine, published recently, which
stated — “His life and work were characterized by
a zealous devotion to his work. It is said of him
that he had no hobbies, except his work, and
he was untiring in it and never refused a request
for aid from a patient.”
Throughout his years of arduous work he had
cherished the dream of some day having time
to go fishing, which was the one sport he most
enjoyed. At last in December 1949, after surviv-
ing a series of heart attacks, he planned a vaca-
tion in Florida, where he could realize his ambi-
tion to go fishing. However, on December 27,
1949 he succumbed to cerebrovascular accident.
It was later than he thought — he did not live
to realize his life's ambition to go fishing.
The following is the full quotation of “A Chi-
nese Garden".
IN A CHINESE GARDEN
“In the past few years the epigram or aphor-
ism which is the inspiration for this little story
has been widely used (says its author). It was,
in part, the title and the theme of a poem written
years ago by Robert Service. It was used again,
in part, as the title of a book on the perils of
democracy written by Max Lerner and published
in 1937. I have seen it used in numerous adver-
tisements. If Robert Service coined the expres-
sion, if others saw it and read it in a Chinese
garden, or if like other strange Chinese sayings
it made its way into our lives by other means, I
do not know.
“I have told the story of a certain letter which
I received nearly ten years ago a good many
times because the impression it made on me was
very deep and very lasting, but I have never
written it for publication; and I have never told
it. on ships in distant seas or by quiet firesides
nearer home, without a reflective, thoughtful
response from several of those in the little group
around me who made it a matter of immediate
and personal concern either for themselves or
for someone dear to them.”
Peking, China
Dear Doctor:
“Please don’t be too surprised in getting a letter
from me. I haven’t any real right to address you and I
am signing only my first name. My surname is the same
as yours.
“You won’t even remember me. Two years ago I was
in your hospital under the care of another doctor. I
had never heard of you. I lost my baby the day it was
born. That same day my doctor, who was skillful
enough hut perhaps not too understanding, came in to
see me, and as he left he said, ‘Oh. by the way, there is
a doctor here with the same name as yours who noticed
your name on the hoard, and asked me about you. He
said he would like to come in to see you if you were
willing and I would permit him to, because the name
is not a common one and you might be a relative.’ 4 told
him you had lost your baby and 1 didn’t think you would
want to see anybody, but it was all right with me.’
“And then in a little while you came in. You put your
hand on my arm and sat down for a moment beside my
bed. You didn’t say much of anything but your eyes
and your voice were kind and pretty soon I felt better.
I was a very long way from home and had no one of my
own. As you sat there I noticed that you looked tired
and the lines in your face were very deep. I never saw
you again hut the nurses told me you were in the hos-
pital practically night and day.
“This afternoon 1 was a guest in a beautiful Chinese
home in Peking. The garden was enclosed by a high
wall, and on one side, surrounded by twining red and
white flowers, was a brass plate about two feet long
embedded in the wall. I asked someone to translate
the Chinese characters for me. They said:
ENJOY YOURSELF
IT IS LATER THAN YOU THINK.
“I began to think about it for myself. I have not
wanted another baby because I am still grieving for the
one 1 lost, but I decided that moment that I should
not wait any longer. Perhaps it may be later than I
think, too. And then, because I was thinking of my
baby, 1 thought of you and the tired lines in your face,
and the moment of sympathy you gave me when I so
needed it. I don’t know how old you are but I am quite
sure you are old enough to be my father; and I know
that those few' minutes you spent with me meant little
or nothing to you, of course — hut they meant a great
deal to a woman who was desperately unhappy and
alone.
“So I am so presumptuous as to think that in turn I
can do something for you too. Perhaps for you it is later
than you think. Please forgive me, but when your work
is over, on the day you get my letter, please sit down
very quietly, all by yourself, and think about it.
Marguerite.”
“Usually I sleep very well when I am not dis-
turbed by the telephone, but that night I was
restless. I woke a dozen times seeing the brass
plate in the Chinese wall. I called myself a silly
old fool for being disturbed by a letter from a
woman I couldn’t even remember, and dismissed
the thing from my mind; and before I knew it
I found myself saying again to myself: ‘Well
maybe it is later than you think; why don't you
do something about it?5 And the argument with
myself continued until I did what I really knew
I would do all along. I went to my office next
morning and told them I was going away for
three months.
“It is a wholesome experience for any man
June, 1950
255
who thinks he is important in his own organiza-
tion to step out for a few months. The first time
1 went away on a long trip, some years before
th is letter came, I felt sure that everything would
go to pieces, even though I had an entirely
competent associate, but I was almost too tired
to care. When I returned I found there were just
as many patients as when I left, everyone had
recovered just as fast or faster, and most of my
patients did not even know I had been away.
It is humiliating to find how quickly and com-
petently one’s place is filled, but it is a very good
lesson.
“I telephoned to Shorty, the retired colonel
who was perhaps my closest friend and w'ith
whom I had been around the world, and asked
him to come to my office. On his arrival I told
him that I wanted him to go home and pack a
grip and come on down to South America with
me for a little jaunt. He replied that he would
like to but that he had so much to attend to in
the next few months that it was out of the ques-
tion to be away even for a week.
“I read him the letter. He shook his head.
‘I can’t go,’ he said. ‘Of course I’d like to, but
for weeks now I’ve been waiting to close a deal
for all that property I’ve had so long, down by
the lake. I’m sorry, old man, but maybe some-
time— sometime — his words came more slowly.
What was that thing again that woman said?
‘It is later than you think’? Well — -
“He sat quietly for a moment. Neither of us
spoke. I could almost see the balance swaying
as he weighed the apparent demands of the pres-
ent against the relatively few years each of us
still had to live, exactly as I had done the night
before.
“At last he spoke, very seriously and thought-
fully.
‘I have waited three months for those people
to make up their minds. I am not going to
wait any longer. They can wait for me now.
Perhaps it is quite a little later than I have
thought in the last few years. Maybe they are
the last few years — and —
“He jumped to his feet, again the soldier, re-
placing the dreamer of a moment before.
‘They can go to the devil. They can go and
jump in that damn lake for all I care;’ and then
more quietly: ‘When would you like to go?’
“We went to South America. We spent day
after day at sea on a comfortable freighter,
feeling our burdens slip off with the miles and
our tired bodies being made over by the winds
that swept across the Pacific from China. In the
course of time we found ourselves in one of the
great cities of South America. By good fortune,
we became friendly w'ith one of the prominent
men of the country, a man who had built enor-
mous steel plants and whose industries were
growing rapidly. We went with him on Sunday
to his estancia, where we were entertained with
the perfect hospitality of the South American
aristocracy.
“During the afternoon. Shorty, who loves his
golf, asked our host if he played the game. He
replied: ‘Senor, I play a little, I would like to
play more. My wife is on a vacation in the
United States with our children. I would like
to join her. I have beautiful horses here which
I would love to ride. I can do none of these
things because I am too busy. I am fifty-five
years old and in five years more I shall stop’.
“It is true I said the same thing five years ago,
but I did not know how much we should be
growing. We are building a new plant in Cali;
we are making steel such as South America has
never known. My steel will still be good when I
am gone, and I must watch until our way is made
more clear. I cannot let go even for an afternoon
of golf. My office boy has better leisure’.
“Senor,” I said, “do you know7 why I am in
South America?”
“Because,” he said “because perhaps you had
not too much to do and had the necessary time
and money to permit it.”
“No,” I replied, “I had a great deal to do and
I did not have too much of either time or money.
We are sitting here on a lovely terrace because a
few weeks ago a girl whom I wouldn’t know now
if I saw her looked at a brass plate in a Chinese
wall in the city of Peking in the heart of China.”
“I told him the story. Like Shorty, he made
me repeat the words ‘Enjoy yourself, it is later
than you think.’ During the rest of the after-
noon he seemed a bit preoccupied, but continued
to be a solicitous and perfect host.
“The next morning I met him in the corridor
of our hotel. ‘Doctor’, he said, ‘please wait a
moment. I have not slept well. It is strange, is it
not, that a casual acquaintance, which you would
say yourself you are, could change the current
of a very busy life? I have thought long and
hard since I saw you yesterday. I have cabled
my wife that I am coming. I shall do myself the
honor of calling upon you when I am there.’
“He put his hand on my shoulder. It was a
very long finger indeed, that wrote those words
on the garden wall in China.”
To the members of the Medical profession,
especially to those who are past forty years of
age, I wish especially to commend the above
story for thought.
A former patient of mine whom I had ex-
plored for painless jaundice, and found ad-
vanced carcinoma of the pancreas and liver, dur-
ing his convalescence, talked to me quite freely,
and being older than I, at the time, gave me
some good advice. He said that he had been
working hard all of his life, taking no vacations,
with the idea of enjoying himself, on his sav-
ings, in his old age. Now it was too late to carry
out his plans — he was dying and leaving his
256
Thk Journal of the Medical Association of Georcia
savings to others. He offered me this advice for
what it was worth — ou must have your pleas-
ure from day to day and not try to save it up
for some tomorrow, when it will be too late.”
To my fellow physicians again I would like to
repeat — “Enjoy yourself, it is later than you
think”.
T. C. Davison, M.D.
AWARDS, MACON SESSION, 1950
In addition to the awards to Dr. Cleveland
Thompson, of Millen, and Dr. Claude A. Smith,
of Stockbridge, for their contributions to medi-
cine and to public welfare, by the Committee on
Awards, another special committee whose names
are always held anonymous judged the scientific
and educational exhibits and made the follow-
ing awards:
Group A, Scientific:
First award to exhibit No. 9 Gallbladder Roentgen-
ology— Ted F. Leigh and Edgar A. Thompson. Depart-
ment of Roentgenology, Emory l niversity School of
Medicine, Atlanta.
Second award to exhibit No. 5 Angiograph in Cerebral
Vascular Lesions- Edgar F. Fincher, Homer S. Swanson
and Wm. S. Warren, Department of Surgery. Neurosurgi-
cal Section, Emory University School of Medicine, At-
lan'a.
Third award to exhibit No. 29. The Detection of Pre-
clinical Uterine Cancer — H. E. Nieburgs, E. R. Pund,
J. M. B'umbcrg and S. Bamford, Department of Clinical
Cytology, Medical College of Georgia, Augusta.
Group B. Educational :
First award to exhibit No. 23. IVhat the General Prac-
titioner Should Know About Tuberculosis — United States
Public Health Service, Communicable Disease Center, At-
lanta.
Second award to exhibit No. 21. Physical Medicine in
Child Rehabilitation- Harriet E. Gillette and Fred G.
Hodgson, Cerebral Palsy Society of Georgia, Crippled
Children’s Department of Public Welfare, and Aid-
more, Atlanta.
Third award to exhibit No. 1. Activities and Training
Program. Department of Ophthalmology and Otolaryn-
gology— Lawson VA Hospital in conjunction with Emory
University School of Medicine. T. W. 0. Meissner, A.
Paul Keller, Augustus Gafford, John Howard. F. Phinizy
Calhoun, Jr., Nathan i. Gershon and Lester Brown,
Atlanta.
Drs. Thompson and Smith received silver cups
for their contributions: Thompson for his untir-
ing work for the Medical Association of Georgia
and his continued interest in the development of
the practice of medicine, improvement in Geor-
gia's hospitals and clinics and improvement of
public health; Smith for his work many years
ago when he described the cycle for hookworm
infestation of the human body.
Certificates of merit will be sent the winners
of the awards named under Groups A and B.
EGYPTIAN DRUG PRODUCES GOOD
RESULTS IN HEART DISEASE
A drug known as visammin and also as khellin,
obtained from the fruit of a plant which grows
in Egypt, Arabia and Eastern Mediterranean
countries, produces good results in angina pec-
toris, a group of Chicago doctors report.
Drs. R. H. Roseman, A. P. Fishman, S. R.
Kaplan, H. G. Levin and L. N. Katz of the Medi-
cal Research Institute, Michael Reese Hospital,
describe their study of the drug in an article in
the May 13 Journal oj the American Medical
Association.
“Improvement of the cardiac status was defi-
nite in 1 1 of the 14 cases of angina pectoris,” the
doctors say. “Moderate improvement occurred
in another case, hut in the remaining two no
benefit was obtained. In four instances the im-
provement persisted for a time after administra-
tion of the drug had been discontinued. This is
attributable to the cumulative effects of the
drug.”
Nausea and insomnia believed to be caused by
the drug occurred in five of these 14 patients.
Response of the heart condition to visammin is
described as “dramatic and unequivocal" in some
cases.
A typical example of an excellent result was
seen in the case of a 66 year old man with long-
standing severe angina pectoris.
His response to visammin was rapid and pro-
gressive. Not only was he spared surgical opera-
tion to relieve the anginal pain, but he was able
to extend his activities. The number of glyceryl
trinitrate tablets he required daily dropped pre-
cipitously. His appetite improved, his despair-
ing attitude resolved and he became alert.
In eight patients with enlargement of the right
side of the heart or increased stress placed upon
the right side of the heart by lung disease, striking
improvement was noted following administration
of visammin.
Single injections of visammin resulted in sig-
nificant improvement in nine of 21 patients with
acute bronchial asthma. The response was
prompt, occurring within five or 10 minutes;
and was often dramatic but usually shortlived.
LINK LUNG CANCER TO PROLONGED
TOBACCO SMOKING
A significant relationship between prolonged
tobacco smoking and development of cancer of
the lung is shown by two reports published in
the May 27 Journal of the American Medical As-
sociation .
Excessive and prolonged use of tobacco, espe-
cially cigarets, seems to be an important factor
in causing cancer which originates in the lungs,
Ernest L. Wynder, B.A., and Dr. Evarts A.
Graham of Washington University School of
Medicine and Barnes Hospital, St. Louis, con-
clude.
Among 605 men with lung cancer, 96.5 per
cent were moderately heavy to chain smokers for
many years, compared with 73.7 per cent among
the 780 men in the general hospital population
without cancer, the St. Louis doctors point out.
Among the cancer group, 51.2 per cent were ex-
cessive or chain smokers compared to 19.1 per
cent in the general hospital group.
June, 1950
257
“In general, it appears that the less a person
smokes the less are the chances of cancer of the
lung developing and the more heavily a person
smokes the greater are his chances of becoming
affected with this disease,’" they say.
Smokers were classified on the basis of number
of cigarets smoked per day for 20 years or more.
Pipe and cigar smokers were included by count-
ing one cigar as five cigarets and one pipeful as
two and a half cigarets. Light smokers were
classified as smoking one to nine cigarets, mod-
erately heavy smokers 10 to 15, heavy smokers
from 16 to 20, excessive smokers 21 to 34 and
chain smokers 35 or more.
There may be a lag period of 10 years or more
between the cessation of smoking tobacco and
the occurrence of clinical symptoms of cancer,
however, the St. Louis doctors found. Among
the patients with cancer who had a history of
smoking, 96.1 per cent had smoked for over 20
years.
The occurrence of carcinoma of the lung in a
male nonsmoker or minimal smoker is a rare
phenomenon (2.0 per cent), according to the
study.
Tobacco seems to play a similar but somewhat
less evident role in causing cancer in women, the
doctors found. The incidence of lung cancer is
less in women than in men today. This is be-
lieved to be due in part to the fact that few
women have smoked for over 20 years.
There is rather general agreement that the
incidence of bronchiogenic carcinoma has in-
creased greatly in the last half century, the doc-
tors point out. The enormous increase in the
sale of cigarets in this country approximately
parallels this increase of bronchiogenic carci-
noma.
Among male patients with cancer of the lungs,
94.1 per cent were found to be cigaret smokers,
4.0 per cent pipe smokers and 3.5 per cent cigar
smokers. This prevalence of cigaret smoking is
greater than among the general hospital popula-
tion of the same age group. The greater practice
of inhalation among cigaret smokers is believed
to explain the increased incidence of the disease.
Data obtained from 1,650 patients admitted
routinely to the Roswell Park Memorial Institute,
Buffalo, N. Y., indicate that in a hospital popu-
lation cancer of the lung occurs more than twice
as frequently among those who have smoked
cigarets for 25 years than among other smokers
or nonsmokers of comparable age, according to
another study published in the same issue of the
Journal of the A.M.A.
“Pipe smokers apparently experience an al-
most equal increase in the incidence of lip can-
cer, compared with other smokers or nonsmok-
ers,” say Drs. Morton L. Levin, Hyman Gold-
stein and Paul R. Gerhardt of the Bureau of
Cancer Control, New York State Department of
Health, Albany.
“The data suggest, although they do not estab-
lish, a casual relation between cigaret and pipe
smoking and cancer of the lung and lip. Cancer
is now generally considered a disease attributable
to multiple causative factors. Among these are
‘irritants.’
“An irritant which is noncarcinogenic alone
may nevertheless increase the percentage of tum-
ors produced when its action is combined with
that of a carcinogen. Thus, some experimental
basis exists for explaining the apparent effect of
cigaret and pipe smoking, although the true na-
ture of the association with lung and lip cancer
remains to be determined.”
HORMONE-RELATED DRUG FAILS IN TEST
AGAINST RHEUMATOID ARTHRITIS
Pregnenolone, which showed some promise in early
tests against rheumatoid arthritis, failed to produce good
results against the disease in 18 patients, according to a
report by New York doctors which appears in the May
27 Journal of the American Medical Association.
The study was made by Drs. C. Maynard Guest, Wil-
liam H. Kammerer, Russell L. Cecil and Solomon A.
Berson of the Veterans Administration Hospital, Bronx,
and the New York Hospital and Cornell University
Medical College.
“Intramuscular injections of pregnenolone or pregne-
nolone acetate daily or two or three times a week
resulted in no improvement in 17 cases of rheumatoid
arthritis,” the doctors say.
“One patient with rheumatoid arthritis of the spine
improved objectively and subjectively. In one patient
with rheumatoid arthritis of the spine there was minor
improvement at the end of one week’s treatment, but
this was followed by gradual relapse in the face of
continued therapy.
“It may be that larger amounts given over a longer
period of time would have a more beneficial effect. The
negative results have led us to believe that these agents
offer no real promise in the treatment of rheumatoid
arthritis.”
The doctors found also that treatment with adrenalin
and testosterone propionate fthe male hormone) failed
to result in any consistent improvement in patients with
rheumatoid arthritis.
CALIFORNIA REPORT INDICATES 0 FEVER IS
TRANSMISSIBLE BY PERSONAL CONTACT
A report from Los Angeles indicates that Q fever may
be transmitted from person to person.
Three persons apparently have contracted the disease
by attending a patient. Dr. David L. Deutsch and E.
Taylor Peterson, a laboratory worker, of Wadsworth
Hospital, Veterans Administration Center, say in the
May 27 Journal of the American Medical Association.
The mode of transmission of the disease was not
determined.
More than 50,000 persons in the Los Angeles area
probably have been infected during recent years with
the microbe that causes 0 fever, doctors and an epidemi-
ologist of the National Institutes of Health, the U. S.
Public Health Service and the California State Depart-
ment of Public Health announced recently.
The disease was found to have occurred in the metro-
politan area of Los Angeles in 1947. It commonly is
characterized by headache, high fever, severe sweats and
pneumonia-like changes in the lungs. Nine deaths from Q
fever have been reported.
A study of Q fever made in the southern California
area where infection with the microbe is widespread
among cattle suggests that humans may contract the
infection by occupation in dairy or livestock industries,
use of raw milk and residence within one fourth a mile
of places where cattle are maintained or beef is pro-
cessed.
258
The Journal of the Medical Association of Georgia
GEORGIA DEPARTMENT OF PUBLIC HEALTH
METHEMOGLOBINEMIA
CAUSED BY NITRATE POLLUTION
IN DRINKING WATER
Gilbert R. Frith, Public Health Engineer
Georgia Department of Public Health,
Atlanta
Many reports have appeared in the literature1 s
describing methemoglobinemia, cyanosis and fa-
talities due to the administration of compounds
containing the nitrate radical, but Comly was the
first to recognize high nitrates in drinking water
as a cause of methemoglobinemia in infants. In
1945 Comly9 reported two cases of methemoglob-
inemia in infants which resulted from this pre-
viously unrecognized cause. Treatment with oxy-
gen for 30 minutes was ineffective but the admin-
istration of a l per cent solution of methylene
blue, 1.1 cc. per kilogram, was followed by
dramatic improvement. After several attacks and
repeated hospitalization, it was realized that the
only significant difference between hospital and
home environment was the drinking water. The
well water concerned was found to contain high
nitrates and when another supply was substituted,
no further difficulty was experienced.
Nitrates, when ingested, may be converted to
nitrites in the intestinal tract through bacterial
action. Nitrites are absorbed and convert hemo-
globin to methemoglobin.
In 1948 Cornblath and Hartmann10 used hu-
man subjects in a thorough study dealing with
the manner in which nitrates affect the body.
They concluded that “only infants who have a
gastric juice pH higher than 4.0 and nitrate re-
ducing bacteria in the upper gastrointestinal tract
develop methemoglobinemia from oral ingestion
of water containing nitrate ; that “if nitrate is
introduced into the colon (where nitrate reduc-
ing bacteria abound), methemoglobinemia de-
velops readily”; that “the treatment of choice
for the cvanosis is intravenous administration of
methylene blue, 1.0 to 2.0 mg. per kilogram”;
and that “the prevention of methemoglobinemia
can be accomplished by adding lactic acid to the
nitrate containing formula to inhibit bacterial
growth in the upper gastrointestinal tract as well
as by prohibiting the ingestion of nitrate.
In 1949 Donahoe11 described 5 cases of meth-
emoglobinemia in infants of 2 to 7 weeks of
age who were exposed to a nitratebearing water
supply. Mention was also made of 7 other cases,
one of which was breast fed and received no
water. In the latter case the mother was told to
drink water from a nitrate free source and to
drink no milk from cows using the nitratebear-
ing water. The baby recovered within a week
and remained normal with no more blue spells.
Bolts1", in 1949, reported 14 cases of cyanosis
associated with water supplies in which, at the
time of analysis, the nitrate nitrogen ranged from
20.0 ppm to 0.4 ppm. In 2 additional cases no
nitrates were detected in the water but no other
cause of the cyanosis was apparent. The fact was
noted, also, that shallow' well waters vary greatly
in nitrate content from time to time and one
instance was cited in which the nitrate nitrogen
content varied from 10 ppm to 70 ppm within a
two w'eeks period. Many additional observa-
tions12 20 have been reported by various authors
in recent years.
During the latter part of March 1950 a sample
of well water was submitted to the Georgia De-
partment of Public Health Water Pollution Con-
trol laboratory by Dr. R. C. McGahee, Augusta,
Georgia, with a request for nitrogen examination.
Dr. McGahee sent a brief statement with the
sample to the effect that a baby using the w'ater
was having periodic attacks of cyanosis which
were unexplained. The analysis of the water re-
vealed 7.5 ppm (parts per million) of nitrate
nitrogen equivalent to about 33 ppm of nitrates.
Drinking water from a municipal supply had been
prescribed for the mother and baby and the
attacks of cyanosis ceased.
Investigation by the author revealed that the
above family lived on a farm in Screven County,
Georgia, and that they had five children, the last
two- of whom were born after the family moved
to their present location. For convenience this
family is designated as Family A. The youngest
child, age 2 months, was born in the Svlvania
hospital and stayed three days, then came home
but received no water from the open rope and
bucket well for about four days. During this
period the child was nursing. When about 2
weeks old the child began to have “blue spells and
drowsiness”. Although still nursing, it was also
receiving some boiled water from the well. The
child was taken back to the Sylvania hospital for
examination but this revealed nothing since there
was no evidence of cyanosis at the time and no
other symptoms of illness. The parents wrere re-
ferred to Dr. McGahee in Augusta and the child
developed cyanosis while in his office. Hos-
pitalization and administration of oxygen were
ordered and the child returned to normal in 18
to 24 hours. After remaining in the Augusta
hospital six days no further symptoms developed
and the child was released on March 1, 1950. The
baby wras brought back on March 10, 1950 with
cyanosis. It was immediately hospitalized with
the administration of oxygen and again returned
to normal within 18 to 24 hours. This time the
baby remained in the hospital with no further
June, 1950
259
symptoms until March 18, 1950 when it was re-
leased with instructions to the parents to change
the drinking water of the mother and baby. The
attacks of cyanosis did not recur.
The fourth child (now two years old) of
Family A was also born while the family was
residing on the same farm and was given water
from the same well. This child was born in the
hospital and began having periodic blue spells
shortly after it was brought home. These attacks
of cyanosis continued until the child was about
6 months of age when they ceased and have not
returned. The cause of the attacks was never
determined.
On March 29, 1950 an investigation of condi-
tions on the farm of Family A as well as eight
other farms in the immediate vicinity, was made.
The area in question lies in the coastal plain
section of Georgia where the Sunderlin formation
outcrops adjacent to the Hawthorne formation.
The soil surrounding all of the wells concerned
is loose and sandy to about an 18 inch depth
under which a 6 to 8 foot layer of stable clay and
sand exists. Below that the formation is unstable
and subject to caving. All wells concerned had
some type of casing or shoring below the 10
foot depth. Static water levels in these wells
varied from 3 to 15 feet below the ground sur-
face.
Usually in the spring farmers in Georgia
store a certain amount of commercial fertilizer
in out buildings which are never far from
the well. In handling, a certain amount of fer-
tilizer is always lost on the ground in the storage
area. Frequently the fertilizer sacks are washed
in the wash pots, never far from the well, and
the wash water is dumped on the ground. The
nitrate radical in the well water may be derived
either from commercial fertilizer or manure.
All of the wells were of open rope and bucket
type with some type of curb. Samples of the water
were obtained for nitrate analysis and brief
notes were made relative to sanitation. One well
contained only a trace of nitrate nitrogen, the
other wells ranged from 3 ppm to 10 ppm with
an average of about 6 ppm. The following brief
comments relate to the well of Family A: Open
rope and bucket well. Electric pump installed in
pit to one side. Shed about 15 feet away periodi-
cally used for fertilizer storage. Slope from this
shed is toward well. Earth floor in shed thickly
covered with chicken manure. A manure laden
chicken house was within 30 feet of well. The
barn, hog pen and privy were about 100 feet
from well. The nitrate nitrogen content of the
water at this time was 7.0 ppm. Space does not
permit descriptions of the other eight farms and
wells.
The families living on these 9 farms were in-
terviewed with respect to the occurrence of other
cases similar to the one described above. Alto-
gether, 6 babies had been called blue babies
during early infancy by physicians and, of these,
3 died during attacks of cyanosis before the age
of 6 months. The oldest living child of this group
is now 3 years old. Although the evidence re-
lating to these cases is fragmentary and incon-
clusive, the high incidence of reported blue babies
in the small area survey is of interest.
Reported observations stress the danger of
feeding water containing nitrates to infants. This
danger may be increased by prolonged boiling.
Although it is desirable to destroy pathogenic
bacteria by bringing the water to a brisk boil,
continuous boiling for 5 to 30 minutes tends to
concentrate the nitrate ion. The extent to which
water supplies in Georgia are polluted by the
nitrate radical is not known, but the results of
this study appear to be sufficiently significant
to warrant investigation of the situation on a
statewide basis.
Acknowledgement: The author wishes to express his
appreciation to Dr. R. C. McGahee, Augusta, Georgia
for providing him with information relating to the case
reported above. Appreciation is also expressed for the
valuable assistance given by N. M. dejarnette. Public
Health Engineer, Elizabeth McEntire, Bacteriologist, and
W. H. Powell, Sanitarian.
REFERENCES
1. Barker, M. H., and O’Hare, J. P. : J.A.M.A. 91: 206,
1928.
2. Eusterman, G. B., and Keith, N. M.: M. Clin. North
America, 12 : 1489, 1929.
3. Roe, H. E. : J.A.M.A. 101: 352, 1933.
4. Marriott, W. M. ; Hartmann, A. F., and Senn, M. J. E. :
J. Pediat. 3: 181, 1933.
5. Hartmann, A. F. ; Barnett. H. L., and Perley, A.: J.
Clin. Investigation 17 : 699, 1938.
6. Evelyn, K. A., and Malloy, H. T. : J. Biol. Chem. 126:
655, 1938.
7. Wendel, W. B. : J. Clin. Investigation 18: 179, 1939.
8. Schwartz, A. S., and Rector, E. J., Methemoglobinemia
of Unknown Origin in a 2 Weeks Old Infant, Am. J. Dis.
Child 60: 652, 1940.
9. Comly, H. H. : Cyanosis in Infants Caused by Nitrates in
Well Water. J.A.M.A. 129: 112, 1945.
10. Cornblath, Marvin, and Hartmann, Alexis F. : Meth-
emoglobinemia in Young Infants, J. Pediat. 33: 421, 1948.
11. Donphoe, Will E. : Cyanosis in Infants with Nitrates in
Drinking Water as Cause, J. Pediat. 3 : 308, 1949.
12. Borts, I. H. : Water-borne Diseases, Am. J. Pub.
Health, 39: 974, 1949.
13. Johnson, G., et. al. : Nitrate Levels in Water from
Rural Iowa Wells, J. Iowa M. Soc. 36 : 4, 1946.
14. Faucett, R. L., and Miller, H. C. : Methemoglobinemia
Occurring in Infants Fed Milk Diluted with Well Water of
High Nitrate Content, J. Pediatrics 29 : 593, 1946.
15. Ferrant, M. : Methemoglobinemia; 2 Cases in Newborn
Infants Caused by Nitrates in Well Water, J. Pediat. 29:
585, 1946.
16. Medovy, H. ; Guest. W. C., and Victor, M. : Water
Supply; Cyanosis in Infants in Rural Areas (well water
hemoglobinemia), Canad. M.A.J. 56: 505, 1947.
17. Weart, J. G. : Effect of Nitrates in Rural Water Sup-
plies on Infant Health, Illinois M. J. 93 : 131, 1948.
18. Waring, F. H. : Significance of Nitrates in Water
Supplies, Jour. A.W.W.A., 41: 147, 1949.
19. Robertson, H. E., and Ruddell, W. A., Cyanosis of
Infants Produced by High Nitrate Concentration in Rural
Waters of Saskatchewan, Canad. J. Pub. Health, 40:72, 1949.
20. Bosch, H. M., et. al. : Methemoglobinemia and Minne-
sota Well Supplies, Jour. A.W.W.A., 42 : 171, 1950.
FAMILY FARE
If housewives find the recipes in today's magazines
take too much time, energy, and costly food items for
their purpose they may find a new booklet printed by
the Federal government a help. Its purpose is to help
home-makers serve enjoyable meals, keep the family
well nourished, practice thrift and save time and energy.
“Family Fare Food Management and Recipes" is the
name of the bulletin, and it can be secured from the
Government Printing Office, Washington, D. C., for
twenty-five cents.
260
The Journal of the Medical Association of Georgia
NEWS ITEMS
Dr. John S. Atwater, Atlanta, was elected a member
of the American Gastro-enterological Society at the
annual meeting of the society held at Atlantic City,
April 27-29.
* * * *
The Baldwin County Medical Society held its regular
meeting May 1. The guest speaker was Dr. D. F.
Mullins, Jr., of Athens, who presented a very interesting
program on the Rh factor. At the previous meetings, the
following were guest speakers: In April, Dr. Hoke Wam-
mock. of Augusta, spoke on "Early Diagnosis of Can-
cer."' ' In M arch Dr. R. M. Reifler, of Macon, spoke on
“Elementary Treatment of Skin Disorders." Dr. Robert
D. Waller, Secretary.
* * *
Bibb County held its own on the health front in
1949 despite popidation increases, Dr. R. Frank Cary
said recently. Dr. Cary’s figures showed no marked
hikes or drops in 1949 health figures compared with the
totals for the previous year. His figures were taken from
the Macon-Bihh County Health Center's annual report.
Dr. Cary heads the Health Center. He said Bibb Coun-
ty’s birth rate is "a good deal higher” than that of
Georgia or the nation. A breakdown of death figures
listed these ailments as the principal causes of fatalities:
Cerebral hemorrhage. 157; coronary artery disease, 138;
heart disease 98; cancer. 89; nephritis, 78; pneumonia,
71: accidents, 64; tuberculosis, 28; automobile accidents,
26; homicides, 15; suicides, 10; unknown, 79; and ill-
defined. 67. The death rate in Bibb County is very near
the national average. Dr. Cary summed up 1949 as a
healthy year. He proudly pointed out that no malaria
or typhus cases were reported, as compared with recent
years when those diseases hit hard.
* * *
Dr. Long's Claims Sustained. Dr. Frank Kells Boland
of Atlanta is the author of a book entitled The First
Anesthetic, which has just been published by the Uni-
versity of Georgia Press.
Dr. Boland has evidently rendered a public service
to the people of Georgia and indeed of the entire South
by presenting convincing evidence that Dr. Crawford
W. Long was the first person in history to make use of
anesthesia in performing a surgical operation. The ques-
tion has been in controversy for more than a hundred
years. Opinion divided as almost entirely along sectional
lines. The people of Georgia gave expression to their
own opinion when they placed the statue of Dr. Long in
Statuary Hall at Washington. Others in the South feel
that an impartial examination of all the evidence proves
that Dr. Long was entitled to the credit for the first use
of this great humanitarian agency, anesthesia.
Dr. Boland claims that Dr. Charles T. Jackson is the
“villain ” in the piece. He shows that Jackson visited
Georgia in connection with the gold mine operations at
Dahlonega at about the time Dr. Long performed his
first operation with the use of anesthesia. The author
of this book feels that Jackson learned of Dr. Long’s
discovery and passed on the information to Dr. W. T. G.
Morton, a Boston dentist who is sometimes credited
with having been a pioneer in this field. Dr. Boland
says that Jackson and Morton first tried to claim joint
credit for the discovery and later that Jackson claimed
it exclusively for himself.
According to Dr. Boland’s book. Jackson was a vain
and ambitious sort of person who claimed credit for the
discovery of gun cotton and tried to take from Samuel
F. B. Morse the credit of inventing the telegraph. He
made many other fantastic claims which have as little
foundation in fact.
The presumption would therefore be against Jackson
in any case but Dr. Boland seems to have provided
evidence which should settle this controversy for all
time. — Editorial page of The Macon Telegraph. April
23, 1950.
* * *
The Warren A. Candler Hospital staff. Savannah, re-
cently elected Dr. Walter E. Brown to succeed Dr. D. B.
.MEETING OF THE OFFIGERS AND GOllNCIL
Medical Association of Georgia
Academy of Medicine
Atlanta, May 18, 1950
1. Gall to order by Chairman W. G. Elliott.
2. Roll call by Clerk M. C. Pruitt of the Council.
Present were: Drs. A. M. Phillips, W. F. Reavis. Leon
I). Porch, T. A. Peterson. Edgar D. Shanks. Lee Howard,
W. G. Elliott, .1. W. Chambers, M. C. Pruitt, H. D. Allen,
Jr., D. Lloyd Wood, Sage Harper, Bruce Schaefer. A
quorum was declared present.
3. Discussion of prepayment medical care plans by
Dr. W. S. Dorough, Atlanta.
4. Di cussion of current public relations problems by
Drs. Mason Lowance. Hal Davison. S. A. Kirkland, and
J. C. Norris, all of Atlanta.
5. Executive session:
a. Further discussion of the public relations problem,
after which it was voted that the present personnel of the
public relations department vacate their positions but
that the department be continued, that it be adminis-
tered by the Executive Committee of the Public Relations
Committee; namely, the President of the Association,
the Chairman of the Council of the Association, the
Secretary-Treasurer of the Association, the Chariman of
the Committee on Public Policy and Legislation of the
Association, and the Chairman of the Public Relations
Committee of the Association; that $15,000 be appro-
priated for the public relations department for the ensu-
ing Association year; and that the activities of the public
relations program be more closely tied to the activities
of the office of the Association, all for the improvement
of the public relations program and for the benefit of
the Association as a whole.
b. After reviewing the current audit of the Associa-
tion’s finances, by Ernst & Ernst, Atlanta, and consider-
ing the costs for all current activities of the Association,
it was voted that the dues for 1951 be $15.
c. After discussion cf the current needs of the Com-
mittee on Prepayment Medical Care Plans, the Secretary-
Treasurer was authorized to pay the necessary bills in-
curred in the development of this program to and not to
exceed $1,000 for the ensuing Association year. In this
connection, it was agreed that the final plan, as adopted
by the Committee on Prepayment Medical Care Plans,
would be submitted to the Council for approval before
the plan was offered to the public.
6. Adjournment.
Edgar D. Shanks, M.D.
Secretary-Treasurer
Fillingim as president of the group at the annual meet-
ing. Dr. C. R. A. Redmond was elected to serve as
vice president, and Dr. Anne Hopkins, was re-elected
secretary. Dr. Jacob Rubin is the outgoing vice presi-
dent.
♦ ♦ ♦
Dr. Raymond S. Crispell, Atlanta psychiatrist, was
guest speaker at the meeting of the Savannah Mental
Hygiene Society in the Gold Room of the Hotel DeSoto.
Savannah, May 8. Dr. Crispell spoke on “The Community
and the Psychiatrist”. Now' chief of the neuropsychiatry
division of the Southeastern area of the Veterans Admin-
istration. Dr. Crispell also serves as consultant in mental
hygiene to the Georgia Institute of Technology.
* * *
Dr. Walter W. Daniel, Atlanta, past-president of the
Fulton County Medical Society, was elected president
of the Atlanta Wofford College Alumni Club at the din-
ner meeting April 21.
* * *
Emory University School of Medicine and its Alumni
Association, Atlanta, recently published a medical
alumni directory, the first of its kind published at Emory.
Whatever-became-of-old-Joe is answered for 2,733 alumni
of Emory. The directory was mailed to doctors in 41
States, 830 towns, and 17 foreign countries, and carried
with it the name, address, specialty, and class year of
all practicing graduates. Names are given according
June, 1950
261
FACULTY APPOINTMENTS AT EMORY
The appointment of Dr. F. William Sunderman as
professor of clinical medicine at Emory University was
announced recently by Dr. Goodrich C. White, Emory
president.
Dr. Sunderman, whose appointment is effective im-
mediately, recently came to Atlanta to head the section
on clinical pathology in the communicable disease center
of the U. S. Public Health Service. He is a former
member of the board of governors of the College of
American Pathologists, and is president-elect of the
American Society of Clinical Pathologists.
Other appointments in the medical school are Dr.
Martin Frobisher, Jr., Dr. Alexander D. Langmuir, Dr.
Richard E. Felder, Dr. Elizabeth Gambrel], Dr. Lee N.
Cordrey, Dr. David James Hughes, Dr. Robert F. Mabon,
Dr. Irvin Trincher, and Aloysius I. Miller. Miss Helen
Goodroe was appointed instructor in nursing.
New professors announced in the College of Arts and
Sciences are Dr. Joseph M. Conant, assistant professor
of classics; Dr. Granville B. Johnson, assistant professor
of education; William Franklin Ingram, instructor in
geology; and Richard F. Maher, instructor in speech.
These appointments are effective in September. Dr.
Conant will come to Emory from a position as instructor
in Latin and Greek at Columbia. Dr. Johnson is now a
member of the faculty at Arizona State College. Maher
is a graduate clinician with the Wayne University Speech
clinic. Ingram, an Atlanta and Emory graduate, is a
research associate in the Emory geology department.
to geographic location, followed by an alphabetic cross-
index. According to the listing, three-forths of Emory's
medics are serving in the Southeast. Georgia takes the
lead with 1,258 alumni at work. Florida has 880; Ala-
bama, 202; North Carolina, 102; South Carolina, 94;
Mississippi, 65; Tennessee, 71; Louisiana, 34. Others are
scattered throughout the United States, and as far as
Hawaii, West Africa, and Korea. Named in the directory
are graduates of the Atlanta Medical School in 1915.
Among them is one from the class of 1892, Dr. William
Stokes Goldsmith, retired, of Stone Mountain. The
total number in general practice is 1161, or 42 per cent.
Other Emory medical graduates are found in such spe-
cialties as surgery, internal medicine, and public health.
The directory was compiled as a cooperative project by
the Emory publications office, alumni association, and
school of medicine.
* * *
Dr. Robert G. Ferrell, who has served as a physician
in Dublin since 1936, has moved to Macon and is now
located in the Professional Building, Macon, where he
will do surgery and general practice.
* * *
The Georgia Chapter of Ophthalmology and Otolaryn-
gology, at the annual luncheon and business meeting
held at the Hotel Dempsey, Macon, April 20, elected Dr.
Braswell E. Collins, Waycross, president. This meeting
was coincident with the annual session of the Medical
Association of Georgia. Other officers elected were Dr.
Thomas S. Harbin, Rome, vice president, and Dr. W. E.
Matthews, Augusta, secretary-treasurer. Dr. Lester A.
Brown, Atlanta, is retiring president of the organization
numbering approximately 250 doctors. Dr. William A.
Barton, Macon, retired as vice president. Dr. Collins
is the former secretary-treasurer. The annual scientific
session will be held at the General Oglethorpe Hotel,
Savannah, March 2 and 3, 1951.
* * *
The Georgia Department of Public Health held its
twenty-first annual meeting at the Hotel DeSoto, Savan-
nah. .May 1-3, with more than 750 public health officials,
doctors, and nurses attending. National authorities on
child and public health were guest speakers. Speakers
included Dr. Harold Hillenbrand, executive secretary
of the American Dental Association in Chicago; Dr.
John R. McGibony, medical director, division of medical
and hospital resources of the U. S. public health serv-
ice; Dr. Leona Baumgartner, assistant chief of the Chil-
dren's Bureau in Washington, Dr. Evan Thomas, director
of the Bellevue Hospital rapid treatment center and a
professor at New York university; Dr. Clair E. Turner,
assistant to the president, National Foundation for In-
fantile Paralysis, Inc., New York; Dr. H. G. Baity,
professor of sanitary engineering at the University of
North Carolina; Gov. Herman Talmadge, and Dr. T. F.
Sellers, head of the Georgia Department of Public
Health. Dr. C. D. Bowdoin, Atlanta, was elected presi-
dent of the association, succeeding Dr. J. A. Thrash, of
Columbus. Other officers elected were Miss Bessie
Swann, Atlanta, president-elect; Dr. John Venable,
Griffin, vice president ; C. S. Buchanan, Atlanta, secre-
tary, and Ernest B. Davis, Atlanta, treasurer. The con-
vention voted to hold its meeting in Savannah again
next year for the fourth consecutive time.
* * * *
Dr. I. S. Giddens, Lakeland, will manage the Louis
Smith Memorial Hospital, Lakeland. Dr. Giddens was
born and reared in Lanier County and graduated from
University of Georgia School of Medicine, Augusta, in
1933. He practiced medicine in Adel before going to
Lakeland in January, 1949.
* * *
The Glynn County Medical Society held its meeting
in Brunswick. May 17. A prepared study on “Ulcers of
the Stomach’’ was presented members of the society.
Physicians leading the discussion were Dr. Mack Sim-
mons, Dr. H. L. Moore. Dr. A. N. Galin, Dr. V. Kanauka,
and Dr. T. V. Willis, president of the society. Dr. T. H.
Johnston, secretary.
* * *
Dr. J. Harold Harrison, Wrightsville, was recently
named to the Johnson County Board of Health for a
four-year term, beginning immediately, by the grand jury
of the March term of Superior Court. The County Board
of Health is made up of a doctor named by the grand
jury, the county school superintendent, and the chairman
of the Board of County Commissioners.
* * *
Dr. Clair A. Henderson, Savannah, city-county health
officer, recently conducted an open forum at the Isle
of Hope Community Club on the subject of “Health
Problems of the Isle of Hope Community.”
* * *
Dr. Marcus L. Howard. Ellaville physician, and for-
merly of Dawsonville, announces the opening of his
offices in Dahlonega for the practice of medicine. He
is a graduate of George Washington Llniversity School
of Medicine, Washington, D. C., and also Washington
School of Law, a veteran of World War II, serving in
the Pacific theatre of operations. He spent a year at the
Naval Air Station, Atlanta, and was elevated to Lieuten-
ant Commander and is now a naval reserve officer.
Following his release from the Navy, he practiced medi-
cine in Dawsonville and served one term in the Georgia
Legislature.
* * *
Dr. Steve P. Kenyon, Dawson physician, was recently
honored by Dawson Rotary Club at its regular luncheon
at Standley-Oxford Club. He was unanimously elected
an honorary member, following his resignation as an
active member because of his health. Dr. Kenyon is
one of the charter members and first president of the
Dawson Rotary Club. President Ed Stevens paid glow-
ing tribute to the esteemed doctor who was instrumental
in organizing the Rotary Club six years ago. Dr. Kenyon
is retiring temporarily from active practice of medicine
on advice of his physician. In addition to president. Dr.
Kenyon has served the club in many capacities and was
chairman of the classifications committee. Rotary's most
important body. Dr. Kenyon expressed his appreciation
to the club for its action and said he was grateful for
the privilege of serving the club.
* * *
Dr. Milton H. Freedman, Atlanta, announces the re-
moval of his office to 21 Eighth Street, N. E., Atlanta.
Practice limited to internal medicine and hematology.
262
The Journal of the Medical Association of Georgia
TEN COMMANDMENTS FOR GOOD SLEEPING
1. Go to bed at the same hour every night.
2. Try to get at least one hour of sleep before mid-
night (Yes, you can!).
3. Eat no more than a glass of milk or a small
bowl of cereal before retiring. Leave those crab cakes
alone.
4. Never eat or drink ice cold foods before retiring.
Ice cream is the worst kind of midnight snack.
5. Never listen to the radio in bed. (I know the
radio can put you to sleep, but it can also wake you.)
6. Never, positively never, read in bed.
7. Provide a regular schedule for the hobby, dog, wife
or husband who interferes with your rest.
8. W hen you go to bed, close your eyes and go to
sleep.
9. If that doesn’t happen, try to remember what posi-
tion you awake in the next morning. Then take that
position when you go to bed that night.
10. Relax every nerve, muscle and thought. Patience
won't kill you; sleeping pills may . Paul H. Fluck,
M.D., in TODAY’S HEALTH.
The Fulton County Medical Society held its semi-
monthly dinner meeting at the Academy of Medicine,
Atlanta, May 18. Scientific program: Dr. James H.
Byram. moderator. ‘"Recent Advances in Treatment of
Urinary Infection," Dr. Harold McDonald. Drs. Reese
C. Coleman. Jr.. James H. Semans and H. B. Stillerman
discussed the paper. “Uses and Abuses in Glandular
Therapy," Dr. J. K. Fancher. Greetings by Dr. J. F.
McCahan, Chicago, assistant secretary of the Council on
Industrial Health of the American Medical Asociation.
Guests of honor were the members of the Cobb County
Medical Society.
* * *
The Kennestone Hospital, Marietta, was dedicated
May 22 as Governor Herman Talmadge paid tribute to
city, State and Federal authorities for creating reality
from a dream. Some 7.000 Georgians attended the dedi-
cation of the $1,500,000, 105 bed. hospital by Governor
Talmadge, who had warm praise for the late John
Ransom, director of the state division of hospital serv-
ices, who died only three days before the Kennestone
dedication as the result of an automobile accident. Other
speakers included Dr. T. F. Sellers, Atlanta, director
of the Georgia Department of Public Health; Walter A.
Altmann. hospital administrator; William L. Harris, of
the authority; Mayor Sam Welsch of Marietta, and
Rep. Harrold Willingham, who introduced Governor
Talmadge.
* * *
The Macon Hospital Tumor Clinic, Macon, leads the
State in number of cancer patients treated. The State
of Georgia spent $34,000 in 1949 to fight cancer and
part of that money went to the Macon Clinic, which
serves 17 counties. Dr. Thomas Harrold, Macon physi-
cian, is clinic director; other members of the staff are
Drs. Milford B. Hatcher, assistant director, R. W.
Reifler, Jule C. Neal, Charles McLaughlin, William
Barton and Earl Lewis, all of Macon. Operating under
the state cancer program, the clinic services are “free"
for persons unable to pay.
* * *
The Bibb County Medical Society held its dinner
meeting at the S & S Cafeteria, Macon. May 2. Pro-
gram: '■.Malpractice." Dr. Frank Eskridge, Atlanta, lec-
turer in forensic medicine, Emory University. Dr. Henry
H. Tift, secretary.
* * *
The senior class of the Medical College of Georgia,
Augusta, graduated 78 new doctors this year, with the
baccalaureate address delivered by Dr. R. C. McGahee,
Augusta, at the Municipal Auditorium, June 5. The
senior class had 79 members but the death of one of
the young doctors, Stanley McCarty Robinson. Savan-
nah, on March 4 reduced the number to 78. A diploma
was conferred posthumously for Robinson at the exer-
cises. In the class of 78, six were women.
The Medical College of Georgia, Augusta, announces
the Seventh Graduate Course in Endocrinology which
will be given September 4-9, inclusive. The course is
offered as a refresher and guide in those aspects of
basic endocrinology which have practical and clinical
application. The lectures will deal with endocrine prob-
lems which arise in everyday practice and are designed
for the practicing physician. Registration is limited to
fifty. Enrollment is open to all qualified physicians.
Applications should be addressed to the Registrar,
Medical College of Georgia. Augusta, Ga.
* * * *
Drs. Roger W. Dickson, William Friedewald, and
David Henry Poer. all of Atlanta, were recent dinner
guests of the Tanner Memorial Hospital. Carrollton,
where they read papers before the regular meeting of the
Carroll-Douglas-Haralson Medical Society.
* * *
Dr. Lewis W. Moore, formerly of Atlanta, announces
the opening of his offices at 310-312 Peoples Bank Build-
ing, W inder, for the practice of medicine and surgery.
He is associated with Dr. E. R. Harris.
* * *
The Medical College of Georgia. Augusta, in coopera-
tion with the Medical Association of Georgia, conducted
a postgraduate course for general practitioners June 20,
21 and 22. Dr. G. Lombard Kelly, president of the medi-
cal college announced. The course, given annually, is a
refresher course and is designed, said Dr. Kelly, to
present new as well as accepted methods of diagnostic
and therapeutic procedures in general practice. Attend-
ance of the course met in part the requirements for
membership in the American Academy of General Prac-
tice. The fee for the course was $15. which included
three luncheons during the three-day courses. The pro-
gram included lectures on many phases of medical prac-
tice of special interest to the practicing physician.
* * *
Dr. Michael V. Murphy, Jr.. Atlanta, announces the
removal of his office for the practice of internal medicine
to 21 Eighth Street, N. E., Atlanta.
* * *
Dr. C. T. Nellans, Atlanta, is the chief medical officer
of the Veterans Administration Regional Office, 105
Pryor Street, N. E., Atlanta. He succeeds the late Dr.
J. A. McAllister.
* * *
Dr. J. H. Nicholson, Madison, recently assumed his
duties with the United States Army, as a member of the
medical staff of Fort Benning, Columbus. Since his re-
lease from W’orld W'ar II. Dr. Nicholson has been a
practicing physician in Madison and Morgan County. He
has also served on the surgical staff of McGeary Hospital,
Madison and the Minnie Boswell Memorial Hospital,
Greensboro. He will sene at Fort Benning for a period
of three months, at which time further orders will be
issued.
* * *
Dr. Perrin Nicolson, Atlanta, was guest speaker before
the Cornielian Corner in Detroit, Michigan, in April;
subject “Breast Cancer, Its Incidence and Relationship
to Lactation.”
Dr. Nicolson recently addressed the staff of the
Minnie Boswell Memorial Hospital. Greensboro. His
subject was “Breast Lesions.”
* * *
Dr. Irving Greenberg, Atlanta, was recently guest
speaker at the Walton County Medical Society, Monroe.
His subject was “W'hat the Red Cross Blood Program
Can Mean to You and Your Community.”
* * *
Dr. Thomas J. Peacock, Milledgeville, superintendent
of the Milledgeville State Hospital, was guest speaker to
the students of the Atlanta division. University of Geor-
gia, in the sixth floor assembly room, April 21. He
discussed "How to Keep a Sound Mind.”
* * *
Dr. David Henry Poer, Atlanta, was guest speaker at
the dinner meeting of the Jefferson County Medical
June, 1950
263
Society held at the Country Club, Birmingham, Ala.,
May 15. His subject was “Carcinoma of the Thyroid."
* * * *
Dr. Samuel R. Poliakoff, of Abbeville, S. C., has been
appointed assistant of obstetrics and gynecology on the
staff of Emory University Hospital, Atlanta. He gradu-
ated from the Medical College of the State of South
Carolina, Charleston, and served his internship at Grady
Memorial Hospital, Atlanta, and has received a fellow-
ship at Harvard .Medical School. Boston, Mass. He served
in the Pacific area during World War II.
* * *
Dr. J. C. Patterson, of Patterson Hospital. Cuthbert,
was the interesting Rotary speaker at the luncheon meet-
ing on May 3. Dr. Patterson described some of the
results of the use of the famed “steel pin” for holding
bone fractures in place and effecting a cure without
stiffness of joints or deformity. He exhibited specimens
of the stainless steel rod used for this purpose and showed
actual x-ray pictures revealing the manner in which the
pin is used and follow-up pictures showing the cured
fracture, when the bones have reknit. He explained
several methods of the treatment, the Rush method
being the one he uses. The ability of the patient to
walk within a day or so after the operation was empha-
sized, also the fact that the patient has perfect use of
the injured member and no pain. The method can be
used for leg bones and arm bones as well. Dr. Patterson
explained.
* * *
Dr. Joseph Read and Dr. Perrin Nicolson, of Atlanta,
recently attended the meeting of the Southern Society of
Clinical Surgeons held in Detroit and Ann Arbor, Mich-
igan. Dr. Nicholson was president of the society this
year. At this meeting Drs. Duncan Shepard and Charles
Jones, of Atlanta, were elected to membership.
* * *
Dr. Lee Rogers, of Gainesville, was recently re-elected
chairman of the State Board of Health and increased the
ratio of state funds in a federal-state local hospital build-
ing program. Meeting at Alto State Hospital, the board
set up a hospital program for the next fiscal year with
the Federal Government paying 55 per cent of the cost,
the state 25 per cent, and local sources 20 per cent. The
S12.000.000 program for 1950-51 is being worked out now
under changed priorities.
* * *
Seven doctors from the Medical College of Georgia
recently presented papers at the annual convention of
the Federation of Societies of Experimental Biology in
session at Atlantic City, N. J. They were: Drs. W. F.
Hamilton. Jr., Philip Dow. J. W. Pennington, Virginia
Sydow. W. Knowlton Hall, Sam Singal and Ray Picker-
ing. The convention of the federation was attended by
physiologists, pharmacologists, biologists and kindred
lines of the medical profession.
* * *
Dr. Sterling Rogers, of Coleman, recently visited Dr.
Sterling Jernigan, of Sparta. Both were schoolmates at
the old Atlanta Medical College and have been practicing
medicine for 50 years. Both have a son named “Sterling”.
Dr. Sterling Jernigan is practicing medicine in Atlanta,
and Dr. Sterling Rogers in Washington, D. C.
* * *
Dr. Harriet E. Gillette, Atlanta, specialist in the cer-
ebral palsy field of medical science, conducted Savannah’s
first diagnostic and treatment clinic for cerebral palsied
children at the Chatham-Savannah Health Center, May
26-27. The clinic serves the entire first congressional dis-
trict. Attendance at the clinic is free of charge. Children
needing braces were measured and fitted at the clinic.
They educate cerebral palsied children and put them on
the road to becoming self-sufficient children.
* * *
Dr. Richard Torpin and his staff at the University
Hospital, Augusta, recently conducted a surgical clinic
at the hospital for members of the South Carolina Obstet-
rical and Gynecological Society at their annual meeting
held in Augusta. Papers by Drs. Frank B. Giebel, of
WHY A CASE HISTORY?
The mental attitude of a patient in the course of a
physical examination is most important. Yet many peo-
ple overlook this, theorizing that it is the physician’s
job to locate the source of the ache or pain, the Educa-
tional Committee of the Illinois State Medical Society
observes in a Health Talk.
Actually this is true, but the cooperation of the patient
is essential in providing information that will assist the
physician in establishing a diagnosis. That is why a
complete case history is important.
Frankness on the part of the patient is imperative.
Being secretive serves no purpose whatsoever except to
obscure facts that might be helpful. To deny a history
of tuberculosis in the family, for example, defeats the
purpose of the examination. This is true, of any other
condition, whether it be mental or physical.
For this reason, a person should select a physician to
whom he can speak freely without being self-conscious.
He should trust his physician, knowing that his confi-
dence will not be misplaced. In explaining his physical
aches and pains, the individual should also account for
the fears, worries, resentments and other emotional atti-
tudes that characterize almost every human being.
Sometimes it takes years for a patient to speak frankly
of these emotional attitudes, incorrectly believing that
they don’t fit into the picture of a complete case history.
A person may complain constantly of various pains, yet
attempt to obscure the awareness of noticeable person-
ality changes about which he was worried.
The physician is a trained observer and the person
who is evasive in explaining his history is fooling no one
but himself. Very often, it is necessary for the ohysician
to probe verbally and adroitly to evoke a single honest
reply to a question that may have a profound influence
on the person’s ailment.
All emotional upsets should be recalled, even though
they are long past. A person may not wish to admit an
unhappy love affair, the brooding over the death of a
loved one, or the disappointment of defeat in business,
but these incidents are important to the phvsician in
taking your case history. They may shed light on the
physical discomfort, particularly when laboratory and
other tests are negative.
There is no point in withholding such information from
your physician. It is much like dropping a watch. Even
though it is still ticking, it does not indicate that a
piece of the machinery was not jarred. It might stop a
week or a month later. So it is with the human body.
In a physical condition where heredity is a factor the
tendency is there. And concealing the fact does not
necessarily mean that it lias not left a mark somewhere
on the path of our nervous system.
While a regular examination is recommended, don’t
ignore symptoms that may develop in the interim.
Symptoms are warning signals and it is wise to heed
them.
So help yourself first of all by selecting a physician
you can talk to easily, and remember that frankness is
important in providing a complete medical history.
Columbia, Frank Woodruff, of Greer, and William H.
Bateman, of Greenville, were read during the scientific
session. Dr. J. Decherd Guess, of Greenville, is president,
and Dr. Henry W. DeSaussure, of Charleston is presi-
dent-elect.
* * *
Dr. T. O. Vinson, Decatur, former Spalding Countv
health commissioner and now health commissioner of
DeKalb County, and his health department recently
sponsored a health survey, giving free health tests for
six diseases to residents of DeKalb County. A group of
DeKalb county citizens formed a DeKalb Citizens Com-
mittee to help Dr. Vinson make the program a success.
* * *
The Southern Medical Association, with headquarters
in Birmingham, Ala., will hold its fortv-fourth annual
meeting in St. Louis, Mo., November 13-16, upon the
invitation of the St. Louis Medical Society. On the
scientific program there will be four general sessions
264
The Journal of the Medical Association of Georgia
COMMUNICATION
AMERICAN MEDICAL ASSOCIATION
Chicago 10. April 27, 1950
To: The Secretary or Executive Secretary of the state or
county medical society
1 am enclosing herewith marked copies of the ques-
tionnaires being used in the survey of physicians' in-
comes— a joint undertaking of our Bureau of Medical
Economic Research anil the United States Department of
Commerce.
1. The white questionnaire is the short-form (only 1949
income) schedule which is being sent to 100.000 physi-
cians and for which there will be no follow-up.
2. The huff colored questionnaire is also the short-
form schedule and is being sent to 10.000 physicians
with his code number of the Bureau of Medical Eco-
nomic Research on the outside of the return envelope.
The sole purpose of the code number is to enable the
Bureau to address follow-ups to those physicians who do
not reply to the first, second, or third request. An
attempt will be made to obtain replies from all physicians
who receive the buff colored questionnaire.
3. The green questionnaire is the long-form schedule
(that is, it requests more information and for four more
years. 1945-48) which is being sent to 15.000 physicians
with his code number of the Bureau of Medical Economic
Research on the outside of the return envelope. Again,
the sole purpose of this code number is to enable the
Bureau to address follow-ups to those who do not reply
to the first, second, or third request. Also, an attempt
will be made to obtain replies from all physicians who
receive the green colored questionnaire.
I thought it would be helpful for you to have a copy
of each of these three schedules because you may be
asked about them. You understand thaf no physician
will get more than one of these three schedules. Further-
more. approximately three physicians out of eight will
receive none.
1 hope that you will urge physicians in your society to
fill out these schedules which have been prepared by our
Bureau of Medical Economic Research and the Depart-
ment of Commerce. This study bids fair to become the
most comprehensive ever made of the incomes of a
profession. I hope that you will especially urge your
members with small practices to reply in full, as 1 am
informed that earlier surveys of physicians’ incomes have
not obtained a representative number of responses from
physicians with small practices. A fine response from
every physician who receives a questionnaire will help
to correct certain misinformation regarding physicians’
earnings and expenditures by the American people for
the service of physicians.
Sincerely,
Geo. F. Lull
covering the broader aspects of medicine and thirty-two
section sessions covering every specialty. Members of the
state and county medical societies in the South
are eligible for membership in this Association, and are
invited to attend the St. Louis meeting. There is no
registration fee for members of the Southern Medical
Association. Dr. Olin S. Gofer, Atlanta, is one of the
councilors of this Association.
* * *
The Ware County Medical Society held its meeting in
the office of Dr. H. T. Adkins, Ware County commis-
sioner of health. Waycross, April 6. Dr. Harold W.
Muecke presided over the meeting. Dr. Albert S. True-
lock, Jr.. Veterans Administration, Pinellas, Fla., was
received into membership of the society. Dr. William
H. Hendry, president of the Ware County Medical So-
ciety and his wife, Dr. Katherine Hendry of Blackshear,
will be hosts to the May meeting of the medical group.
* * *
Dr. W. D. Willcox, Fitzgerald, and Dr. William Sams,
Macon, announce their association with Drs. Herman L.
Dismuke and G. W. W'illis in offices at the Ocilla Hos-
pital. Ocilla, for the practice of medicine and surgery.
* * * *
The Washington Clinic Building on Spring Street,
Washington, owned by Dr. A. W. Simpson, Jr., was re-
cently opened to the public when hundreds of Washing-
tonians showed great interest in seeing these very modern
doctors’ offices. The building is heated by the ray
system and is air-conditioned. Identical equipment and
all modern conveniences are offered in the clinic to white
and colored patients.
* * *
Dr. Charles Edward Wills, Sr., Washington surgeon,
has been notified of his acceptance as a Fellow of the
International College of Surgeons, with headquarters at
Geneva, Switzerland. The notice was in the form of an
unusually beautifully designed diploma, and Dr. Wills
many friends in Washington and throughout Georgia
will learn with pleasure of this recognition of his years
of outstanding work in the field of surgery. The Inter-
national College of Surgeons was founded in Geneva in
1935, and on its roster are the names of eminent surgeons
from all parts of the world.
* * *
Three Griffin physicians are conducting a clinic at
Hampton. The participating physicians are Drs. Abe
Oshlag, William King and Harry King. The clinic has
been in progress for some time, with at least one of the
three doctors visiting Hampton every afternoon in the
week. Appointments are made with a receptionist for
the afternoon visits of the physicians.
* * *
Dr. M. E. Winchester. Brunswick. Glynn health com-
missioner and City Hospital administrator, was the fea-
tured speaker of the Rotary Club at its luncheon meeting
April 26. He said Brunswick and Glynn County should
give serious consideration to the idea of building a new
hospital. He told the Rotary Club that he believes an
appropriation for such a project would be approved by
the group in charge of the program made possible by
the Hill-Burton Act during the fiscal year beginning
July 1. If a 11.000.000 hospital should be erected, he
pointed out, the cost for the local government would be
only 1200,000. “I am not saying that the community
should build a new hospital,” he declared. He said,
however, he felt obligated to advise local citizens of the
opportunity which now presents itself.
* * *
Dr. Wallace E. Winter, Augusta, has resigned as act-
ing director of the Gracewood Training School for Men-
tal Defectives, Gracewood, and will go to the Orange
Memorial Hospital, Orlando, Fla., as resident physician
to continue his medical training, he recently announced.
Dr. Winter, who took over the direction of the Gracewood
school last year at the age of 23 years, stated that al-
though he liked the work at that institution he felt that
it is desirable for a physician to supplement his training
as much as possible.
* * *
Dr. Peter B. Wright, Augusta, profesosr of orthopedic
surgery of the Medical College of Georgia and district
orthopedist for the Crippled Children’s Division of the
State Department of Welfare, talked to members and
friends of the Augusta Area Chapter for Cerebral Palsy,
on the role of orthopedic surgery in the treatment of
cerebral palsy. He appealed to the group and com-
munity to continue the work under way and to secure
financial aid for the vital cerebral palsy program. Dr.
Wright spoke briefly but emphatically of the role of
preventive medicine in cerebral palsy, mentioning spe-
cifically proper and adequate obstetric and pediatric care.
Relative to the corrective aspects of medical care, Dr.
Wright stressed the importance of early treatment in
order best to attain the ultimate goal of independence
for each individual child. Operations by orthopedic sur-
geons have proved of special benefit to youngsters suffer-
ing from the spastic type of cerebral palsy and consist
of operative procedures on hones, joints, capsules about
Junk, 1950
265
the joints, muscles, tendons and nerves. It also comes
within the province of the orthopedist to prescribe cor-
rective braces, so necessary in the treatment of many
cerebral palsied children. Following his most helpful
talk, it was announced that Dr. Wright has accepted the
chairmanship of the Medical Advisory Committee for
the Augusta Area Chapter. Dr. Wright named to the
committee Dr. Maron Estes, psychiatrist and Dr. K. C.
McGahee, pediatrician.
* * *
The annual Postgraduate Course for General Prac-
titioners given by Emory University School of Medicine
in cooperation with the Medical Association of Georgia
has been scheduled for the week October 9-13, 1950. If
you plan to attend and have in mind any topic you
would like to have discussed, please send it to: Director
of Postgraduate Education. Emory University School of
Medicine, 36 Butler Street, S. E., Atlanta 3, Georgia. A
completed program will be published in the September
issue of the Journal of the Medical Association of Georgia
and also sent to each member of the Association.
* * *
The Georgia Medical Society held its regular meeting
at 612 Drayton Street, Savannah, May 9. Program:
"Breast Feeding,” Dr. Howard J. Morrison. Dr. Sam
Youngblood. Jr., secretary.
* * *
The Jonte Et|uen Memorial Lecture was delivered at
the Fulton County Medical Society, Academy of Medi-
cine, Atlanta, on June 15 by Dr. Hermon Marshall Tay-
lor. noted Jacksonville, Fla., otolaryngologist, on the
"Hygiene of Swimming”, a subject of vital interest both
to laymen and medical men. Dr. Taylor used a film to
illustrate the lecture.
Dr. Murdock Equen, Atlanta, established the lecture-
ship some years ago in memory of his father, the late
Jonte Equen, a New Orleans grain broker.
OBITUARY
Dr. Jesse Lee Howell , aged 59, practicing physician of
Atlanta and Georgia for many years, died at his home,
915 East Rock Springs Road. N. E., Atlanta. April 25.
1950. Born in Canton. Dr. Howell was a graduate of the
Georgia College of Eclectic Medicine and Surgery, At-
lanta, in 1913. He did postgraduate work at Tulane
University of Louisiana School of Medicine, New Or-
leans. He formerly held memberships in the Fulton
County Medical Society, the Polk County Medical So-
ciety, the Medical Association of Georgia, the American
Medical Association, the State Board of Medical Exam-
iners, and the Georgia National Guard. He was a veteran
of World War I; was a member of the American Legion,
a Mason, and a member of the Baptist Church. Surviv-
ing are his wife; two brothers, John C. Howell and
Homer Howell, of Canton, and sister-in-law, Mrs. Helen
Peek, Atlanta. Funeral services were held at Spring
Hill. Burial was in West View Cemetery, Atlanta.
* * *
Dr. Edwin Lankin Jelks, aged 76, retired Quitman
physician, died at the Brooks County Hospital, Quit-
man, April 27, 1950. He was the son of the late Mr.
and Mrs. Nathaniel P. Jelks, of Hawkinsville. He grad-
uated from Bellevue Hospital Medical College, New York
City, in 1P96, and served his internship at Brooklyn
Hospital. In Quitman, Dr. Jelks was associated with his
uncle, the late Dr. E. A. Jelks, in the practice of medi-
cine. He had served as mayor of Quitman in two differ-
ent terms. He was an honorary member of the Brooks
County Medical Society, the Medical Association of
Georgia, and the American Medical Association. He is
survived by his wife, the former Miss Alma Allbritton;
two sisters. Miss Ruth Jelks, Waycross, and Mrs. Dave
McGriff, Hawkinsville, and several nieces and nephews.
Funeral services were held at the residence on North
Court Street, with the Rev. F. H. McElroy and the Rev.
C. C. Kiser officiating. Burial was in West End Ceme-
tery, Quitman.
Dr. lEiUiam Marshall Shepard, aged 81, beloved Adel
physician for many years, died at the Clinic, April 26,
1950. He was born in Winder, and graduated from the
Southern Medical College, Atlanta, in 1892. He had prac-
ticed medicine for 55 years and retired from active prac-
tice several years ago. He was among the Georgia physi-
cians honored at the Savannah session of the Medical
Association of Georgia for having practiced medicine
for 50 years or more. He had long been a devout mem
her of the Methodist Church. He was twice married,
both wives having preceded him in death. Surviving are
four sons, Edgar Shepard, Atlanta; Earl Shepard, Rich-
mond Hill; Paul Shepard, Adel, and Writ. A. Shepard,
Atlanta; a daughter, Mrs. Alene Shepard Ross, Atlanta;
a brother; two sisters; six grandchildren and one great-
grandchild. Funeral services were held at the Adel
Methodist Church. Burial was in Sparks Cemetery.
* * *
Dr. P. A. Tatum, aged 68. Columbus physician and
surgeon, died at the City Hospital, Columbus, April 2,
1950. He graduated from the Atlanta College of Physi-
cians and Surgeons, Atlanta, in 1905. He moved to Co-
lumbus from West Point in 1909, two years after he
started to practice medicine, and had practiced in
Columbus for 40 years. He retired 10 months ago be-
cause of ill health. In addition to membership in medi-
cal societies. Dr. Tatum was a member of the Masonic
Order and of the Shrine. He was a member of St. Luke
Methodist Church. Surviving are his wife, the former
Miss Elward Whitaker; two brothers, M. M. and Ferrell
Tatum, West Point; a sister, Mrs. R. A. Ridgway,
Monticello, Fla., and several nieces and nephews. Funeral
services were held at the home, 1220 Sixteenth Avenue,
with the Rev. W. Howard Ethington officiating. Burial
was in Pinewood Cemetery, West Point.
PLASTIC SURGERY AWARD
The Foundation of the American Society of Plastic
and Reconstructive Surgery offers as its 1950 award
1500.00 ( first prize of $300.00. and second prize of
$200.00) and a Certificate of Merit, for essays on some
original unpublished subject in plastic surgery.
Competition shall be limited to residents in plastic
surgery of recognized hospitals and to plastic surgeons
who have been in such specific practice for not more
than five years.
The first prize essay will appear on the program of
the forthcoming annual meeting of the American Society
of Plastic and Reconstructive Surgery, to be held in
Mexico City, November 27-29, 1950. Essays must be in
before August 15, 1950.
For full particulars write the Secretary, Dr. Clarence
R. Straatsma, 66 East 79th Street, New York, N. Y.
EXAMINATIONS ANNOUNCED FOR
MEDICAL OFFICER
(Rotating Intern and Psychiatric, Surgical and General
Practice Resident)
In the enclosed announcement are described examina-
tions for positions of Medical Officer (Rotating Intern
and Psychiatric, Surgical, and General Practice Resident I
in St. Elizabeths Hospital, Washington, D. C. We will
greatly appreciate your cooperation in helping us to
bring these examinations to the attention of qualified
persons who might be interested in applying.
Salaries for rotating intern are $2,200 the first year
and $2,400 the second year; for psychiatric resident and
general practice resident, from $2,400 to $4,150 a year;
and for surgical resident, from $3,400 to $4,150 a year.
To qualify for these positions, all applicants must have
had appropriate education in an approved medical
school. Applicants for psychiatric, surgical and general
practice resident must also have completed a 1-year
internship. In addition, applicants for surgical resident
appointments must have completed a 3-year residency in
surgery. No written test will be given.
We will be glad to send announcements and applica-
The Journal of the Medical Association of Georgia
266
lion forms to any persons whose names are referred to
us or to those who write direct to this office. Information
and applications may also he obtained at most first- and
second-class post offices and from Civil Service regional
offices. Applicants should he sent to the Committee of
Expert Examiners, St. Elizabeths Hospital. Washington
25, D. C. They will be accepted until June 20. 1950.
PSYCHOLOGIST GIVES REQUIREMENTS IN
SCHOOL LIGHTING
Certain basic requirements in school lighting are
advised by Miles A. Tinker, Ph.D., professor of psychol-
ogy at the University of Minnesota, Minneapolis, in a
report to the Council on Physical Medicine and Re-
habilitation of the American Medical Association.
I)r. Tinker's report appears in the May 27 Journal oj
the American Medical Association.
“In prescribing illumination for any school, one
should coordinate the intensity and distribution of light
with the decoration,” he says.
“Several illuminants, varying in character, are avail-
able. Variation usually is accompanied with some
changes in color of the light. The more common artificial
illuminants are tungsten filament incandescent light,
mercury arc light and fluorescent light.
“In ordinary seeing situations such as found in schools,
efficiency of seeing is just as good under one as under
any other of the illuminants. Researchers of Harvard
University claim that the quality of light derived from
fluorescent lamps, no matter what combination of colors
is used, is both unpleasant and distracting to workers in
reading rooms.
“A recently devised fluorescent tube (soft white) ap-
pears to yield less disagreeable light. Under the light
of many of the fluorescent tubes, colors in decoration
tend to go 'flat' and the colors of objects frequently are
altered in appearance.
“The following points will aid in eliminating undesir-
able distribution of illumination and brightness in the
school: 1. Avoid bright peripheral light sources, such as
low-hanging fixtures; 2. Avoid as far as possible the
use of glazed paper, highly polished desk tops and
other working surfaces; 3. Avoid any marked changes in
brightness from one area to another; 4. Keep the surface
brightness of light fixtures in the field of vision within
the limits suggested herein ; 5. Maintain, in general, as
even a distribution of light as possible over work sur-
faces.”
FIND NEW ANTIBIOTIC DRUG EFFECTIVE
AGAINST BACTERIAL AND VIRUS DISEASES
Medical research reports on a new antibiotic drug,
terramycin, indicate that it is effective against whooping
cough, several kinds of pneumonia, syphilis, gonorrhea
and other diseases.
Early clinical trial of the drug is described in two
articles in the May 6 Journal of the American Medical
Association by two Washington, D. C., research groups.
Terramycin is produced by a newly-discovered mold.
Streptomyces rimosus, which was isolated from a soil
sample. It belongs to the same family that produces
streptomycin.
Drs. Ernest Q. King, Charles N. Lewis, Eugene A.
Clark, Jr., John B. Johnson, John B. Lyons. Roland B.
Scott and Paul B. Comely and Henry Welch. Ph.D., of
the Federal Food and Drug Administration and Freed-
men’s Hospital, administered terramycin to 30 patients
having various types of infections.
Their results indicate that the drug is effective against
pneumococcic and streptococcic pneumonias, urinary
tract infections and whooping cough. Whooping stopped
within 24 hours in one patient and within three days in
another patient after treatment with terramycin was
begun.
Terramycin was used in the treatment of venereal
diseases at the Polk Health Center and the Rapid Treat-
ment Center of Gallinger Municipal Hospital, District
of Columbia Health Department. Drs. F. D. Hendricks,
A. B. Greaves, S. Olansky, J>. R. Taggart, C. N. Lewis,
G. S. Landman and G. R. MacDonald and Henry Welch,
Ph.D., of the Fed eral Food and Drug Administration and
the District of Columbia Health Department, report.
Eighty-one patients were treated, including 73 with
gonorrhea, six with syphilis and two with granuloma
inguinale (a venereal disease).
I erramycin effects a satisfactory cure rate in gonor-
rhea, although the dose required is somewhat higher
than has been found necessary with chloromycetin,
according to this group. Clinical healing of lesions of
both syphilis and granuloma inguinale occurred prompt-
ly with daily doses of terramycin.
Laboratory work shows that terramycin appears com-
parable to aureomycin in its activity against certain bac-
teria and viruses, they say.
Both groups report that although the drug generally
was well tolerated, nausea, vomiting, faintness and dizzi-
ness were experienced by some patients.
FIND CHLOROMYCETIN EFFECTIVE AGAINST
TULAREMIA
Successful treatment of six cases of tularemia, also
known as rabbit fever, with chloromycetin. one of the
newer antibiotic drugs, is reported by a group of
doctors from the University of Maryland School of
Medicine, Baltimore.
The disease is acquired from wild rabbits and other
wild animals and insects. It occurs as a local skin lesion
and as a generalized infection with fever.
The doctors — Robert T. Parker, Robert E. Bauer,
Howard E. Hall and Theodore E. Woodward —and Leon-
ard M. Lister, a medical student, describe their findings
in the May 6 Journal of the American Medical Associa-
tion.
Both streptomycin and aureomycin previously have
been shown to be valuable in treating tularemia.
ADVANCES IN NUTRITION PROMISE GREATER
VIGOR AND LONGER LIFE
Newer advances in nutrition promise better control of
disease, greater vigor and longer life, according to Dr.
James R. Wilson, Chiiago, secretary of the American
Medical Association's Council on Foods and Nutrition.
Enrichment and fortification of cheap staple foods,
such as bread, milk and oleomargarine, addition of
iodine to table salt and discovery of the B complex
vitamins were cited by Dr. Wilson as major achievements
in nutrition which are making important contributions
to health and vigor.
There is evidence that good nutrition has been impor-
tant in producing the increase in height observed in the
United States during the past 30 years, and that it may
play an important role in delaying the degenerative
changes of aging, he pointed out.
Practically all scientific knowledge of nutrition is
relatively new, he said. The vitamin series dates from
the work of Dr. Elmer V. McCollum at the University
of Wisconsin in 1909. Dr. McCollum isolated and named
vitamin A and vitamin B1. Isolation of vitamin B>- and
its use to prevent degeneration of the nervous system in
pernicious anemia is an achievement of the last few years.
On the frontiers of nutrition, the search for additional
useful vitamins and minerals continues and research is
being carried on in geriatrics (the science of aging)
and plant genetics.
Effective application of scientific knowledge of nutri-
tion largely depends on housewives, Dr. Wilson said. As
“administrators of civilization” they are important in
bringing advances in nutrition into practical use.
Dr. Wilson emphasizes these rules to follow daily for
good nutrition at any age above infancy:
1. Eat an egg and at least one serving of another
protein food.
2. Use whole grain or enriched bread and other whole
grain or enriched cereal products.
3. Make sure the salt in the kitchen is iodized unless
you live near the sea coast or eat sea foods liberally.
June, 1950
267
4. Drink pasteurized milk (a pint for adults, a quart
for children and old persons — vitamin I) enriched for all
persons who get little sunlight).
5. Eat at least two servings of green leafy or yellow
vegetables and at least one serving of citrus fruit or
tomatoes and other fruits or vegetables containing vita-
min C.
6. Use butter or enriched oleomargarine.
FIND CRITICISM INJURES CHILDREN
WITH READING DISABILITY
Criticism by the teacher and parents makes a child
who reads poorly lose confidence in his ability to do
school work and leads to the development of various
emotional problems, with psychologic blocks which
further aggravate the condition.
This point is brought out in an editorial in the
April 15 Journal of the American Medical Association
which says that an estimated 12 per cent of all children
in the United States fail to learn to read as well as
the average of their school class.
“It is doubtful that there is in these children any
underlying organic lesion,” the editorial says. “Emo-
tional factors such as fear, anxiety, rivalry, jealousy,
hostility for the parent or the teacher and a feeling
of inferiority undoubtedly play an important role in
creating these difficulties.”
Three recent articles in medical publications pointed
out the belief that the new method of teaching reading,
the so-called “flash” method, is an important contribu-
tory factor in the creation of these disabilities, according
to the editorial.
“The flash method employs whole words on cards
with pictorial representation to develop pure visual
associations,” the editorial says. “The method was
expanded into a phrase and later into a sentence
method. The child on entering school immediately
learns to read whole sentences.”
Another article in a medical publication points out
that, while this method produces rapid and intelligent
readers, it tests to the limit the child's power of
attention and concentration, the editorial says, adding:
“These authors feel that certain minor difficulties
(of vision) which were of minor importance under the
older methods of teaching have now become significant.”
According to one author, there were three times as
many cases of reading difficulties among children who
had been taught by the flash method as among those
who had been taught by the older phonetic method,
the ediiorial says.
REPORT PROGRESS IN
TREATMENT OF LEPROSY
Clinical treatment and public health management of
leprosy (Hansen’s disease) can be viewed with more
optimism than formerly was possible, says an editorial
in the April 29 Journal of the American Medical
Association.
The editorial follows in part:
During the last decade a much more hopeful outlook
in respect to medical treatment has been effected.
Chaulmoogra oil and its derivatives, which were the
drugs that were chiefly used for years, have been dis-
carded, their usefulness having been demonstrated to
the satisfaction of most students of the disease. Much
credit fur the prospect for improved therapy is due to
the work of the United States Public Health Service
officers at the federal hospital at Carville.
This group used promin, which had been tried by
others without much success in human tuberculosis.
After months of discouraging trial, definite improve-
ment was observed in many cases, a result never before
shown by any other therapeutic agent, although leprol-
ogists generally agree that it is too early to speak
of the new agent as definitely curative.
Some other members of the sulfone group gave
similarly encouraging results. Some of the latter,
notably diasone, which recently was accepted by the
Council on Pharmacy and Chemistry of the American
Medical Association, may be given by mouth. Results
with the sulfone drugs put the treatment of the disease
in the hands of the practicing physician, although most
physicians no doubt will prefer to have the treatment
inaugurated at Carville.
The changes in the public health point of view are
to some extent due to the development of a more hope-
ful outlook for successful treatment hut are associated
more with a somewhat belated recognition of certain
not widely appreciated features in the epidemiology
of the disease. There are limited areas in which the
disease tends to spread in the United States, mainly
in parts of Florida, Louisiana and Texas. Elsewhere
the disease shows little or no tendency to be com-
municable.
Another influencing factor is the recognition that
even in areas of prevalence, only persons discharging
or likely to discharge the causative organism are sources
of new infections. Furthermore, it is becoming increas-
ingly accepted that with some exceptions infection is
likely to occur only in the early years of life, although
there may be clinical manifestations for many years
because of the long incubation or latent period.
In these days, when so much emphasis is being
placed on the organization of research and the neces-
sity of large funds to carry it on, it is significant to
recall that the advances in control of leprosy have
been made by careful clinical observation and epidemio-
logic facts judiciously appraised without special organi-
zation or special financial support.
WARNS OF DANGER IN INDUSTRY
FROM BERYLLIUM
Recent reports from doctors and other research work-
ers emphasize danger of poisoning in industry from
beryllium, Dr. C. M. Peterson, Chicago, secretary of
the American Medical Association’s Council on Indus-
trial Medicine, said today.
Dr. Peterson cited articles in the April issue of
Archives of Industrial Hygiene and Occupational Medi-
cine, published by the A.M.A.
Exposure to beryllium, a metallic element, produces
both a severe, acute lung disease which resembles
pneumonia and a chronic form of lung disease with a
fatality rate of from 10 to 35 per cent. Dr. Peterson
said.
A report in this issue of the Archives by Dr. James
K. Scott and Herbert E. Stokinger, Ph.D., Robert H.
Hall, Ph.D., L. T. Steadman, Ph.D., Norman J. Ashen-
btirg, M.S., and George F. Sprague HI, M.S., of Roches-
ter, N. Y., concerning tests on animals reveals the
high toxicity of beryllium.
“Not only is beryllium unquestionably a toxic agent
but it is toxic in such small quantities as to be among
the most toxic chemically of all elements yet investi-
gated,” this research group points out, adding:
“These amounts give rise to acute effects. It is rea-
sonable to believe that still smaller quantities produce
the chronic disease in human beings and that ‘safe’
levels of beryllium exposure ultimately may be set well
below one microgram per cubic meter of air.”
REVISED EDITION OF MOTION PICTURE
REVIEWS NOW AVAILABLE
The Committee on Medical Motion Pictures of the
American Medical Association has completed the
second revised edition of the booklet entitled “Reviews
of Medical Motion Pictures.” This booklet now con-
tains 225 reviews of medical and health films review in
The Journal of the American Medical Association to
January 1, 1950. Each film has been indexed according
to subject matter. The purpose of these reviews is to
provide a brief description and an evaluation of the
268
The Journal of the Medical Association of Georgia
motion pictures which are available to the medical
profession. Each film is reviewed by competent authori-
ties and every effort has been made to publish frank,
unbiased comments. Copies are available at a cost of
25 cents each from: Order Department, American
Medical Association, 535 North Dearborn Street, Chi-
cago 10, Illinois.
HEALTHCRAMS
It is estimated that, including approximately 700,000
in resident institutions, there are 2,160.000 persons from
14 to 64 years of age who are incapacitated to such an
extent that they must be considered to be out of the labor
force permanently or at least for 10 years or longer.
Theodore D. Woolsey, Pub. Health Rep., February 10,
1950.
A mycotic infection should be suspected in every
patient who has chronic draining sinuses even though
the clinical appearance of the lesions may be identical
with those produced by the tubercle bacillus and by
certain anaerobic streptococci. David T. Smith, M.D.,
J.A.M.A., December 24, 1949.
The early manifestation of pulmonary tuberculosis is
usually a lesion of a predominantly exudative, pneumonic
character. It may vary in extent from a small localized
focus to massive pneumonic involvement in some extreme
cases. Lesions of a massive pneumonic type were ob-
served much more often in nonwhite than in white pa-
tients. The great majority of patients with early minimal
pulmonary tuberculosis have no symptoms. At present,
the only method available for detection of the truly in-
cipient tuberculous lesion is routine chest "X-ray exami-
nation at periodic intervals. David Reisner, M.D., Am.
Rev. Tuberc., March, 1948.
If welfare departments are to have the personnel to
give the service that they are fitted to render and if they
are to have funds enough to give relief allowances ade-
quate for the needs of the tuberculous, public support
must be rallied around the social welfare aspects of the
anti-tuberculosis campaign. The tuberculosis association
can help to build up a foundation of public opinion in
support of adequate relief under social welfare laws for
the families of the tuberculous. R. D. Thompson, M.D.,
Nat. Tuberc. A. Bull., October, 1949.
The study of tuberculosis cannot be separated fruit-
fully from that of other pulmonary diseases. The teach-
ing of the disease should be organized in conjunction
with that in other pulmonary diseases from the stand-
point of physical findings, clinical course, differential
diagnosis, and management. Robert G. Bloch. M.D.,
Bull. Nat. Tuberc. A., January, 1950.
The skills required in the modern treatment of pul-
monary tuberculosis are many and varied. The frequent
association of tuberculous and nontuberculous compli-
cations adds further to the need for practically all medi-
cal and surgical specialty services, not excluding re-
search facilities. The closest possible association and
interchange of information and ideas between the tuber-
culosis and general hospitals is for these reasons evi-
dently desirable. Particularly is it desirable for the
teaching hospitals, which are the principal centers of
clinical research, to maintain active contact with tuber-
culosis institutions, and even to provide a quota of beds
for the interchange of patients. Carl Muschenheim,
M.D., Am. Rev. Tuberc., July, 1949.
NEW BOOKS
BREAST DEFORMITIES AND THEIR REPAIR.
By Jacques W. Maliniac, M.D. Clinical Professor of
Plastic Reparative Surgery and Associate Attending
Plastic Reparative Surgeon, New York Polyclinic Medi-
cal School and Hospital, New York City; Attending
Plastic Surgeon, Sydenham Hospital; Diplomate, Ameri-
can Board of Plastic Surgery. Cloth. $10. Pp. 193, with
illustrations. Grune & Stratton, Inc.. Medical Publishers,
381 Fourth Avenue, New York 16, N. Y.
“The purpose of the book is to show the surgeon,
gynecologist, and obstetrician, interested in mamma-
plastic surgery but without special experience in the
field, which are the safe procedures available for cor-
rection of breast deformities, and to help him deter-
mine the proper method for each individual case.
“The author’s extensive experience enables him to
evaluate present-day methods, though he acknowledges
that such an appraisal is a ‘touchy and unrewarding
task.' In analyzing the procedures, he retains w'hat is
sound in each and rejects what is questionable and
untested . .
A PRIMER FOR DIABETIC PATIENTS An Out-
line of Treatment for Diabetes with Diet and Insulin
including Directions and Charts for the Use of Physicians
in Planning Diet Prescriptions: By Russell M. Wilder,
M.D., Pli.D , F.A.C.P., Professor and Chief of the De-
partment of Medicine of the Mayo Foundation, Univer-
sity of Minnesota; Senior Consultant in the Division of
Medicine, Mayo Clinic. New', 9th Edition. 200 pages
with 8 figures. Philadelphia and London: W. B. Saun-
ders Company, 1950. Price $2.25.
This primer for diabetic patients, written by a noted
authority on the subject, will he found to be most useful
both to the patient and his physician. Its cover and
pocket-size are attractive, and the meat contained inside
all make for education and improvement of the diabetic.
* * *
TEXTBOOK OF ENDOCRINOLOGY: Edited by
Robert H. Williams, M.D., Executive Officer and Pro-
fessor of Medicine, University of Washington Medical
School, Seattle. With the collaboration of: Peter H.
Forsham, Harry B. Friedgood, John Eager Howard,
Edwin J. Kepler, William Locke, L. Harry Newburgh,
Edward C. Reifenstein, Jr., William W. Scott, George
Van S. Smith. George W. Thorn, Lawson Wilkins. 793
pages with 168 figures. Philadelphia and London: W. B.
Saunders Company, 1950. Price $10.00.
Professor Robert H. Williams, editor of this volume,
with the able assistance of 11 distinguished collaborators,
has succeeded in making this new hook one that should
be of interest to every physician, and workers in other
fields as well.
* * *
PROCTOLOGY IN GENERAL PRACTICE: By J.
Peerman Nesselrod, B.S., M.S., M.Sc. (Med.), M.D.,
F.A.C.S.. F.A.P.S., Associate in Surgery, Northwestern
University Medical School; Associate of Surgical Divi-
sion of Proctology, Evanston Hospital, Evanston, 111.;
Certified by the Central Certifying Committee in Proc-
tology (Founders’ Group) of the American Board of
Surgery; Commander (MC) USNR. 276 pages with 64
figures. Philadelphia and London: W. B. Saunders Com-
pany, 1950. Price $6.00.
Written and illustrated with the view of giving the
general practitioner helpful aid with his protologic pa-
tients, this small but excellent book should be part of
every physician’s library.
The Medical Association of Georgia will hold its 1951 annual session in Augusta. The dates are
April 17, 18, 19 and 20. Bon Air Hotel will be headquarters, with Partridge Inn participating. Please
make your reservations now.
THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia. July, 1950 No. 7
BURNS: THEIR EFFECTS AND
TREATMENT
Berry Bowman, Jr., M.D.
Albany
The classification of burns as first, second
and third degree needs no explanation. This
discussion applies primarily to those of
second and third degree burns. The pathol-
ogy of burns both from the organic and
physiologic standpoint must be understood
in order to arrive at an intelligent plan of
treatment. Therefore, the disturbed physi-
ologic chemistry of the burned patient shall
be discussed after which a plan of treatment
will be proposed. This shall be offered as a
combination of personal experience and a
limited review of the literature dealing with
the subject.
Pathologic effect of burns: For many
years it has been recognized that there are
systemic changes due to burns that over-
shadow the local lesions. Much debate has
occurred in the past as to whether these ill
effects are due to some histamine-like toxin
produced by the burned tissue or are the
results of changes in blood chemistry and
blood concentration. Unquestionably both
of these factors and, perhaps, others con-
tribute to the morbid condition of the pa-
tient and, together with a number of other
deviations from the normal physiologic
chemistry of the person burned, their effects
have been clearly and unequivocally dem-
onstrated.
There is a marked disturbance of body
chemistry characterized by a loss of electro-
lytes, most prominent of which are chlorides
and sodium. In many instances the chloride
loss only becomes demonstrable on or about
the sixth post-burn day, at which time a
fall from the normal 600 milligrams per
cent to around 300 or 400 milligrams may
be noted. Sodium loss occurs concomit-
antly and, as to which deficit is of most
importance, is a moot question. It has been
shown by the injection of radio-sodium in
experimental animals1 that there occurs a
massive shift of sodium into the injured
tissues with a concomitant but relatively
less transfer of fluid. The sodium ion thus
becomes lost as available circulating so-
dium into the extracellular edema fluid.
Thus a condition is established leading di-
rectly to a decrease in the carbon-dioxide
combining power with a resultant acidosis.
Extracellular fluid volume has been meas-
ured by Cope and Moore1 " by the thiocya-
nate and radio-sodium methods and ex-
pressed in per cent of body weight. Their
findings indicated an extracellular fluid vol-
ume of 18 to 25 per cent body weight.
These workers, using the Evans dye method,
also calculated the plasma volume of the
human patient at 3.5 to 4.5 per cent body
weight. They found that by measuring the
amount of sodium in the burn exudate the
external water loss could he calculated since
its concentration should lie the same as that
of the plasma.
Cope and Moore also found that the maxi-
mal edema in the burned human is reached
between the 36th and the 48th hour and in
burns of partial thickness its subsidence
may be as rapid as its formation. This
270
The Journal of the Medical Association of Georgia
knowledge is of importance in preventing
overzealous fluid therapy which might re-
sult in overloading the circulation.
A “relentless expansion ' ' of the inter-
stitial fluid volume occurs in the first 48
hours after severe burn which depletes the
protein and water resources of the plasma
leading to severe dehydration if not treated
promptly and efficiently. It is here that
inadequate replacement of electrolytes and
protein results in renal failure and paren-
chymatous changes in other organs. Cope1 "
states that fundamentally this interstitial
fluid volume is the edematous distention in
the wound area and is proportional to the
area burned. However, the latter relation-
ship is not direct since a burn1 of 30 per
cent of the body area may he found to be
accompanied by an expansion of interstitial
space of 50 per cent above normal. Expan-
sion to this degree and above carries a
gloomy prognosis as to survival. External
fluid loss is of minor degree as compared
to the pooling of edema fluid in the wound
area.
As a result of hemoconcentration, acido-
sis and sluggish pulmonary circulation,
oxygenation of the blood becomes increas-
ingly inefficient, producing tissue anoxia
and hyperventilation with a further loss of
fluids by the patient. Thus a vicious cycle
of reduction of the plasma volume and
increased hemoconcentration is established
which, if not successfully combatted, leads
to a fatal end.
Post-burn anasarca is an evidence of dis-
turbed albumin-globulin ratio secondary to
the loss of albumin due to increased capil-
lary permeability. An index to protein
loss, in addition to reversed albumin-globu-
lin ratio is the early fall in total nonprotein
nitrogen. Later there may be a rise in total
nonprotein nitrogen, creatinine and urea
secondary to renal tubular damage. Kay-
ser,1" in bis metabolic studies of burn cases,
confirmed the well known tendency of these
patients to go into negative nitrogen bal-
ance but concluded that in his own cases he
believed this due to low intake rather than
increased loss of nitrogen. He found exu-
date nitrogen made up 2 to 25 per cent
of the total nitrogen output (excluding
feces ) .
Hyperglycemia occurs in some burn
cases though not all. In one personal case
a three plus urinary sugar was noted in the
first 24 hours following injury, but a blood
sugar determination was not done. When
present, hyperglycemia is thought due to
adrenal stimulation. It may also be due to
liver glycongenolysis and may possibly be
a contributing factor in the post-burn acido-
sis of severe cases. The actual significance
of elevated blood sugar in burn cases, how-
ever, is of doubtful importance in that we
see this sometimes occurs after severe trau-
ma from sources other than heat.
The determination of ldood concentration
by the hematocrit evaluation is important
although it should be considered together
with blood counts and hemoglobin determi-
nations. The hematocrit determination has
been used by some in calculating plasma
replacement. This will be given later.
Complications and morbid changes:
Cooper, in 1839, first described ulceration
in the duodenum in burned cases. This was
more clearly done in 1842 by Curling,
whose name has since been applied to this
peculiar phenomenon. So-called “Curling’s
ulcer” has been found to be present in 3.8
per cent of all cases coming to autopsy from
fatal burning. Hartman1’ produced the lesion
in 12 per cent of his experimental animals
and curiously enough showed that of these
63.6 per cent occurred in animals treated
by bland dressings in contrast to 6.6 per
Cent treated with tanning agents. No explan-
ation was offered. Various hypotheses as to
July, 1950
271
the cause of Curling’s ulcer include:
1. Hyperacidity of the gastric secretion with increased
gastric motility (Mecheles & Olson).
2. Actions by burn toxins, “protein metabolites”,
formed by digestion of burned areas producing focal
necrosis and hemorrhage of the duodenal mucosa which
is then transformed into an ulcer by the pancreatic
juices (Harris).
3. Blood concentration leading to stasis, ruptured
capillaries and mucosal anoxemia, followed by necrosis
and ulceration (Kapsinow).
4. Lou blood volume leading to necrosis, congestion,
hemorrhage and ulceration (Blalock).
5. Petechiae secondary to sepsis (Perry & Shaw).
At any rate, edema and congestion of the
duodenal mucosa has been noted within
three days after burns. Hartman' believes
that otherwise normal gastric acidity in die
presence of an edematous mucosa is prob-
ably sufficient to produce ulcer, particularly
if a concomitant decrease in duodenal alka-
linity is present.
Liver: Parenchymatous degeneration has
been frequently noted in the liver at autopsy
of fatally burned persons. Furthermore,
numerous and varied liver function tests
have shown impairment of liver function in
these injuries. That this may be facilitated
by the loss of liver glycogen, as mentioned
earlier in this paper, is speculative. Mc-
Clure, Lam et al'1 have clearly demonstrated
that tannic acid produces severe, if not
fatal, lesions in the liver. Liver damage is
often evidenced in burned patients by nau-
sea, vomiting and hematemesis. The lesion
is one of congestion and necrosis.
Kidneys: Interstitial pyelonephritis and
nephrosis have been found at autopsy of
fatally burned patients. This could account
for the gradual increase in creatinine, urea
and total nonprotein nitrogen in cases re-
sponding poorly to therapy. The presence
of albuminuria discloses the permeability
of the renal glomerulus to this large protein
molecule.
Bowel: Many burned patients have a
mild or moderate melena, usually appear-
ing around the sixth post-burn day. This
can be extreme and severe and is due to
hemorrhagic petechiae and ulceration with-
in the gastro-intestinal tract.
Skin: Toxic erythema, thought due to pe-
techial hemorrhage in the skin, has been
noted.
Ficarro1 reports a fatal burn in which, in
addition to the above-listed phenomenae,
the autopsy disclosed bilateral adrenal hem-
orrhage, hemorrhagic cystitis, acute trachei-
tis, ulcerative esophagitis and pulmonary
edema. Edema of the trachea and esopha-
gus are not difficult to fathom, particularly
in those patients who have been burned
about the face and who have, in all likeli-
hood, breathed in the flame.
Treatment: With the above-cited morbid
anatomy and physio-chemical changes in
mind, the treatment of burns immediately
and obviously falls into two distinct cate-
gories: (a) restoration of the normal blood
chemistry and (b) treatment of the local
lesion.
Of value in the prognosis and treatment
is a standard of estimation of the body sur-
face area burned. Numerous workers have
attempted to set forth a table or standard
whereby this can be done — all have their
points of value but probably the simplest
and most accurate is that of Lund and Brow-
der,4 reproduced herewith:
Age-years
Head
Trunk
U p. Ext.
Low. Ext.
Per cent
Per cent
Per cent
Per cent
0
19
34
19
28
1
17
34
19
30
5
13
34
19
34
10
11
34
19
36
Adult
7
34
19
40
Breaking
this still further: neck:
2 per cent;
genitalia:
1 per cent
; buttocks:
5 per cent ;
anterior
trunk: 13 per
cent; posterior trunk:
13 per cent
; thighs:
: 19
per cent ;
legs: 14 per cent and
feet: 7 per
cent.
In the determination of the amount of
plasma indicated in the individual burn
case several methods have been advanced.
Most often quoted of these are two as fol-
lows: (1) 50 to 100 cc. of plasma for each
1 per cent of surface area burned and (2)
100 cc. of plasma for each point the hemato-
crit exceeds 45. The latter is that of Hark-
ness and would appear more reliable.
It has been shown that plasma, by virtue
of its protein element, is superior to the ad-
272
The Journal of the Medical Association of Georgia
ministration of either normal saline or glu-
cose-saline alone. Administration of the
latter would seem to further increase the
loss of electrolytes and albumin by “wash-
ing out due to its deficiency in oncotic
properties as compared to plasma. Even
better, of course, would be the administra-
tion of whole blood. Transfusion of whole
blood increases the oxygen-carrying ele-
ments that the patient badly needs. By giv-
ing whole blood (up to 5 per cent of the
body weight) during the shock phase Abbott
et al" state that the anemia encountered in
the convalescent period of burned animals
and patients can be ameliorated or prevent-
ed. \\ hen salt solution is given by mouth
in conjunction with whole blood intraven-
ously, during the shock phase, hemoconcen-
tration is not encountered according to these
investigators. It has been definitely estab-
lished that the transfusion of whole blood
in the presence of henioconcentration is not
contraindicated due to the fact that the
donor blood is dilute in comparison to that
of the patient.
Where evidence of reduced adrenal func-
tion is present, the use of one of the adrenal
cortex preparations is indicated. Such evi-
dence may take the form of a feeling of
weakness with profuse sweating.
Cope and Moore1' have brought forth a
surface area formula for fluid therapy that
is more appealing to me than those given
above. This formula is based upon the con-
cept that wound demand is proportionate
to extent, that rate of edema formation de-
creases with time after injury and that re-
quirements of normal metabolism, includ-
ing kidney function, must be met in addi-
tion to those of the wound itself. Therefore,
they offer the following formula which, of
course, cannot he offered dogmatically for
all burns hut from which satisfying adjust-
ments may be made to suit the individual
problem. Their formula for fluid replace-
ment is:
1. For wound edema give 10 per cent of the body
weight.
2. For external loss of an amount varying according
to the area of wound surface:
Burns of 25 to 35 per cent — 1000 cc.
Burns of 35 to 60 per cent -2000 cc.
Burns of 60 per cent and over — 3000 cc.
1 and 2 are added and 2/3 of the total is given as
plasma and the remaining third as isotonic electrolytes.
This total is subdivided into four portions, two of
which are given within the first 12 hours post-burn, the
third part in the second 12 hours and the fourth part
in the second 24 hour period. This prevents an over-
whelming release of fluid when the extracellular fluid
begins to recede after the 36 to 48 hour high. In addi-
tion to the above, 1500 cc. of isotonic electrolyte (to a
total of 3000 cc. ) is given for renal excretion for each
24 hour period, one-half of this being given intravenously
and one-half orally as glucose in water or, if necessary,
also intravenously. For insensible fluid loss 1500 cc.
(3000 cc. total) of glucose in water intravenously or
palatable low salt solution orally is advocated.
Cope and Moore believe the hourly check
of renal output by indwelling catheter is the
safest method of guarding against renal
shutdown. This together with hourly deter-
minations of urinary specific gravity. These
should be recorded on the chart. They state
that where the hourly renal output is 50 to
200 cc. therapy is adequate and no increase
should be permitted; 30 down to 5 cc. per
hour calls for immediate increase in fluid
replacement; over 200 cc. per hour if en-
countered in the first 48 hours indicates
over-treatment — after the first 48 hours it is
probably due to spontaneous diuresis. A
continued low output (0 to 30 cc. per hour)
in the presence of continued therapy sug-
gests inadequate replacement or a renal
lesion. In the latter instance continued in-
crease in therapy threatens to produce
edema or cardiac failure. The rapid fluid
injection test ( 1000 to 1500 cc. of 5 per cent
glucose in distilled water within 45 to 60
minutes) should be done. If immediate in-
crease in renal output occurs then the fluid
replacement therapy has been inadequate
and should be increased at once; however,
should no increase in renal output occur it
can be assumed that kidney damage is pres-
ent and an increase in fluid replacement
will be dangerous.
Olson and Necheles1, in their studies of
anuria in thermal burns found it similar to
July, 1950
273
the anuria of transfusion reaction, crush-
syndrome and hemolytic disease and that
death obviously will ensue unless the anuria
is overcome. They felt that the common
factor of these anurias is intravascular he-
molysis due to sudden and rapid destruction
of red blood and muscle cells liberating
large amounts of hemoglobin and myoglob-
in and fragments of cells into the circula-
tion. Added to this, of course, is renal tubu-
lar damage by anoxia and toxins. They
found that the intravenous administration of
2^/2 per cent sodium sulfate solution was
the only fluid that worked reliably and
beneficially in burn anuria. The sulfate ion
is comparatively inactive physiologically
and is excreted rapidly, thus producing a
diuretic effect. Needless to say mercurial
diuretics should not be considered in burn
cases.
Local treatment of the burned area: In
1924, Davidson, working in the Henry Ford
Hospital in Detroit, brought forth the use
of tannic acid (which had been used cen-
turies before by the Chinese in the form of
strongly brewed tea). This treatment gained
wide popularity and, until recently, has been
almost universally employed. However,
among its earliest recognized shortcomings
was the fact that, due to its almost complete
lack of bactericidal properties, infection fre-
quently occurred under the eschar, necessi-
tating removal of the latter. Recently Mc-
Clure and Lam,11 working in the same insti-
tution as Davidson, have shown that tannic
acid produces severe, if not fatal, lesions
in the liver and definitely inhibits healing of
the wound. Liver damage, due to tannic
acid, was further shown by Saltonstall et al'
who found by liver function tests that tannic
acid used in burn therapy is absorbed suffi-
ciently to produce liver damage. They con-
cluded that tannic acid is the most hepato-
toxic agent, although all tanning agents are
toxic to a lesser extent. McClure states that
tannic acid is particularly obnoxious in the
treatment of second degree burns due to the
great absorptive property of these burns.
It produces less damage in third degree
burns as these possess less absorptive poten-
tiality. McClure states that “it is hoped that
this communication from a group working
in the same institution (as Davidson) will
result in the abandonment of the treatment
of burns by this (tannic acid) and related
methods”. The fact was shown that the
mortality rate from burns actually increased
during the tannic acid era, although this is
contested by some. Rae and Wilkerson1 ’
felt there was less likelihood of liver dam-
age where tannic acid followed by silver
nitrate was used than tannic acid alone.
In a comparison of 82 experiments con-
ducted by burning symmetrical areas on
the thighs of 41 volunteers, Dingwall and
Andrus8 found that the best results meas-
ured in time of healing, absence of symp-
toms and freedom from complications were
obtained by tbe use of sulfonamide impreg-
nated film. Next best was local treatment
with a bland ointment together with sulfona-
mide by mouth.
Some have objected to the use of sulfona-
mides locally on the basis of creating a
sulfonamide sensitivity in the patient. How-
ever, in the 41 cases cited sensitivity oc-
curred in only six with mild reactions and
no sensitivity could be demonstrated in any
of them five weeks after cessation of treat-
ment. Jenkins states that in the use of sul-
fonamide ointments there is sufficient libera-
tion of sulfathiazole from its ointment to
produce a bacteriostatic effect which may
continue for a week or more. He further
states that the liberation of sulfathiazole
from the ointment is sufficiently gradual to
prevent overwhelming systemic absorption
and advocates its use especially in situations
where adequate cleansing cannot be obtain-
ed. Evans1" demonstrated clearly that the
274
The Journal of the Medical Association of Georgia
absorption of a sulfonamide is limited when
used in an oil base ointment and that where
water dispersive bases are used a toxic
blood level can occur.
Sulzberger and Karnoft'1'' investigated the
debriding effect of 0.1 M pyruvic acid in a
starch paste on burn wounds. They found
this to offer a simple and practical topical
treatment for third degree burns which
would produce a pink granulating base suit-
able for grafting within three to five days
after beginning treatment. Viable areas
were not adversely affected by the acid and
were thus preserved as islands for re-epi-
thelization. The treatment, when used,
should be started within two or three days
of initial injury or as soon as the peripheral
vascular failure has been controlled. The
pyruvic acid-starch dressing affords fre-
quent inspection of the wound without pain
to the patient and supposedly without in-
terference with healing. The preparation is
applied in copious amounts (3000 cc. for a
leg — 8000 to 9000 cc. for leg and thigh),
covered with a layer of dry gauze, then a
layer of vaseline gauze and finally multiple
layers of gauze and semi-pressure bandage.
Recently various protein extracts and
preparations have been tried in the local
treatment of burns in the hope of forming a
more physiologic eschar than could be pro-
duced by chemicals. Chase1” obtained an
extract from beef aorta which, while a pro-
tein, contained no albumin, proteoses nor
peptone. This could be used in saline or in
an ointment to which sulfathiazole or peni-
cillin could be added. He has employed it
with satisfactory results in over 500 ambu-
latory cases and feels that its advantages are
that it can be removed with water or saline
with ease, it forms a flexible, dry eschar over
denuded surfaces, there is no evidence of
tissue injury or retarding of growth, that
infected areas are easily identified as the
protecting eschar liquifies and disintegrates
over areas of infection and, finally, that be-
cause of the protective eschar the wound
can be inspected frequently without fear
of contamination.
It has become increasingly evident of re-
cent years that wounds can be dressed too
often. Particularly is this true of burns. A
direct relationship can be said to exist be-
tween the time of healing and the number of
times the dressings are removed; i.e., the
fewer the dressing changes, the quicker the
healing. This is clearly understandable
when one reflects that at each dressing one
simply removes much newly-formed, deli-
cate epithelium that is attempting to cover
the burned area. That the fewer the dress-
ings, the better the healing is true has been
the experience of the writer who refuses to
change the initial dressing unless clinical
evidence of infection beneath them appears.
So far this has not occurred and the satis-
faction of removing a dressing after 14
to 16 days and finding the burned area
completely covered with new skin is a de-
lightful experience. Patients must frequent-
ly be reassured to prevent them believing
themselves neglected, as the average one
feels that any dressing or bandage must be
frequently changed!
In the two station hospitals in which
I worked during World War II, the
treatment of burns consisted of analgesia
with morphine and atropine, followed by
the meticulous scrubbing of the burn area
with white soap and sterile saline under
aseptic technic. Following the scrubbing a
complete change of sterile drapes, gown
and gloves was accomplished and the burn
was covered with a single layer of sterile,
plain vaseline gauze in accurate apposition
to the burn surface and covered by multiple
layers of sterile gauze dressings which, in
turn, were held in place by roller bandage
followed with ACE bandages. The bandage
was applied gently but with firm pressure.
July, 1950
275
Where fingers or toes were involved they
were dressed separately and bandaged in
full extension. A cast was applied if deemed
necessary. Postoperatively a close check
was maintained on the blood chemistry,
intake and output. Daily hematocrit, blood
counts, plasma, protein and urinalyses were
obtained. A urinary output of 1500 cc/24
hours was striven for. After insuring ade-
quate intake and output of fluids, sulfadia-
zine or sulfathiazole was given orally and
blood concentration tests for sulfa requested
every other day with daily urinalyses. Mul-
tiple layers of sterile gauze were preferred
by me to sterile mechanics’ waste due to the
greater smoothness of the resulting bandage.
In cases where anesthesia was necessary
pentothal sodium by vein was the agent of
choice. Particularly would this seem true
in patients burned about the face or with
laryngeal injury. Furthermore, pentothal
sodium is less prone to produce circulatory
complications and less likely to contribute
to postoperative blood and hemoglobin con-
centration. The complication most feared
was severe laryngeal spasm, which has
never befallen me, and which should be
avoided by the use of atropine instead of
scopolamine and by use of an airway.
Papper1' regards morphine as the analgesia
by choice in the anesthetic management of
the severely burned patient and uses pento-
thal only where morphine is inadequate
and supplements the pentothal with 50 per
cent nitrous oxide in oxygen.
Not to be overlooked is the nutritional
care of the burned patient: the protein and
vitamin losses must be restored as well as
the electrolytes and must be kept at a nor-
mal level. This should be accomplished by
feeding the patient high-protein high-vita-
min diets by mouth if possible and gavage
if necessary. One of the principal demands
of the burn victim is for nitrogen due to the
excessive loss of this element in the urine
in the early convalescent period. Marked
abnormalities of the carbohydrate metab-
olism occur in severely burned animals and
humans and are associated with hypergly-
cemia, lactacidemia and lowered carbon-
dioxide combining power. In all probabili-
ties protein catabolism is increased by
absorption of specific substances from the
burned areas.
Failure to meet the nutritional demands
results in progressive weight loss and hypo-
proteinemia. The latter, when progressive,
is a bad sign and should be considered as
present when the plasma protein falls to any
value below 5.
Supplying food by mouth is the most
convenient and ideal procedure. Food must
contain adequate protein, carbohydrates,
fats, minerals and vitamins. High-caloric
high-vitamin diets with upwards of 400
grams of protein daily may be necessary in
some cases. Where gavage is necessasy mix-
tures of egg white, skim milk, orange juice,
brewers’ yeast, lactose and freshly ground
liver are recommended. Elman2'1 advocates
a high protein milk diet in which 100 grams
of protein and 1000 calories are considered
a daily minimum. He urges his patients to
take twice this amount.
Summary: In summarizing it may be
said that the burned patient suffers from
general and local injury. The changes in
blood chemistry are of extreme importance
and must be combatted quickly. In brief,
they include:
Loss of chlorides and sodium ions, blood
concentration, acidosis with lowered car-
bon-dioxide combining power, sluggish pul-
monary circulation with resultant tissue
anoxia and hyperventilation, loss of fluids,
protein and plasma volume, hyperglycemia,
loss of nitrogen followed in fatal cases by
nitrogen retention.
Organic pathologic changes include liver
degeneration, kidney damage, ulcerations
276
The Journal of the Medical Association of Georgia
of the gastro-intestinal tract, toxic erythe-
mas, hemorrhagic cystitis, tracheitis and
adrenal injury.
Treatment consists of restoration of the
abnormal blood chemistry by the indicated
use of plasma, whole blood transfusions,
electrolytes, high-caloric, high-vitamin diets
with adequate protein, carbohydrates and
fats. Adequate fluid intake must be attained.
Proper observation as to response of the
patient to treatment must include daily uri-
nalyses, hematocrit determinations, plasma
protein concentration, blood chlorides and
blood counts.
It is to be understood that variations of
all the above are to be expected and treat-
ment varied to meet all cases which will
naturally range from small second degree
burns to extensive, severe ones or third de-
gree types with all intervening degrees of
severity.
The local treatment advocated by the
writer is that of meticulous cleansing of the
burned area under aseptic precautions fol-
lowed by a single layer of plain vaseline
gauze held in place by a voluminous pres-
sure bandage. Sulfadiazine by mouth
should be an integral part of the treatment.
BIBLIOGRAPHY
1. Fox, C. L., and Keston, A. S. : The Mechanism of Shock
from Burns and Trauma Traced with Radio-Sodium, Surg.,
Gynec. & Obst. 80: 561 (June) 1945.
2. Abbott, W. E., et al : Metabolic Alterations Following
Thermal Burns, Surgery 17: 794 (June) 1945.
3. Ficarra, B. J., and Naclerio, E. A. : The Physiochemical
Disturbances in a Severe Burn, Surgery 16: 529 (Oct.) 1944.
4. Lund, C. C., and Browder, N. C. : The Estimation of
Areas of Burns, Surg., Gynec. & Obst. 79: 352 (Oct.) 1944.
5. Roback, R. A., and Ivey, A. C. : Therapy of Burns,
Surg., Gynec. & Obst. 79: 469 (Nov.) 1944.
6. Hartman, F. W. : Curling’s Ulcer in Experimental
Burns, Ann. Surg. 121: 54 (Jan.) 1945.
7. Saltonstall, et al : The Influence of Local Treatment of
Burns on Liver Function, Ann. Surg. 121: 291 (March I 1945.
8. Dingwall, J. A., and Andrus, W. D. : A Comparison of
Various Types of Treatment in a Controlled Series of
Experimental Burns in Human Volunteers, Ann. Surg. 120 :
377 (Sept.) 1944.
9. McClure, R. D., and Lam, C. : Tannic Acid and the
Treatment of Burns: An Obsequy, Ann. Surg. 120: 387
(Sept.) 1944.
10. Evans, E. I., et al : The Absorption of Sulfonamides
from Burned Surfaces, Surg., Gynec. & Obst. 80: 297
(March) 1945.
11. Jenkins, H. P., et al : Further Studies on the Prepara-
tion and Use of Sulfathiazole Ointment in the Treatment of
Burns.
12. Papper, E. M. : Anaesthesia for Burned Patients,
Surgery. 17 : 116 (Jan.) 1945.
13. Levenson, S. N., et al : The Nutrition of Patients With
Thermal Burns, Surg., Gynec. & Obst. 80: 449 (May) 1945.
14. Walker, J., Jr., and Shenkin, H. : Studies on the
Toxemia Syndrome After Burns II : Central Nervous System
Changes as a Cause of Death, Ann. Surg. 121: 301 (March)
1945.
15. Cope, Oliver, and Moore, F. D. : The Redistribution of
Body Water and the Fluid Therapy of the Burned Patient.
Ann. Surg. 126: 1010 (Dec.) 1947.
16. Kayser, J. W.: Metabolic Studies of Burned Cases,
Ann. Surg. 127: 605 (April) 1948.
17. Olson, W. H., and Necheles, H. : Studies on Anuria — •
Effect of Infusion Fluids and Diuretics on the Anuria Result-
ing from Severe Burns, Surg., Gynec. & Obst. 84 : 283,
(March) 1947.
18. Sulzberger, M., and Kanof, A.: Studies on the Acid
Debridement of Burns, Ann. Surg. 125: 418 (April) 1947.
19. Chase, C. H. : A New Eschar Technique for Local
Treatment of Burns, Surg., Gynec. & Obst. 85: 308 (Sept.)
1947.
20. Elman, R., et al : Severe Burns: Clinical Findings
with a Simplified Plan of Early Treatment. Surg., Gynec. &
Obst. 83: 187 (Aug.) 1946.
21. Cope, Oliver: Anemia in Burns (Ed.) Surg., Gynec.
& Obst. vol. 84 (May) 1947.
USE OF THE ORAL MERCURIAL
DIURETICS IN ADVANCED CONGES-
TIVE HEART FAILURE
J. Gordon Barrow, M.D.
and
Clayton R. Sikes, M.D.
Atlanta
Oral mercurial diuretics have been re-
ported of value as an adjunct to intramus-
cular mercurial diuretics in the treatment
of the edema of congestive heart failure.1 6
We wished to determine their value in pa-
tients not able to come to the hospital for
treatment as often as desirable. This group
had required frequent visits by a physician
or nurse for the administration of intra-
muscular mercurial diuretics.
Material and Methods
Patients chosen for this study required at
least one intramuscular mercurial injection
each week for the maintenance of “dry’'
weight. Many of them required two and
even three intramuscular injections weekly,
and in some even these frequent injections
failed to maintain “dry” weight. Their
ages ranged from 35 to 65 years. All of
them had hypertensive or arteriosclerotic
heart disease. The intramuscular mercurial
diuretic used was Mercuhydrin* * and the
oral preparation was a Mercuhydrin and
Ascorbic Acid* tablet containing 19.5 milli-
From the Cardiac Clinic of Grady Memorial Hospital
and the Department of Medicine, Emory University School
of Medicine, Atlanta.
* Product of Lakeside Laboratories.
July, 1950
277
grams of mercury and 100 milligrams of
ascorbic acid in each tablet.
A total of 16 patients was treated. The
longest period of treatment was 21 weeks.
All patients were on a cardiac regimen in-
cluding a low salt diet, full digitalization,
weight reduction if necessary, and limited
physical activity. The patients were ob-
served during a control period consisting of
at least three visits at intervals not longer
than one week. Weight, symptoms, and signs
of congestive failure were recorded, and the
dose of intramuscular mercurial diuretic be-
ing received was recorded during this con-
trol period. At the end of this time intramus-
cular injections were discontinued and the
patient was instructed to take two Mercu-
hydrin-and-Ascorbic Acid tablets daily. If
the patient was unable to tolerate two tab-
lets daily, the medication was temporarily
discontinued and then begun again in a
dosage of one tablet daily. Supplementary
mercurial injections were given as neces-
sary, depending upon the weight and symp-
toms of congestive failure.
Results
A brief summary of the course of treat-
ment in each of the 16 patients is shown in
Table 1. The results are concisely shown
in Table 2. It should be noted that the inci-
dence of unpleasant gastrointestinal symp-
toms was high, and in 5 of the 16 patients
the oral medication had to be discontinued
because of nausea, vomiting, diarrhea, or
abdominal cramps. One patient with poor
oral hygiene developed a severe stomatitis
after eight weeks of treatment. The most
severe reaction occurred in a patient who
had experienced nausea since the second
week of treatment, and whose dose had been
reduced to one tablet daily. In spite of
this, a severe bloody diarrhea developed
and she became extremely weak. These
symptoms disappeared immediately when
the oral mercurial was discontinued. Of the
11 remaining patients who tolerated the
drug, 5 required no intramuscular injec-
tions while on oral Mercuhydrin and As-
corbic Acid tablets for periods ranging from
4 to 21 weeks. Of the remaining 6 patients,
all but one noted either a definite improve-
ment in edema while on oral mercuhydrin
in addition to supplemental intramuscular
injections, or a definitely decreased need
for intramuscular mercuhydrin. One failed
to show any improvement during three
weeks on both intramuscular injections and
oral tablets.
Discussion
The high incidence of gastrointestinal
toxic symptoms accompanying the adminis-
tration of oral mercurials in this group of
advanced cardiac patients proved a serious
drawback. It is probably true that patients
in severe congestive failure are more prone
to develop gastrointestinal symptoms than
patients in somewhat milder congestive fail-
ure. Among the patients who tolerated the
drug the results were good in all except one,
either definitely reducing or completely
abolishing the need for intramuscular in-
jections. In our experience the most satis-
factory dose was one tablet, given twice
daily, although an occasional patient ex-
hibited a satisfactory response to one tablet
per day.
The patient should be seen frequently
during the first four weeks of trial on an
oral mercurial diuretic in order that tox-
icity may be discovered early, and the de-
gree of effectiveness may be quickly deter-
mined. Severe nausea, vomiting, diarrhea,
and stomatitis are indications for discon-
tinuing oral administration. If toxic symp-
toms do not develop during the first six
weeks, it is unlikely that they will appear
during the succeeding weeks.
Conclusions
Oral mercurial diuretics, in a dosage of
1-2 tablets daily, can be valuable adjuncts
27F>
The Journal of the Medical Association of Georgia
TABLE 1
Oral
Mercurial Diuretics
in Advanced
Congest i ve
Heart Failure
Parenteral
Parenteral
Diuretic
Oral
Toxic
Weeks on
Diuretic
Patient
( Control
Mercurial
Signs and
Treatment
(Treatment
Weight
Period)
Diuretic
Symptoms
Period)
L. W.
1 cc. weekly
2 tabs.
Abdominal
3
None
Stable
daily
cramps.
1 tab.
Nausea and
8
daily
stomatitis.
M. B.
1 cc. weekly
2 tabs,
daily
None
19
None
Stable
J. L.
2 cc. weekly
2 tabs.
Nausea and
1
2 cc. x
2
Edema
( edema poorly
daily
diarrhea.
better
controlled)
1 tab.
Nausea.
1
controlled
daily
vomiting
& diarrhea
M. R.
2 cc. weekly
1 tab.
daily
None
7
2 cc. x
4
Stable
E. P.
2 cc. weekly
1 tab.
None
8
2 cc. x
2
Edema
daily
better
controlled
M. D.
2 cc.
1 tab.
None
6
0
Stable
alternate
alternating
weeks
with 2
tabs, daily
B. M.
2 cc. weekly
2 tabs.
Nausea and
1
0
Stable
daily
vomiting.
1 tab.
Diarrhea
3
daily
& cramps.
I. W.
2 cc. weekly
4 tabs.
Nausea
1
0
Slight
daily
increase
in edema
2 tabs,
daily
None
8
E. B.
2 cc. weekly
2 tabs.
Slight
6
2 cc. x
3
Stable
daily
nausea.
R. H.
2 cc. twice
2 tabs.
Nausea
2
2 cc. x
4
Edema not
weekly
daily
vomiting
controlled
(edema not
controlled)
& diarrhea
J. S.
2 cc. weekly
2 tabs,
daily
None
4
0
Stable
F. J.
2 cc. weekly
2 tabs.
Slight
5
0
Stable
daily
nausea
A. Y.
2 cc. weekly
2 tabs.
None
3
2 cc. x
3
Stable
(edema poorly
controlled)
daily
S. H.
2 cc. weekly
2 tabs.
None
8
2 cc. x
3
Edema
(edema poorly
daily
better
controlled )
controlled
I. 0.
2 cc. weekly
2 tabs.
Diarrhea
2
2 cc. x
1
Increase
(edema poorly
daily
in edema
controlled)
1 tab.
Nausea,
4
daily
vomiting
& bloody
diarrhea
R. K.
2 cc. twice
2 tabs.
None
21
2 cc. x
7
Stable
weekly
daily
July, 1950
279
to the use of parenteral mercurial diuretics
in the treatment of chronic, severe, conges-
tive heart failure. The physician must be
aware of the frequency of gastrointestinal
toxic symptoms following use of the drug.
The incidence of toxic reactions seen in this
clinic has been significantly higher than that
reported in other series. The tablets have
been of particular benefit in patients who
could not be given intramuscular mercurial
injections as frequently as needed.
TABLE 2
Results of Treatments with Oral Mercurial Diuretics in
Advanced Congestive Heart Failure
Results No. Patients
1. Weight satisfactorily controlled
without toxic symptoms 11
(a) No supplemental par-
enteral mercurial diuretics
necessary 5
(b) Supplemental parenteral
mercurial diuretics neces-
sary 6
2. Toxic symptoms necessitated
omission of the oral drug.. 5
la) Weight satisfactorily con-
trolled while on the drug . 3
(b) Slight to moderate in-
crease in edema in addi-
tion to toxic symptoms 2
BIBLIOGRAPHY
1. Vander Veer, Joseph B. ; Clark, Thomas W., and
Marshall, Davis S. : The Prolonged Use of an Oral Mer-
curial Diuretic in Ambulatory Patients with Congestive
Heart Failure, Circulation 1:516, 1950.
2. Derow, Harry, A., and Wolff, Louis: The Oral Admin-
istration of Mercupurin Tablets in Ambulatory Patients with
Chronic Congestive Heart Failure, Am. J. Med. 3:693, 1947.
3. Batterman, Robert C. ; DeGraff, Arthur C., and Shorr,
Harold M. : Further Observations on the Use of Mercupurin
Administered Orally, Am. Heart J. 31:431, 1946.
4. Soloman, H. A., and Abraham, A.: Success with Oral
Mercurial Diuretic, New York State J. Med. 48:1593, 1948.
5. Shaffer, C. F., and Chapman, D. W. : The Use of Oral
Mercuhydrin Combined with Ascorbic Acid in Cardiac
Decompensation, J. Lab. & Clin. Med. 34:1750, 1949.
THE INJECTION TREATMENT OF
HEMORRHOIDS
Fred B. Hodges, Jr., M.D.
Atlanta
The injection treatment of hemorrhoids
has been practiced for over 80 years. It has
been only within the past two or three de-
cades, however, that this method of therapy
has assumed its rightful place among scien-
tifically recognized procedures. During
earlier years many men, untrained in its
use, caused so much adverse criticism that
it was abandoned by all but a few. Kelsey,
Andrews and others recognized the value of
injections in selected cases, and it is through
the efforts of such men that this form of
treatment has reached its present day
status.
Only patients with internal bleeding
hemorrhoids and those who have a mild
degree protrusion should be treated by this
method. Those with external hemorrhoids,
strictures, fissures, ulcerations, fistulas, or
any inflammatory process, should not be
treated by injections. However, there are
many occasions when injections may be
used to an advantage as a palliative meas-
ure, such as to control hemorrhage while
preparing a patient for surgery, or in cases
of advanced pregnancy, old age, diabetes,
tuberculosis and cardiorenal diseases where
operative procedures may be definitely con-
traindicated.
Among the advantages of the injection
treatment are: freedom from pain, no con-
finement to bed, no hospitalization, little or
no loss of time from work, and relief is
usually prompt. It should be explained to
the patient that, as soon as relief is experi-
enced, they are not necessarily cured and
should continue treatments until the hemor-
rhoids have disappeared.
The purpose of the injections is to pro-
duce irritation with a chemical solution
sufficient fibrosis to obliterate the network
of dilated veins forming the hemorrhoid,
causing it to shrink but not sufficient to
cause sloughing of the tissues.1 To accom-
plish this, the most frequently used and most
universally accepted solutions are:
Rx
5% to 10% Phenol in Olive Oil or Almond Oil.
Rx
Phenol — fl. dr. i
Glycerine — fl. dr. iii
Distilled water — fl. dr. iv
Quinine and urea-hydrochloride — gr. xxiiss
Distilled water — fl. oz. i
More recently Terrell' of Richmond, Va.,
280
The Journal of the Medical Association of Georgia
lias advocated quinuride, which is a 4Ty>
per cent solution of anhydrous quinine and
urea, adjusted to a pH of 2.6 with hydro-
chloric acid. Good results may he obtained
by using any one of the above mentioned
solutions. In my experience phenol in oil
lias been very effective and the technic will
be described below.
No expensive equipment is required, the
essentials being a suitable speculum, pre-
ferably the blunt end type; the sclerosing
fluid; suitable syringes; needles; a good
light; a mild antiseptic; lubricating jelly;
some sponges; forceps and cotton. Most
of these are always found in the average
doctor's treatment room.
Before giving an injection it is always
well to remember the types suitable for in-
jection and to rule out any disease above
the rectum that might be causing bleeding.
With the patient in the left lateral, or
Sims’ position, the buttocks are retracted by
an assistant or, if none is available, the pa-
tient may use the right hand to retract the
right buttock. A well lubricated gloved fin-
ger is gently inserted into the anus and
rectum to lubricate the parts. Also a few
circular movements with the finger helps to
relax the anal spincter. At the same time
the degree of induration resulting from pre-
vious injections may be determined.
After inserting the speculum and inspect-
ing the hemorrhoids, any fecal material
present is wiped away and some mild anti-
septic is applied to the rectal mucosa. With
the hemorrhoids exposed, the needle is
inserted into the submucosa and the solution
slowly injected. While there is no definite
rule as to the amount to be injected, the
solution is injected until a definite pale
swelling occurs over the ballooned-out
hemorrhoid, usually from one to three cubic
centimeters. The needle is left in place for
thirty to sixty seconds after stopping the in-
jection. This gives time for the edema,
which immediately occurs, to obliterate the
needle puncture and prevent bleeding.
Usually one or two hemorrhoids are in-
jected at each office visit. Care should be
taken not to inject too much solution as
sloughing is likely to occur. Pain occurring
at the time of injection is usually due to the
point of injection being too low and it should
be discontinued immediately. The number
of treatments required varies from six to
ten, depending on the number and size of
the hemorrhoids.
No special after-treatment is required.
Patients should be told to avoid unneces-
sary straining or any strenuous exercise. If
one of the injected hemorrhoids should pro-
lapse, it should be replaced by gentle digital
pressure. Complications following injec-
tions are very few. Sloughing occasionally
occurs, due to too much sclerosing fluid
being injected. Abscess and strictures have
been reported but they are relatively few
and rarely occur if the proper technic is
used.
REFERENCES
1. Pruitt, Marion C.: Hemorrhoids, St. Louis, The C
V. Mosby Company, 1938, p. 116.
2. Terrell, R. V., and Chewning, C. C., Jr.: The Present
Status of Injection Treatment of Internal Hemorrhoids,
Am. J. Surg. 79:44-48, 1950.
DEATHS FROM INFLUENZAL MENINGITIS
ALMOST ELIMINATED BY DRUGS
A recovery rate from influenzal meningitis
of 96 per cent following treatment with sulfa-
diazine and streptomycin is reported in June 24
journal of the American Medical Association.
Before the use of sulfa and antibiotic drugs,
the mortality from the disease varied from 90
to 100 per cent, according to Drs. Emanuel
Appelbaum and Jack Nelson of the New York
City Health Department, authors of the article.
This form of meningitis is essentially a dis-
ease of infants and young children, the doctors
point out.
Of 90 patients treated, 87 recovered and three
died. In the vast majority of these patients, there
was marked improvement in six days after
treatment with streptomycin was begun, the
doctors say.
Residual damage, including deafness and
defective vision, occurred in nine of those who
survived.
July, 1950
281
THE SIGNIFICANCE OF NIPPLE
DISCHARGE
B. T. Beasley, M.D.
Atlanta
A working knowledge of the anatomy and
histology of the mammary gland is neces-
sary for a discussion of its physiology.
The glands in the human are located on
each side of the lower portion of the chest
walls in the upper third of the mammary
ridge. In the lower mammals the glands are
located along the mammary ridge from the
axillae to the groins. The number varies
in different animals from two to fourteen,
depending upon the number of offsprings
the mother is capable of producing at each
conception.
In animals that lie down to nurse the
young the glands are located on each side
of the chest and abdomen along the mam-
mary ridge; in those that stand up to nurse,
they are located in the groins, while those
that hold the young in their arms for nurs-
ing the glands are located on the chest
wall.
The mammary glands vary in size in the
different mammals as well as in the same
group of mammals. No other organ in the
body shows such variations in size.
The glands with all their component parts
are formed during intrauterine life and
contain all the elemental histologic struc-
tures they ever contain. The anatomic units
of the glands are the acini and ducts and
the histologic units are the epithelial cells
lining the acini and ducts. One layer in the
acini and two layers in the ducts. The
fibrous tissue framework and fatty pads as
well as the fascia and skin act as supporting
and protecting structures for the secreting
glands.
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
The purpose of the gland is to furnish
nourishment for the young offspring, hence
its function is to secrete. The epithelial cells
lining the acini begin secreting at birth. The
infant breast may become engorged with
secretion two or three days after birth pro-
ducing the condition called “mastitis neona-
torum'’. There is present a small amount
of secretion in the ducts at all times. Again,
the breasts may become engorged during
adolescence producing “adolescent masti-
tis”. The former is due to lactogenic stimu-
lation from the mother, while the latter is
due to hormone stimulation from the endo-
crine glands of the young girl herself. Dur-
ing pregnancy and lactation the glands be-
come engorged again due to increased
hormone stimulation. Even after menopause
there is present demonstrable quantities of
secretion in the breast.
It is thus seen that the epithelial cells
lining the acini and ducts continuously se-
crete from infancy to old age. It is also
seen that there are periods in the life of the
individual during which secretory activity
is accelerated, during infancy, adolescence
and during pregnancy and lactation. This
phenomenon is due to the variations in
hormone stimulation to the glands. These
extra hormones may he produced in the
individual or they may he introduced into
the individual, at different times. These
periods may he divided as follows:
I. Prelactation Interval.
1. Infancy.
2. Childhood.
3. Adolescence.
4. Girlhood.
II. Lactation Interval.
1. Pregnancy.
2. Lactation.
III. Postlactation Interval.
1. Menopause.
2. Senility.
During the so-called resting periods, that
is between infancy and adolescence, and the
nonlactating period, and senility, the epi-
thelium of the acini and ducts is only
passively stimulated. During the resting
intervals there is a trace of secretion in the
282
The Journal of the Medical Association of Georgia
ducts, some of which may he expressed
from the nipples as a thin viscid secretion
in the nulliparous and a thick creamy secre-
tion in the parous breast.
During the height of the secretory peri-
ods; i.e., early infancy, adolescence and
pregnancy and lactation, the epithelium is
actively stimulated by lactogenic and estro-
genic hormones which causes a rise in the
secretory level.
This orderly pattern runs constant in the
breasts of women who live unrestrained
lives, and whose breasts function without
interruption, according to nature’s laws.
Only when normal function is prevented
through restraint of natural instincts or
abnormally stimulated by emotional stress
does the organ develop abnormal function
and the physiology of the gland converted
into a pathologic process. To tabulate the
biologic sequence womankind was intended
to take, the following events may be con-
sidered:
1. Birth followed by infancy and childhood.
2. Adolescence, the natural transformation from
girlhood to womanhood.
3. A period of fertility for the purpose of repro-
duction.
4. Menopause, another period of transformation
from that of fertility into infertility and the
beginning of senility.
The same physiologic pattern is followed
by other organs of the body, particularly
the reproductive organs. The ovaries and
womb respond to the same stimulation in
an orderly fashion. The pituitary glands
direct their hormones to the organ which is
called upon to do a particular job as natural
demands are made upon that particular
organ. During pregnancy and lactation the
estrogenic and lactogenic hormones are di-
rected to the mammary gland, where the
epithelial structures are stimulated for the
production of colostrum and milk.
At the termination of nursing there being
no further demands upon the gland to pro-
duce milk, pituitary activity is directed to
the endometrium for the purpose of pre-
paring the uterus for another fertilized
ovum. If a fertilized ovum is received by
the endometrium, another cycle of preg-
nancy and lactation is begun. If the endo-
metrium does not receive a fertilized ovum,
and pregnancy does not take place, the
pituitary is called upon to repeat the cycle
for another try at pregnancy. This process
continues throughout the childhearing life
of the individual. Any break in this orderly
phenomenon may convert a normal physi-
ologic process into an abnormal or patho-
logic one. Hippocrates wrote in his Aphor-
isms as early as 460 B. C.: "All parts of the
body which are designed for a definite use
are kept in health and in the enjoyment of
fair growth and of employment of which
they are accustomed. But when they are
disused they grow ill and stunted and be-
come prematurely old.''
It is an historic fact that the barren womb
is more likely to develop fibroids than
the functioning womb, and that the unnursed
breast is more likely to develop neoplastic
disease than the regularly nursed breast. The
endocrine system which controls the secre-
tory activity of the mammary glands is un-
der the direct influence of the sympathetic
nerves which supply the different endocrine
glands. Interruption or interference Avith
normal impulses transmitted by these sym-
pathetic nerves causes a change in the rate
of secretory activity; i.e., abnormal im-
pulses may cause a rise or fall in the secre-
tory level. It has been shown that emotional
disturbances influence all gland activity.
Unpleasant emotions such as fear, grief,
etc., depress, while pleasant emotions stim-
ulate. Sexual excitement produces in the
adrenals, thyroid, the pituitary and ovaries
a step-up in tempo resulting in increased ac-
tivity in the mammary glands as well as the
menstrual mechanism. Increased mammary
stimulation produces increased activity of
the epithelial structures of the acini and
tubules. During lactation this is character-
July, 1950
283
ized by the production of large quantities of
milk. During the so-called resting interval
it is characterized hy the formation of fib-
rous tissue or epithelial over-growth such
as fibroadenoma, intraductal papilloma,
and cystic disease. The relationship between
these benign lesions and malignant disease
is a controversial issue.
The physiology of the lactating breast is
maintained by regular nursing or “milk-
ing”. The converse is true if the breast is
not nursed. The old practice of “weaning
the baby” is now frowned upon by the more
progressive physicians, and mothers are
advised to nurse their babies.
Nipple discharge may occur spontaneous-
ly or by manual pressure. There are two
types of nipple discharge: (a) physiologic
secretion, and (b) pathologic discharge.
Nipple secretion containing no blood or pus
in the absence of demonstrable disease has
no clinical significance. Discharge contain-
ing blood or pus is significant and may indi-
cate (a) benign, (b) malignant, or (c) in-
flammatory lesions. If no palpable tumor is
present a benign lesion should be suspected
in more than 90 per cent of the cases. If a
palpable tumor is present with bloody nip-
ple discharge, a malignant lesion should be
suspected in nearly 50 per cent of the cases.
If the lesion is small an intraductal papil-
loma should be suspected in more than 50
per cent of the cases. If the breast presents
evidence of inflammation a's characterized
by pain, redness and swelling, either infec-
tion, plasma cell mastitis or so-called in-
flammatory carcinoma should be suspected.
Examination of the discharge should aid in
making a differential diagnosis.
The normal expectancy of cancer of the
breast in all women is 0.42 per cent. The
expectancy of cancer in breasts showing
abnormal signs is as follows:
1. Chronic cystic mastitis 0.88%
2. Adenomas 2 %
3. Cystic disease 0.79%
4. Intraductal papilloma 6 %
5. Mastodynia \nn<-
6. Bloody discharge without palpable
tumor - 9 %
7. Bloody discharge with palpable
tumor 33 to 14%
Conclusions
1. Normal or physiologic discharge is a
secretory product of the epithelial cells of
the acini and milk ducts, and does not indi-
cate disease.
2. Abnormal or pathologic discharge is
not a secretory product of these cells. It
may be blood escaping by way of the nipple
as a result of trauma or disease; or it may
be pus, the result of infection in the ducts
or in the breast which is draining through
the ducts.
3. It is possible to obtain both normal
and abnormal discharge from the same
breast. There may be a bleeding intraductal
papilloma from which blood can be ex-
pressed; or it may bleed spontaneously,
and at the same time normal appearing
secretion may be expressed from a healthy
segment of the breast. This is possible even
in the presence of a palpable tumor, either
benign or malignant.
4. Perverted physiology or abnormal
function of an organ predisposes to disease.
ENDOMETRIOSIS: THE URGENCY FOR
EARLY DIAGNOSIS AND TREATMENT
Edgar H. Greene, M.D.
Atlanta
The frequent occurrence of endometrio-
sis in young women prompted me to bring
the subject here for your consideration.
With the exception of pelvic inflamma-
tory disease, no benign pathologic process
is more crippling to young women than
endometriosis.
Etiology
As a result of his widely accepted theory,
Sampson in 1921 suggested that certain free
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
281
The Journal of the Medical Association ok Georgia
and loose endometrial tissue (or tubal epi-
thelium) frequently is transferred to an-
other location in the pelvis, and becomes
implanted on tissue for which it has an
affinity and begins a secondary growth.
These scattered islands of endometrial tis-
sue implanted on an ovary have a tendency
to menstruation which frequently results in
a cystic formation. This newgrowth is usu-
ally known as a “chocolate” cyst because of
the color and consistency of its contents.
It seems to be generally believed that a
likelv explanation of the dissemination of
viable endometrial cells in the pelvis is by
exfoliation or expulsion of the cells through
the fimbriated ends of the fallopian tubes.
Mild uterine contractions may bring about
a back flow of menstruum if the cervix is
blocked. Implantation as described by
Sampson1.
In support of the theory of “reflux” men-
struation reference is made to an observa-
tion by Dr. Robert Pendergrass and me" in
an original study of lipiodol injections of
the uterus and fallopian tubes and reported
before this Association at its 1927 meeting
in Athens. “With slight pressure upon the
syringe plunger, there was noted a ‘peristal-
tic-like’ action of the fallopian tube and in
some cases there appeared to be a spasm of
the isthmus which prevented the passage of
the oil until the spasm disappeared, where-
upon the gentle pressure from below easily
forced the iodized oil through the patent
tube. It is not unlikely, therefore, that with
an occluded cervical canal, mild uterine
menstrual contractions may produce a retro-
grade menstruation.”
It has been suggested that endocrine dys-
function and also embryologic development
has a place in the etiology of endometriosis.
Dr. Wolbach of the Nutrition Foundation,
who recently made a talk in Atlanta, has
found on histopathologic examination of
infants’ uteri that there is a degeneration of
the epithelial surfaces by a keratinization
which was found (by rat experimentation)
to be reversible by adequate vitamin A diet.
This observation may prove of definite value
in the treatment of endometriosis. Whatever
the cause and or pattern of dissemination,
the rate and duration of growth, age of
patient, fertility or sterility, time of surgical
intervention and mode of treatment, deter-
mine the ultimate degree of involvement in
a given case since endometriosis is a chronic
progressive disease.
The impression is rather general that en-
dometriosis is very rare in youth. Among
the many articles written on this subject
during the past twelve years, is the report
in 1946 by Fallon" of Massachusetts. Of
225 patients with proved endometriosis 9
(or 4 per cent) were of 'teen age, the
youngest being 13. If he had included
others macroscopically unmistakable but
microscopically unproved, the 4 per cent
incidence in his series would be doubled.
Since endometriosis tends to occur a few
years after puberty it is incumbent upon us
to acquaint parents of its serious nature and
disabling results. Following the early mani-
festations of abnormal menstruation the
girl should promptly seek the advice of her
physician.
History and Symptoms
A careful history may elicit a fairly defi-
nite clue. Unfortunately, the laboratory and
x-ray studies cannot aid in the diagnosis.
Any of the following symptoms should sug-
gest a possibility of endometriosis:
1. Following some months of apparently normal
menstrual cycles, acquired dysmenorrhea with increas-
ing severity develops.10
2. Severe colicky pain low in abdomen during
menses radiating to sacral and coccygeal areas.
3. International (ovulatory) pain. Menorrhagia,
metrorrhagia, clots.
4. Rectal pains during menstruation. Tenesmus.
Gas pains (intestinal implants).
5. And in the married, unexplained sterility. Dys-
pareunia. (tenderness in the cul-de-sac).
6. In any abdominal pain after puberty, endometri-
osis should be considered.
July, 1950
285
Physical Findings and Diagnosis
1. Small nodules, always tender, but
more so during menstruation are palpable
in the uterosacral area. Rectal examination
one or two days before menstruation is de-
sirable.'
2. Abnormal position of uterus, espe-
cially retroversion with tenderness and ten-
dency towards fixation. The uterus may be
moderately and diffusely enlarged and
firmly adhered in the pelvis. In the differ-
ential diagnosis pelvic inflammatory disease
and malignancy must be considered.
3. Marked ovarian tenderness with cys-
tic formation; with or without adhesions.
4. The clinical diagnosis of endometrio-
sis is difficult, but acquired dysmenorrhea
of varying progressive severity may be con-
sidered pathognomonic.0
In many cases the definite diagnosis may
not be made until operation is performed.
Findings at Operation
At operation may be found retroperito-
neal extention along the parametrium pro-
ducing induration and adhesions in the area
of the uterosacral ligaments. Implants
often become adhered to the intestine and
sometimes infiltrate the muscularis of its
wall.4 These implants spread with consid-
erable rapidity and involve one or both
ovaries with the familiar dark, sanguine
(chocolate) cyst.
Recently Javert11 of Cornell University
suggested that “benign endometrial cells
are capable of dissemination and metasta-
sis along the same channels followed by
endometrial adenocarcinoma. Pathologists
should look for this lesion as well as for
carcinoma in pelvic nodes removed by radi-
cal operation.”
Incorporated in this paper are a few
selected illustrative cases:
Case 1. A chocolate cyst ruptured in a young mar-
ried woman as she was preparing to leave her office
work about 5 o'clock in the afternoon. The pain was
similar to a ruptured tubal pregnancy although she
did not faint. About three hours later, at operation,
the large tear was found in the ovary. Considerable
chocolate-like material was dissipated through the area.
Numerous implants were found on the opposite (nor-
mal > ovary and intestine in scattered areas. These
implants varied in size from that of a pin head to a
pea, and tenaciously stuck to the host.
This type of case, rarely encountered so early, is
mentioned to show the rapidity with which the released
implants left the ovary and attached themselves to
adjacent organs and neighboring bowel.
T reatment
Iu all young women found to have a
retroverted uterus and dysmenorrhea, the
early use of a Smith or Hodge type pessary
to elevate the uterus together with hot sitz
baths and douches may relieve the constric-
tion in the canal and allow free flow of the
menstruum with amelioration of the discom-
fort. This may prevent the development of
endometriosis.
After removal of the pessary, should dis-
placement and symptoms recur, then con-
servative surgery is advisable (i.e., D. & C.,
uterine suspension). Examination of the
ovaries determine diagnosis and further
procedure. All uninvolved ovarian tissue
should be left in situ to offer some chance
for subsequent pregnancy. The condition
should be carefully explained to the parents
of a young girl. Likewise a young married
woman should know that her days of fer-
tility may be only a matter of months and
if she desires pregnancy it should not be
delayed. Recurrences are probable in about
25 per cent or even more and those con-
cerned should be apprised of this outlook.
For several years it has been my practice
to sprinkle sulfathiazole crystals over the
pelvic structures including particularly the
remaining ovarian tissue after the surgery is
concluded. Subsequently reaction to a for-
eign body may develop but I am of the
opinion that the sulfonamide retards the
activity of the process and lessens the re-
currences with no deleterious effect result-
ing from the reaction.
Case 2. Mrs. H. W. C., aged 24, married 3 years,
no pregnancy. She was operated on July 5, 1944. A
large chocolate cyst of right ovary with hypertrophied
adherent tube was found and removed. Two hemor-
rhagic cysts were resected from left ovary.
286
The Journal of the Medical Association of Georgia
On recovery the situation was explained to her.
She desired a baby and in the fall of 1946 she had
a normal delivery.
In the spring of 1949. five years after the first
operation, a left ovarian cyst was diagnosed. At opera-
tion, June 6. 1949 the left cystic ovary, fallopian tube
and uterus were removed. Extensive intestinal and
pelvic adhesions were encountered. The diagnosis of
endometriosis was microscopically proven. Her sub-
sequent progress has been satisfactory.
Case 3. On July 24, 1940 Miss A. B., aged 32, had
right salpingo-oophorectomy. The left ovary was par-
tially cystic and resected. She married about four
years later hut no pregnancy has occurred. Regular
examinations indicate that there is no recurrence. Now
that she is 42 years of age with symptoms of beginning
menopause, it is reasonable to expect no subsequent
disturbance.
No medical treatment alone of proven
value has been offered for endometriosis.
Chemotherapy and the antibiotics have been
of no definite benefit, except possibly by
topical application. Endocrine therapy is
of doubtful value although stilbestrol is
strongly advocated hy Karnaky' of Texas.
Indeed it would seem logical to believe
with many observers that estrogenic ther-
apy will aggravate the condition.* The male
sex hormone may retard the activity of the
aberrant endometrial cells, but the use of
testosterone in young women is probably
too hazardous to consider when the results
are so doubtful.
At present surgery is the procedure of
choice. It should be conservative in women
under 35 for reasons previously empha-
sized.'
If the patient is near the menopausal age
and there is extensive pelvic involvement,
surgery probably should not be limited to
extirpation of the ovaries but extended to
include removal of the uterus and fallopian
tubes.
Without ovarian stimulation, which is
essential to survival of the endometrial im-
plants, the cells become inactive, followed
by a regression of symptoms.
Removal of each individual implant is
tedious and unnecessary. Frequently they
involve the bowel, the recto-vaginal septum,
the uterovesical peritoneum and occasion-
ally the bladder wall.
In one’s desire to remove all the involved
tissue, unnecessary and serious complica-
tions may result. It is wiser to leave a por-
tion of the uterus attached to the bladder or
leave some of the involved tissue in the area
of the lower uterine segment and the rec-
tum than to exhibit too much technical bold-
ness. A postoperative fistula in either lo-
cality would be, to put it mildly, most unfor-
tunate.
The abdominal operation should be used.8
Vaginal approach is more difficult and haz-
ardous because of probable fixation of
pelvic organs and frequent intestinal ad-
hesions; moreover, the surgeon is unable to
explore the pelvis and lower abdomen.
Conclusions
1. The frequency of endometriosis, par-
ticularly in young women, is brought to
your attention. Its disabling and sterilizing
effect is emphasized.
2. The value of informing mothers and
young women of symptoms and urgency of
early diagnosis and treatment is stressed.
3. The differential diagnosis, particular-
ly from neisserian infection and malig-
nancy, is important and demands careful
studies and examinations.
4. Local treatment may be of benefit (i.e.,
pessary, douches, sitz baths), but if satis-
factory results fail to develop promptly
then surgery should not be delayed.
5. Sound surgical judgment is necessary
in every case: A conservative procedure in
the young should be followed, while a more
radical operation is advisable in older
women.
REFERENCES
1. Sampson, J. A: Am. J. Obst. & Gynec. 40:549-557
(Oct.) 1940.
2. Greene, E. H., and Pendergrass, R. C.: J. M. A.
Georgia, vol. 16, no. 12 (Dec.) 1927.
3. Morse. A. H. : Connecticut M. J. : 768-770 (Oct.) 1945.
4. Randall, C. L.: J. A. M. A. 139:972-976 (April 9)
1949.
5. Kelley, Francis J., and Schlademan, K. Ramsey: Surg.,
Gynec. & Obst. 88:230-236 (Feb.) 1949.
6. Fallon, John: J. A. M. A. 131. 1405-1406 (Aug. 24)
1946.
7. Karnaky, K. J. : Chicago, The Year Book of Obstetrics
& Gynecology, 1949, p. 464-466.
8. Thierstein, S. T., and Allen, Edward: Am. J. Obst.
& Gynec. 51:635-642 (May) 1946.
9. Stephenson. Richard T., and Graffagnino, P. : South. M.
J. 35:525-529 (May) 1942.
10. Dannreuther, W. T. : Am. J. Obst. & Gynec. 41:461-
474 (March) 1941.
11. Javert, Carl T. : Cancer 2:399-410 (May) 1949.
July, 1950
287
THE ROUTINE USE OF EXFOUIATIVE
CYTOUOGIC EXAMINATIONS FOR
THE DETECTION OF ASYMPTOMATIC
CANCER OF THE CERVIX UTERI
H. E. Nieburgs, M.D.
and
S. Bamford, M.S.
A ugusta
Papanicolaou’s contribution of exfolia-
tive cytology for the recognition of cancer
cells in smears or body fluids presented a
great progress in cancer diagnosis. Its value
for some time a matter of much controversy
and confusion is now shaping into a more
definite form. Though not yet entirely satis-
factory, greater knowledge and improved
technics increasingly raise the percentage
of diagnosed cases. Exfoliative cytology
found its main use for the diagnosis of
uterine cancer. However, most cases of
cervical cancer diagnosed by Papanico-
laou’s method are clinically evident and are
recognized in the biopsy specimen which
is usually taken in conjunction with the
smear. In this connection much criticism
arose as to the necessity and value of vaginal
smears in addition to or preceding biopsies.
The credit for throwing more light on
this problem and for defining the true value
of the method is due mainly to Pund and
others who demonstrated by the sequence
in the rising age groups with pathologic
changes in the cervix that cancer of the
cervix is apparently preceded by a neo-
plastic growth which remains in the non-
invasive phase for an average of six to
twelve years.1 2
Pund’s and Auerbach’s findings indicated
a high incidence of preinvasive cancer of
the cervix uteri in the female population
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
and on the basis of their observations it
became apparent that exfoliative cytology
may prove the method of choice for the de-
tection of sub-clinical cancer.
Detection by Exfoliative Cytology
An attempt was made to investigate
the method of exfoliative cytology as a
screening procedure and to determine
whether its use on a large scale was practical
and economical. Patients attending the Uni-
versity Hospital clinics and a certain num-
ber of private physicians’ offices were rou-
tinely screened. The smears are taken with
a cotton applicator in preference to other
devices. (Figs. 1 and 2). Certain instruc-
tions are observed, such as to advise the
patient to refrain from taking a douche
before the examination, or preparation of
smears before a lubricant is used. Further-
more, the cervix should not be swabbed
before the introduction of the cotton appli-
cator and an additional smear should be
obtained after the removal of a mucus plug.
Slides are fixed in a solution of equal parts
of ether and 95 per cent alcohol before dry-
ing has occurred. In such cases in which
smears have to be mailed to the laboratory,
the slides are removed from the ether-alco-
hol solution after at least ten minutes’ fixa-
tion, a drop or two of glycerin is released
onto the slide and then covered by another
clean slide.
Up to date more than 20,000 women
above the age of 19 were screened in this
manner. Repeated compilation of data on
equal numbers of cases appear to confirm
each time previous results. The incidence
of preinvasive cancer is found to be about
1 per cent, while that of invasive cancer
was about 1.5 per cent.2 The percentage of
the latter is however progressively decreas-
ing. Whether this decrease in the incidence
of invasive cases is directly due to the great-
er detection of preinvasive cancer cannot
be established as yet, but it offers an inter-
288
The Journal of the Medical Association of Georgia
Fig. 1. The cotton applicator should be well introduced in the endoeervical canal and the junction of the squamous and
columnar epithelium swabbed.
esting thought.
The particular effort made to diagnose
cervical cancer in its preinvasive phase very
soon directed attention to the specific mor-
phology of cells exfoliated from a non-in-
vasive cancer.1 The increasing knowledge
of the preinvasive cancer cells greatly en-
hances the detection of cervical cancer in the
incipient stage. Many cell types which at
present are known to derive with certainty
from a non-invasive cancer were previously
classified as Papanicolaou Class II, which
denotes absence of malignant changes. Pa-
tients with Class II smears are not imme-
diately investigated though kept under pe-
riodic observation. Failure to recognize
the “preinvasive cancer cell'’ may in most
cases not reveal the cancer until it has ad-
vanced to the invasive stage. A further diffi-
culty in this connection is presented by the
fact that the diagnosis of the “preinvasive
cancer cell” cannot be accomplished accord-
ing to certain criteria but has to he made
not infrequently by comparison. Experience
with a large number of cases is in this re-
spect of particular importance.
The “preinvasive cancer cell group”
should he distinguished from Ayre’s “pre-
cancer cell complexes”. The latter, accord-
ing to Ayre,4 denote cells which eventually
may or may not develop into a preinvasive
cancer, while cells of the “preinvasive cell
group” are those which have exfoliated from
a cancer area though not invasive.
Diagnosis by Biopsy
The number of cases in which suspicious
and positive smears require confirmation
by biopsy was about 3.2 per cent, but it is
now progressively decreasing with the im-
July, 1950
209
Fig. 2. The applicator is rolled and should not he smeared upon the slide.
Fig. 3. Biopsies taken in four to five posit'ons around
the squamo-columnar junction enhance the likelihood of
finding the cancer area.
Fig. 4. The biopsy punch is placed in such a manner as to
obtain material from the junction of the columnar and
squamous epithelium.
290
The Journal of the Medical Association of Georgia
Fig. 5. Curetting of the endocervieal canal may reveal a
caucer missed by biopsy or show the extent of possible
invasion.
proving knowledge of exfoliated cancer
cells. Cases of Papanicolaou's Class IV and
V, and perhaps Class III with negative biop-
sies do not necessarily fall into the group
of false positives. A negative biopsy indi-
cates solely that no cancer is found in the
specimen submitted to the pathologist.
Often, however, insufficient biopsy material
has been obtained, or the cancer area was
missed regardless of the fact that multiple
biopsies were taken in four or five positions
around the junction of the squamous and
columnar epithelium of the cervix.'1 The
choice of the biopsy punch is important in
order to obtain a clean cut portion from the
cervix. In our experience, the Gellliorn
punch appears to be the most satisfactory
for biopsies (Figs. 3 and 4).
Endocervieal Scraping
A preinvasive cancer found in a biopsy
specimen does not include the presence of
invasive cancer in regions other than that
from which the biopsy has been taken. In
order to establish whether, in addition, any
invasion is present Pund suggested curetting
of the endocervieal canal in every case in
which a biopsy is obtained." The practice
of this procedure has shown that endocervi-
cal scrapings are of additional value in
such cases in which biopsy specimens failed
to reveal the cancer area while it was pres-
ent in the material obtained from the endo-
cervical canal (Fig. 5). Endocervieal
scrapings should be sent to the pathologist in
containers separate from those containing
the biopsy specimens.
Histologic / nterpretation
The last phase in the diagnosis of cervical
cancer is dealt with by the pathologist. The
material removed from the cervix by biopsy
or endocervieal scrapings, though bearing
the cancer area, has to be submitted not in-
frequently to the cutting of serial sections
from serial blocks in order that the cancer
may be found. Biopsy material submitted to
the pathologist which was taken on the basis
of a previous cytologic diagnosis should be
accompanied by the cytologic report. In the
absence of such a report the material is
treated in the routine manner with the result
that a cancer area may be missed. Not in-
frequently there is another factor, which
may obscure the final diagnosis of cancer,
that is the present controversy of opinion
among pathologists as to what constitutes a
preinvasive cancer. Neoplasia limited to
the basement membrane is considered by
us a preinvasive cancer, while others refrain
from making a diagnosis of cancer unless it
is invasive. A cancer in the lumen of a
gland is, according to Pund, a preinvasive
cancer as long as it is confined to the natural
surfaces, while Te Linde and others main-
tain that the presence of a cancer in the
gland constitutes invasion.
Observation and Follow-up of Patients
In order that an investigation may be
carried to final diagnosis a number of facts
should be considered. A patient in whom
biopsy and endocervieal scrapings were
July, 1950
291
4
4 %
m
?
#
*
— * # ;
%
* * »
Fig. G. Invasive cancer cells.
Fig. 7. Characteristic prein vasive cancer cell group.
negative following a positive cytologic re-
port should be kept under observation by
repeated endocervical smears. These should
be taken after healing of the cervix has
occurred, and in case the smears are posi-
tive the biopsy should be repeated. Smears
following biopsy too closely frequently
show atypical cells due to regenerating
epithelium.
A well coordinated method of observation
in collaboration with the cytologist is re-
quired in most cases in which patients have
had smears of an equivocal type or suspi-
cious cells which may indicate the possi-
bility that malignant changes may occur at
a later stage. In our experience, some cases
were diagnosed in this manner at a very
early stage.
Economic Factor
The cytologic examination of slides taken
routinely for the detection of preinvasive
cervical cancer should be treated in a dif-
Fig. 8. Preinvasive cancer cells detected mainly by com-
parison. (Note nuclei with increased nucleoli and condensa-
tion of nuclear borders.)
w
A
*
€
mm
Fig. 9. Cell dyskariosis not associated with cancer.
ferent manner than individual cytologic and
histologic diagnoses. The expense of cyto-
logic diagnosis, though reasonable for indi-
vidual cases, is usually too high to adopt
the method for routine screening of all fe-
male patients. Since it was observed that
80 per cent of all cases of preinvasive can-
cer detected by exfoliative cytology were
asymptomatic, it is evident that such cases
will be missed when the expense of cytologic
examination limits the physician to the use
of the method to a selective type of patient.
Thus a special procedure arranged solely
for the detection of subclinical cervical can-
cer, adequate for routine use regardless of
whether a patient desires the test or is able
to meet the expense, may establish an effi-
cient method of preventive oncology and
progressively decrease the incidence of in-
292
The Journal of the Medical Association of Georgia
vasive cancer.
Organization of a Cytologic Laboratory
Four years’ experience in the organiza-
tion of a cytologic laboratory lias demon-
strated that the knowledge of exfoliative
cytology cannot he acquired by a two or
four weeks’ course in cytology nor by a
theoretic study of the criteria for the diag-
nosis of cancer cells. A large number of
diagnoses are made purely by comparison
(Figs. 6. 7. 8, and 9), and the examination
of a large amount of material is necessary
before a satisfactory standard of efficiency
can be reached. Preferably a trained cy-
tologist should limit himself to* the interpre-
tation of doubtful slides and should devote
most of his time to the study and classifica-
tion of certain cell types in order that they
can be readily available whenever similar
types of cells are encountered for diagnosis.
In addition, a well trained cytologist should
be concerned with the screening of doubtful
slides passed on from technicians who carry
out the actual screening of the material.
Thus for efficient function of a cytologic-
center at least four to six members are re-
quired: a technician for the staining of
slides, two technicians for screening with
one cytologist for the screening of doubtful
slides, a specialized cytologist and a secre-
tary. In the early phases of a newly estab-
lished laboratory four members may suffice
without the two screening technicians.
Conclusion and Summary
In conclusion it can be stated that the
diagnosis of cervical cancer in the incipient
phase depends on the use of exfoliative
cytology as a routine procedure. It should
be available economically to every physi-
cian or patient with adequate facilities for
cytologic interpretation. An efficiently or-
ganized cytologic center is of fundamental
importance for cancer detection. Thorough
knowledge of the physician as to the prob-
lem involved, and his close cooperation with
the cytologist and pathologist is a necessary
prerequisite. Furthermore, the attitude of
the pathologist and his collaboration with
both the physician and cytologist may de-
termine the number of cases detected. Can-
cer diagnosis in the subclinical stage is thus
a teamwork of members adequately quali-
fied in the organization and function of their
particular phases. A further point of impor-
tance is the proper instruction of the patient
as to her condition and adequate explana-
tion for the need of proper investigation by
either repeated smears or biopsies.
REFERENCES
1. Pund, E. R.. and Auerbach, S. H. : Preinvasive Car-
cinoma of the Cervix Uteri, J. A. M. A. 131:960 (July 20)
1946.
2. Nieburgs, TI. E.. and Pund. E. R. : Detection of Cancer
of the Cervix Uteri, J. A. M. A. 142:221 (Jan. 28) 1950.
3. Nieburgs, H. E., and Pund, E. R. : Specific Malignant
Cells Exfoliated from Preinvasive Cancer of the Cervix
Uteri. Am. J. Obst. & Gynec. 58:532, 1949.
4. Ayre, J. E. : Diagnosis of Preclinical Cancer of the
Cervix. Cervical Cone Knife; Its Use in Patients with a
Positive Vaginal Smear. J. A. M. A. 138:11 (Sept. 4)
1948. Ibid: Cervical Cytology in Diagnosis of Early Cancer.
J. A. M. A. 136:513 (Feb. 21) 1948.
5. Foote, F. W., Jr., and Stewart, F. W. : The Anatomical
Distribution of Intraepithelial Epidermoid Carcinoma of the
Cervix, Cancer 1:431. 1948.
6. Pund, E. R.. and Echols, J. M. : Subclinical Carcinoma
of the Cervix Uteri, J. A. M. A. In press.
THE CLINICAL IMPLICATIONS OF
THE RH FACTOR
E. B. Save, M.D.
Thomasville
Every doctor is confronted in one way
or another by the problem of the Rh factor.
Although he may seldom need to apply his
knowledge of the factor in practice, he will
frequently be asked to explain its signifi-
cance to some of his patients. The physi-
cian can find the information in numerous
excellent articles. Yet, some of the litera-
ture is so cumbered with technical terms
that it may be difficult for him to unravel
the usable facts that it contains. Surpris-
ingly, the subject has not yet been presented
at any meeting of this Association. These
thoughts prompt the preparation of this
paper, the sole aim of which is to state the
From the Laboratory of Pathology, the John D. Archbold
Memorial Hospital. Thomasville. Georgia.
Read before the Medical Association of Georgia in annual
session, Macon. April 19, 1950.
July, 1950
essential facts pertaining to the Rh factor
and to give the current views of pediatri-
cians, obstetricians, and pathologists regard-
ing the care of patients who are affected by
sensitization to the factor.
Blood Groups and Types Other Than Rh
The familiar A, B, and 0 properties of
the blood were discovered and fully investi-
gated early in the present century. Conse-
quently, blood transfusions, which had pre-
viously been infrequent and dangerous, are
now made daily in multiplied numbers and
with comparative safety. Minor variations
in the A and B groups were soon recognized,
which subgroups may on rare occasions
bring about transfusion reactions even
though the donor and the patient belong in
the same major group. Later, three other
distinct varieties of human blood were iden-
tified. These are not called groups, hut are
designated as types M, N, and P. They are
unimportant clinically.
Nature of the Rh Type
The Rh type, the latest to be described,
was not known until the beginning of the
last decade. In 1940, Landsteiner and
Wiener announced the finding of a hitherto
unrecognized property in human blood.
They found that the serum of a rabbit which
they had immunized by the injection of ery-
throcytes from a rhesus monkey would,
when mixed with human blood, produce
agglutination of the red cells in at least 85
out of every 100 persons. Taking the first
two letters of the word rhesus, they gave to
the newly discovered factor the name Rh.
They designated as positive persons whose
red blood cells contain the factor, and as
Rh negative individuals in whose cells it is
lacking.
In 1940 and early in 1941, Wiener, Le-
vine, and their associates revealed the clini-
cal importance of the Rh factor. They
showed that severe reactions might follow
the transfusing of Rh positive blood into an
295
Rh negative person, and demonstrated that
Rh negative mothers could become so sen-
sitized to the Rh positive cells of their babies
that the infants would he born with hemo-
lytic disease, or die in utero.
The present concept of the Rh type is that
it includes eight subtypes, seven of which
are positive. Besides these, certain recipro-
cal properties exist regularly in Rh negative
cells, which properties collectively are
called the Hr factor. Moreover, some con-
fusion has arisen because various investi-
gators have classified and named the sub-
varieties of the Rh-Hr series differently.
Nevertheless, the matter of the subtypes
need not disturb us greatly; for, although
it is possible for an Rh positive mother to
become sensitized by the Hr factor or by
subtypes different from those in her own
blood, actually more than 90 per cent of
the mothers who become sensitized are Rh
negative and are sensitized by the kind of
cells that were originally called Rh posi-
tive, but which are now most commonly
designated Rho.
The Rh type, whether negative or posi-
tive, is a normal inheritance, and is not in
any way related to health or disease. It is
transmitted through successive generations
in accordance with Mendel’s laws. Present
at birth, the type does not become modified
by the transfusion of blood or by any other
circumstance, but remains throughout life
as a permanent mark of identity. The inci-
dence of positive and negative findings is
the same in both sexes. The number of Rh
positive individuals is higher in Negroes
than in white persons, and is said to ap-
proach 100 per cent in some of the yellow
races.
The properties of the Rh factor most im-
portant to remember are: that it can act as
an antigen, and that it may be positive in
a baby and negative in the mother. Upon
these facts depend the phenomena of sensi-
294
The Journal of the Medical Association of Georgia
tization which are sometimes manifested
after transfusions, and during or following
pregnancy.
A nt igen-A nt i body Relationsh i ps
Antigens are substances which, when in-
troduced into a human or animal body
through some other route than the alimen-
tary tract, lead to the formation of anti-
bodies. These antibodies can be detected
in the blood serum of the immunized person
or animal. They react specifically upon the
particular antigen that engendered their de-
velopment. Thus, the injection into a rabbit
of the red blood cells of a sheep leads to
the development of antagonistic substances
which can clump or dissolve sheep erythro-
cytes, but which are without effect upon the
cells of other animals. Similarly, the trans-
fusion of Rh positive blood into any Rh
negative person, male or female — or the
entrance of the Rh positive cells of a fetus
into the blood of its mother — may result in
the formation of anti-Rh substances capable
of agglutinating or hemolyzing Rh positive
red blood cells. Time is required for the
elaboration of antibodies, so that repeated
transfusions, or more than one pregnancy,
are necessary to their appearence. When
the antibodies have once been formed, how-
ever, they persist and may be increased by
any further addition of Rh positive blood.
Sensitization to the Rh Factor
Anti-Rh agglutinins and hemolysins are
never present in human blood serum nor-
mally, but are always artificially induced,
and always denote the effort of Nature to
overcome an alien invader. Rh antibodies
have no effect upon the health of the
immunized person, and give no outward
indication of their presence, unless the
serum is again brought in contact with
Rh positive cells. Such conjunction of an-
tigen and antibody may occur in any Rh
negative individual, male or female, who
has previously received a transfusion of
blood from an Rh positive donor, and who,
at a later time, is given another transfusion
of Rh positive blood. An Rh negative
woman may have been sensitized to Rh posi-
tive cells by a transfusion earlier in life,
and therefore be liable to danger from a
similar transfusion during pregnancy. The
transfusion reactions which follow Rh in-
compatibility are identical with those which
result from differences in the ABO groups.
Independently of any blood transfusion,
Rh antibodies may develop in an Rh nega-
tive woman during pregnancy solely because
Rh positive cells from the fetus have gained
entrance into her blood. Normally, the ma-
ternal and the fetal blood do not mingle,
although they are separated in the placenta
by only a narrow membrane. When, there-
fore, actual interchange of blood does take
place, some break in the continuity of the
placental vascular walls is assumed to ex-
plain the abnormal phenomenon.
The formation of Rh antibodies is not
inevitable. Indeed, nearly half the Rh
negative mothers whose husbands and ba-
bies are Rh positive are incapable of pro-
ducing anti-Rh substance in harmful quan-
tity.
The Rh positive cells of the fetus which
sensitize the mother are inherited from its
father. If the Rh type of both parents is
the same, naturally there will be no anti-
bodies formed.
Heredity of the Rh Factor
Hereditary characteristics, including the
Rh property, are believed to reside in genes
attached to the nuclear chromatin of germ
cells. In the fertilized ovum, which ulti-
mately becomes the individual, half the
chromosomes; and, therefore, half the fu-
ture characteristics of the child, are con-
tributed by each parent. If either of the
parents is Rh positive, some of their chil-
dren may be Rh positive and others Rh
negative. If both parents are Rh negative,
July, 1950
295
only Rh negative children will he born to
them.
This, the Mendelian theory assumes, is
because the Rh negative gene is a paired
structure, with each member of the pair
alike and purely negative; whereas the
positive gene, also a paired structure, may
either be pure, having both components
alike, or be impure, with a dominant half
positive and the other half negative. A
domino with two blank spaces might repre-
sent an Rh negative gene; one with a blank
at one end and dots at the other, an impure
Rh positive gene; and one with dots on
both halves, a purely positive gene. The
person who carries only positive, or only
negative, genes is said to be homozygous,
and one who has genes with mixed positive
and negative potentialities is called hetero-
zygous. The genes themselves are also re-
ferred to as homozygous or heterozygous,
depending upon whether they are pure or
are of mixed variety.
Hence, if the husband is heterozygous, it
is still possible that the wife may bear a
normal Rh negative baby, even though she
has borne an Rh positive one and has been
sensitized to the Rh factor. If either parent
of the Rh positive husband is Rh negative,
he is heterozygous.
Diagnosis of Hemolytic Disease
In every case of Rh sensitization, our
primal concern must necessarily be for the
child. The mother, if she receives no trans-
fusion of Rh positive blood during preg-
nancy, labor, or the puerperium, will not
be affected by the antibodies she carries.
The baby, however, may suffer much dam-
age throughout fetal life; and, if it survives,
may give clinical evidence, at birth or soon
thereafter, of the injury it has sustained.
The abnormal changes which occur in
the fetus, and which continue in neonatal
life, all depend upon: the continuous de-
struction of fetal blood cells by antibodies
derived from the mother, the effort of the
fetus to reconvert and utilize the end prod-
ucts of hemolysis, and the attempt to restore
both the volume and the cell content of the
depleted blood.
The lesions in the newborn infant in-
clude: anemia, increased numbers of nu-
cleated red cells in the circulating blood,
hyperactivity of the bone marrow and foci
of blood production outside the marrow,
icterus, enlargement of the liver and spleen,
local or generalized edema, and degenera-
tion and bile pigmentation of cerebral basal
ganglia.
The name erythroblastosis was formerly
used to include all the manifestations of Rh
sensitization in the baby; and, indeed, the
occurrence of immature red blood cells is
almost always a conspicuous finding. At
present, however, the clinical entities are
usually placed in three separate classifica-
tions: Congenital hemolytic anemia, icterus
gravis, and hydrops fetalis; and the term
hemolytic disease of the newborn is com-
monly applied to the whole group.
The mortality rate for the entire group
of hemolytic diseases of the newborn is
well over 50 per cent. Hydrops fetalis is
invariably fatal and usually ends in still-
birth. Fortunately, it is extremely rare.
The icteric variety is the one most frequently
seen. The preponderantly anemic type has
the most favorable prognosis.
The possibility of hemolytic disease
ought to be borne in mind in the case of any
infant born of an Rh negative mother. The
Rh type of the child should be immediately
ascertained, and a simple study of the blood
made to determine the amount of hemo-
globin and the number and appearance of
the red cells.
Ordinarily, there is neither marked pal-
lor nor jaundice for several hours. When
either of these signs is intense at birth,
when they are accompanied by enlargement
The Journal of the Medical Association of Georgia
296
of the liver or spleen, or when there is
focal edema, the finding points to a long
antenatal duration of the disease process.
The blood picture is likewise only mod-
erately altered, with a hemoglobin reading
of 10.5 to 1 1.5 grams; three to four million
R. B. C. per cu. mm.; 20 to 25 nucleated red
cells per 100 W. B. C., among which are a
few erythroblasts. Similar changes in the
blood may result from prematurity, pro-
longed anoxia, or intracranial hemorrhage.
The diagnosis, then, will rest partly upon
clinical evidence and partly upon the his-
tory. The baby is feeble or ill; it is anemic
or jaundiced; and it is Rh positive. Anti-Rh
substance may or may not have been dem-
onstrated in the mother’s serum. In some
of the cases a positive Coombs test for Rh
antibodies in the baby's serum may furnish
corroborative information, but reagents for
the performance of the test are not generally
available. The firstborn is rarely affected.
There is often a history of recurring mis-
carriages or stillbirths, and of other siblings
gravely jaundiced soon after birth.
The differential d iagnosis is not easy. In
icterus neonatorum the infant is not ill.
Symptoms of congenital atresia of the bile
ducts do not appear early. In both of these
conditions, and in malformations of the
heart, the red blood cells are usually not
decreased. The prenatal care of the mother
should have precluded the likelihood of
congenital syphilis.
Management of Cases of Rh Sensitization
The management of cases of potential or
actual Rh sensitization imposes a two-fold
responsibility upon the physician: to discern
any increase in the amount of anti-Rh sub-
stance in the mother’s blood during the
final trimester of gestation, and to secure in
advance a suitable donor who will be im-
mediately available if the baby should need
blood.
When the physician first assumes the care
of an obstetrical patient, he should find out
her Rh ty pe. The State Department of
Health will make the examination gratis.
If she is Rh positive, llu ire is no reason for
further concern. On the other hand, if she
is Rh negative, it will be desirable to know
the Rh type of the husband and helpful to
inquire whether any previous conception
lias terminated unfavorably, and whether
the patient has had transfusions of blood
in the past. Seldom does sensitization to
the Rh factor occur in a primigravida; but,
in a second or later pregnancy, a history of
previous transfusions, or a history of mis-
carriages, may be portentous.
It is our practice to have the mother’s
blood examined for Rh antibodies during
the sixth month of gestation, and again a
month later. The antibodies develop mainly
during the last trimester. They are of two
kinds: agglutinins, and blocking antibodies;
both kinds have the same significance clin-
ically, and the presence of either is indica-
tive of sensitization. Whenever there is an
increasing antibody titer, the obstetrician
may decide to induce labor, believing that
prematurity will be a lesser hazard for the
child than that of exposure to the antibodies
for another month. There is at present no
substance which may be added to the blood
to neutralize the Rh antibodies.
The principles involved in the treatment
of the infant are: to lessen the toxicity of
the blood, to retard the activity of anti-
bodies which have come from the mother’s
serum, and to replenish the blood with
erythrocytes that are functionally potent
and normally resistant to lysis, until the
blood-making tissues can produce such cells
in adequate number.
These objectives are best met, we believe,
by repeated transfusions of small quantities
of fresh blood from Group 0, Rh negative
young women, who have never been preg-
nant nor ever received transfusions of Rh
July, 1950
297
positive blood; — Group 0, because the A
and B properties may not be fully developed
at birth; fresh blood, for the reason that the
survival time of the transfused erythrocytes
will be longer than from stored blood; Rh
negative blood, on account of the insuscep-
tibility of the red cells to hemolysis; and
the blood of a young woman, since Diamond
has shown that it has an inherent life-saving
quality for these infants that blood from
male donors does not possess.
Many good authorities recommend the
method of exchange transfusion, in which,
alternately, small amounts of the donor’s
blood are injected, by way of the umbilical
or other vein, and similar portions of the
baby’s blood are withdrawn until an equiva-
lent amount of donated blood has been sub-
stituted for the whole volume originally
present in the infant’s circulation.
Although we can say nothing in dispar-
agement of the method, we do not attempt
it ourselves; nor do we believe that it should
be undertaken by any others than an espe-
cially trained group, who are accustomed to
working together to the completion of these
particular tasks, and who have ample facili-
ties, including an adequate supply of appro-
priate blood. Babies who are suffering from
hemolytic disease cannot always safely be
transported to distant centers for treatment.
Moreover, we are not convinced that the
method is superior to the less drastic one of
giving repeated small transfusions. Rely-
ing upon the simpler plan, my colleagues at
the Archbold Memorial Hospital have suc-
ceeded in the treatment recently of two in-
fants: one with marked hemolytic anemia,
and the other with icterus gravis.
Conclusion
The facts and opinions which we have
tried to summarize convince us that knowl-
edge of the Rh factor is requisite to efficient,
present-day medical practice. The physi-
cian who has the care of prospective or pos-
sible mothers, at any time from their infancy
throughout the childbearing years, will need
constantly to keep the implications of the
factor in mind. By so doing, and by apply-
ing the principles that have become estab-
lished for the management of cases of Rh
sensitization, he may be able to allay the
apprehensions of some of his patients, to
safeguard others through the course of ma-
ternity, and perhaps to secure to an unborn
child the heritage of life and health.
REFERENCES
References to important monographs may be found in:
1. Potter, E. : Rh, Chicago, The Year Book Publishers,
Inc., 1947.
2. Wiener, A. : Blood Groups and Transfusion, ed. 3,
Springfield, Charles C. Thomas, 1943.
3. Strumia, M. M., and McGraw, J. J.: Blood and
Plasma Transfusions, Philadelphia, F. A. Davis Company,
1949.
DISCUSSIONS
DR. MAX MASS (Macon): Nipple discharge has
generally not been accorded the attention it deserves.
The simple recognition that many discharges are
physiologic or at least engendered by remote causes,
such as endocrine factors, trauma, infection, menstrual
and menopausal, and involutional changes should be
kept in mind. It is well to remember that a simple
milky discharge, known as galactorrhea, may last
for several years after weaning. It may appear grossly
serous or thick and creamy. This discharge tends to
persist longer in nmltipara and in older women. In
about 20 per cent of women after menopause, a milky
secretion may he noted and quite often in nonparous
women. Microscopically, such discharge consists of fat
droplets, colo.trum bodies, desquamated epithelium and
leukocytes. A serous or cloudy discharge may he
found in cases of deficient ovarian function. Some-
times the secretion is a thick inspissated and some-
times greenish material, due to Bacillus Pyocyaneus.
A wine-colored discharge does not necessarily contain
blood. A greenish discharge sometimes occurs bilateral-
ly in young women who have borne children. This
is generally a stagnant secretion. However, it must
be borne in mind that all secretions, of whatever color
or consistency, may be associated with carcinoma.
For this reason, all nipple discharges should be
examined microscopically for cancer cells.
The interpretation of these smears requires a
thorough knowledge of the normal cytology, including
the physiologic variations, mazoplasia and involution,
and a rather thorough familiarity with cytologic
smears, stained by the Papanicolaou technic. The
distinction of carcinoma from the simple papillomas
and the ductal proliferative alterations is rather dif
ficult. However, the detection of pleomorphism,
anaplasia and other atypical cytology can prove of
great a sistance to the clinician.
In cases where no mass is palpable and trans-
illumination renders no positive findings, a very small
discharge may reveal exfoliated neoplas'ic cells, most
often originating from a ductal papilloma. Frank
mammary carcinomas do not generally bleed.
I believe that more careful attention to nipple dis
charges and careful cytologic studies of such discharges
may permit the recognition of an early subclinical
lesion.
I have had ample occasion to follow the work of
Dr. Nielnirgs in the literature and by personal cor-
respondence and consultation, and I believe that his
studies on the subclinical preinvasive cytology is
298
The Journal of the Medical Association of Georgia
unique and highly pertinent to
diagnosis of unsuspected cancer
the fact that
problem of
the cervix.
early
fY.it'biUglhvtmpblieSwl
_ack of biopsy proof, in cases -where a
positive : smear ■ •bus hrfirt < rof i l r t t-ali ' *i h»t " boOin§<Wfc¥&rtly
indicate a false . positive. This lias been, strikingly
deJnwfttra9s3 ’ iri ' ' at 5 1Mi~f 1 ' t \\ <> ot1 my own chs£s, in
which,, repfq^jl,. bipp^fft ,)yry : |yft -jflgrtrftd
block sections of the removed uterus, demonstrated
af rsiuall. ai=e»>‘»f premda^vif {learn moaiitll i " I f fhutt x4fWo
appear obvious . that the smear study cannpt. tell ,us
linear ol ■ ...- ...
Met her Whit irtvaVfon'Tihs f-ali,f“lady^6cbuVV'ed. i nave
>«n dipfurbed bf'i. the though tjfpt .WSf'ffayi9^tUVP-
lass 3 or 4. diagnosis has been made from the smear,
cla
no maUenhoAv -iivan\C$uk*jirqiis>ntr sinpaisiiarkhiiAiStld'lfir
hiopsjes for that matter, proving in all cases negati
except -for ,lhfe">'dnyr'lnfeW,,9e5vbss bAb Hn Mhl ‘pbshli
ive
of being compelled tp , (jo, Vf V-HW |{Pvi asWff r.*%
patient that she ifoes not have carcinoma. 1 have
followed j j|ie ri\le1^thJ^t,l(]ij[ c^quliff^L.fSSes. J3KP -subse-
quent negative smears and^a,. negative endocervical
curettage justifies an assurance^ to the patient that
cancer does^not exist. cijuxseoJ am ncrt speaking: of
cancer of the corpus. In such instances an enpyjjjgetfya1!
dcrapfngn<isil&Mf subWfitte'tf.1JJ‘,J 3. -’O-tqg
It has been of considerable interest to me cio
observe that men in* tbettvwyo'fArefront of this work
on exfoliative cytology are unanimous in urging great
caution in the clinical interpretation of the cytologist's
fnyding.'vmlAlli are < .agreed ;> that biopsies’ are/1 necessary
fW/4-U£i cofjfifffljatjop jofnat pohitivensmear. Io petwonaHyti
iilfiject. , t^r, tbqi.usyniif t h e rt twond 1 1 iae reen i n gl’ pin-- cases
wl)frg.,a.,largAl series ’ftneuiWtplBined-.’i The owotcIc implies
t^at,,j^oyp .,Ydio .pflfs.cJihrough -the -screen <arft» safe.1 >lt-
i^| actqaljy a,.^-ftscfinflj»g iprooedunet rnaohiugnput,08s
iti,,Vippe, iqr,flbe hptie.i.of (hetewring ^icades .:«h camceP of
tljy c^qygx I>pfpyy, ,]it .ibas reached” dliniegls’propnrt'imis’.'
bljvisjl, tq^gaqpojy, those. ^pairing endooermalt’prepapa-’
tjyn^pllipt .apjf;ip^p.yrieticl& iwik-ateshtliatsimiist mew-dtr
nqt obtain thfitf.igpqcinfetfc deftp ianaughnimthe ‘ceirvtealt
capaln .b fie, : Esqy,a#ft< xyobj m i«i yu ructions ’isexfometimes-
rpyrch.-rilcfipefii t]iyrt,,isiiaiP3jar»iD ift>e>Mi external observa^
tipn. , Tip* .yvyippajltplogfet rfmust. mjeopialb smbarsnthaK
du,,ni||. cpqlgjip. <jn<)l!OeiMieall)Cfdlk”in sufficient quantity1
fpfl djagposi|,Bdo8ib vl join ) fti via 6. oa.irl
.4nW»nt fa Kjopgratadpte. DrjfNiebuogsi'On ebenproiligMW*!
aflAyUiOt qf, ggygf aU)!n i copdrhl 1 <n 1 a i« nuk tieia hast done
utjdefinlbp Pgubian^fttiofitouritgrcatt i-tnaolirtryiiDr.t F.dgavt
Pqipd- , oontrihntionT imi'-itiliei detoot ion « of'-
llte,, pr<!tnva(ri|Vt'.ocell 'maihf oencloeeavioal i smeaf iax-and
out,^andj,ug,,fiointrU)jition lUtntheudeteiqiKM’oof .preoJinit-aD
eajii'AV vf the.. cervix, .noitw If ngBi a yuaiano, «i
-,,DR> ALbEfi.- Ho RhUNCEiqfc Atlanta) :olt;<fe ’impossible
for one who llatw hatditairy partieiilaTbimeai'iyn experience1
in, a pa.tludogithff-ftftlti'nic) ton Is it istill tin «m>'-*t»diencb ai'd
not call attention -tomtilre TWD n d ft cf u ft o wrink 1 1 1* bkff I * 1 1 )rG
NiebucgjS’iand bisirjtssoeiales have dmen -doifigl1 ai 1
4,’iipention. in parUearian ssbmMthing that’ has not-
been lirwght,, outsi-.-Sqexdiis scientific exhibit, ft i«‘
bnantifelr., The«scientiifie f»srfiibittso'hKnei ard-wril worth1'
oup trip ■teiMftconoflfo'waBdari't s«J orodohanythingt else'
wlyjlp.-hhtfe.f ol .lie .ril moil moi ibo io n nileil
Dr., bay-burgs illtmtiartioas offi ihis tnrfijiicyihds illuttra1-1
fions of the individuahoiellHp!are-i(lt)eaiitHBl clear.'-
f triiink -rl may bsoipermititedq-toB speak’ ones vsord-vof
caution: 1 believe thosasnula® qrass canoqliiene^ riling^
shonJjdi know cftlilftf-llwfow: they 1 1 state positive finding!.
Whe-p, in ed*ii*bt*Hne-ux*nwne sdhe opatiertt/i'and -get ’’thb1
mass to look Uft. ehtoon t. tsii !.<■ mover <“*■ ogranjeo
jftRrlC. H.KiRlGHAElfb)SOiN.BSHiotiM»ioti i oglTwoitld
like to niakeiojivstKioney aommant' £tm>m0!t} » GreettC^'-
papier nqoendioiiietiitisisif Iiuoibo ero .t it t even i i
Last fall I heard Dr. TeLinde read a paper on enri»d
mptnoai*' im whteh he eallednnitn ‘ftha scikir^e” oft the
private patient”. He felt that late marriages- of‘
private .patiftutjs had aaroetlringftHxdo^winth the” incidence
of endclun-.triosjs. /and’du- advised t idootors' Uo APttgev'tfleiO1
cervix , w as much greater ..
-• »Ub 'll X fit rtSR GjtfO 1
inv^en
patients to marry early.
When he finished. Joe Meggs of Boston arose and!
saidclflndfeufigtfrfcl Aihw'tld11 Ilml rhe'Mffi'fdbnde' ‘b^r
cinoma of the
niifrlHl
\} aWl j MVH ,cMri»4< 'vlteritur :yt>H .wouid
rather advise a jiatient to marry late and have endo-
njltriotii iv Ho iniKryi edriyi lain) 'iriffe^ie* the * irteKledbe
of carcinoma of the cervix. , , .
^RP^SfeMl" MElAYRtTli ‘IXugiBtaS': ^eing'a
j^hologH^ 4(jy<Yil<l rih('i,J<)ns;iyoa,ivv|)ol( irijnsgargbio
Dr. Niehurgs paper, because cytology is somettiing.
t Iptdh viHI;J'pilt)£(-,bu]rdtni upun ithe‘’pafhok)gist.
About four years ago I attended a meeting of
ph'rtilJIf/gPtk rb PTl idJ^d, ih*1 whiPn ’apfi’roxniiafely l.fV)!)-
lyfU^pn^td ’iroua^fty yjej^flunit^ ^ rthftt
time cytology was brought to the floor for discussion^
and most of the. iref-mi Jars i».wre inol 1 in 1 tevoif, ‘of ‘ this
burden being handed to them. As one man brought
out, if every patholbgifth irT'the^tfrtited' Sfates" worked
twenty-four hours a day on nothina but cytcdogy^ at
thP clM'‘ oFThd ^sMai ' 'apjWoxib'iately ’one'-third m the
wom^p^ia t h e j jl 1 ^tje d StjJi^qs ^oidd.Jyy examined.
It was very obvious that the pathologists could not
td^ifyi pub amptheib speciality. Laltliaugjh'c--tlve{ public1 'A^ais
beginning to demand it through) the lay, press.
npi mririthih Hiefiirie fii ffas1 niw1 been 1 found
POffibJ^ v(i%.ftewn iMi'Sfe / dfiyelop
people who 'can screen the normal from the patho-
lqgjtpf aj«l ;tberphy jelirwnatl9i8Q/er99® pdrv<cenr of rikd
smears so that the pathologist or the cytologist hgs
attelrtidfP'biiongfU lAHtWe1 ofhbf^ltf j/e/Sceiff. ' "J Jl *'
Another thing^^^s broug})t oy,t wa^, tjiat
gists frequently' argue and fuss about whether this or
that is maligp3p,t,ipfi Jyqnige ,in., borderline- -case4 nchen
there are some dozens of cells on a slide. When you
r«fb<fl^ib t«j( ac spnglfiicell j jstrult StarD -Vo p^t ^'iirto a
Class 2, 3 or 4, you run uito another problem.
<{i'Ai>iftii)ii Abis^lA-fyfiC-- "tfiri ‘otitef dhy in'1 the mail'' f
re^Hed a lf^,. t^^iam, ?oqiq V( _you, ,<W’ .als<^
staMiig t'hat courses were being given to doctors at
cprlajn, ctjjitey^jpj thffyllniiteri Statesi ortevulrl two » Weeks1
in duration, on pathology.
oHSiring<4v8#Kd3Lw8IiIicj'itfl!0^y''trir ’four1 yvPafs, ‘dl though’
I do not (I c vq
aibcMiTallP
quafe even at this time'To pass upon
cpfffii/L|typpsffVl: ivtlNi tttulv/ th«frefope.i'hvliavb .h&d * t.fl
use men like D,r. Niehurgs as a consultant in .equivocal
slfcHSJCS Io Vi-P! 9 BIip'lOB HP HilillO U '
tru iZmtiMtfi'M-
at’ a shcre Htla gfvb the answer. Dr. Ayers, from Mon-
tr^l.^pjaclm^ my>yje/ 'yhWb ib? sfMiyvs^tbe slide’ bt-ing )
handed to him, he looks at it and says. “The patient,
liyK'rancCr'. ' ! He, ltafcfti»i!np‘Mli|c nPAt s'Me, ?6dkffd'£lV‘ft'
and says, "The patient does not have^ (canQery’v)
is^CfiviMts^'i' MV ori ebbs1 ( infor niation. "
fC v i g y j j y -q.s (y ■ (”iiiJj y . , It ryyiqire^yfjbip of trainings
a lot of information, and there are very few people
whpjdy/iFe That;- ii« fl rniajtion &s‘imu'ch',afsnDr; JNiebui*gs1.'
because he spends the majority of his, time on the.
s.!bje%t:U;iHS loo -{in , Bijq -1- H'-T a*"
DR. B, ^ T,, B .ffrqqritn&yi
of any discharge, according to Garland, is 46 per cent
in., igll.y jyronxtn.v According1 'Wi ^wreebbAum ' ’it
per cent. Gershicler quotes 3 per cent. In, our series
we found 90 p^ff Wfri -fdecfd?ffeV.,f ' 11 1 " 0,1
(Slide I The type of nipple djscharge was physio-
logic. There are three^kinds — mucoid or serous secre-
tion, found in the young breasts, and the thick, creamy
or serous secretion foilifd1 in the older type of woman
w!™ hf home childrej|1()Wd Oje ^stflim or .yiijlk
type Wuncl' in trie breasts of pregnant and lactating
WQ9)£W, . /. ii v 81) 9*>H1 yo<»,» r, TI UJjr- c-i i-*3i i
fSlide I Tbe pathojogic path of discharge: There are
thrtttDthatltfoilnd in-1 fh|d“fJenign 'feiohi. fn ^frtfradudraf’
papilloma, fibroadenoma pysts, arid ^r^upia, jif.
AlfhIi^bkn?'}ebion'sTJb!areinbma',’ Taget s diseas
lit j‘ 1 1
lsease, and
July, 1950
299
sarcoma. Inflammatory lesions, found in mastitis, in-
fected ducts, syphilis, and tuberculosis.
(Slide) This is a slide of plasma cell mastitis.
This is a rather rare condition. It is a rather contro-
versial question as to what plasma cell mastitis is. It
exists, and this slide was taken from the secretion of
a breast which was bloody appearing, but it was not
blood — it was that dark color that looked like blood.
We found the massed cells in the secretion, and we
designate that under the head of plasma cell mastitis.
DR. EDGAR HILL GREENE (Atlanta): Mr. Chair-
man. the only thing I would like to add is that I
appreciate the discussion by Dr. Richardson.
It has been advocated by some that probably early
marriage would prevent the development of endo-
metriosis. I am also aware of the fact that Dr. Meggs
pointed out the early incidence of carcinoma of the
cervix in married women who probably began bearing
children early.
I feel that regardless of the findings of these eminent
men. I want to take the stand in favor of early mar-
riages and the nursing of babies, as advocated by
Dr. Beasley, in order to prevent those aberrant and
peculiar discharges that he talks so much about.
Whether they run the risk of having carcinoma of
the cervix or not, I believe the women of our country
would be so stimulated as a rule by the stimulation
from the pituitary and the other gonadal glands that
they would give little thought to carcinoma of the
cervix until they arrive at that age when it becomes
necessary to make certain examinations — and then
catch them early and give them all necessary treat-
ment.
DR. HERBERT NIEBURGS (Augusta): I have
nothing to add except that I want to thank the dis-
cussers for their presentations. I agree entirely with
Dr. Bunce regarding screening. His term of “case-
finding procedures” is a very good one. A patient who
has a negative smear cannot be called free of cancer
unless smears are repeated over a certain period of
time, periodically, at least once a year.
DR. HELEN BELLHOUSE (Atlanta): I feel priv-
ileged to make comments on a paper which I think
deserves a great deal of thought.
If any of you have done any amount of reading
on the Rh factor, you cannot but pay tribute to Dr.
Saye’s creating order out of choas. His paper was
very simply and clearly done, and every day this
matter of the Rh factor is becoming more and more
important.
No mother in Georgia shou'd go through pregnancy
without being able to have an Rh factor determination.
It is a case of teamwork between the laboratory and
the physician in the prevention of difficulties and
problems. Probably a great many of us heard Dr.
Diamond when he spoke in Atlanta. He has definitely
shown that kernicterus is a preventable disease. That
is the public health point of view.
I am interested in preventable diseases from the
public health point of view. Kernicterus has not been
shown to occur before fortv-eight hours. If a baby
is transfused adequately before forty-eight hours,
kernicterus is a preventable disease, and I think it
is well to realize that transportation has improved
considerably in the last thirty years, so much so
that I doubt if there is a babv born in Georgia now
who cannot be taken to a center where replacement
transfusion can be done.
Just because you are not right in the middle of
scientific activity, don t feel hopeless. Make an effort,
and get the baby to a place where something can be
done for it.
The Medical Association of Georgia will
hold its next annual session at the Bon Air
Hotel Augusta, April 17-20, 1951.
EDWARD CAMPBELL DAVIS, M.D.
(1867-1931)
Isabella Arnold Bunce
Atlanta
In the year 1867 America, the land of the
free and the home of the brave, had much to
occupy her time. One of her many problems
was the badly crippled South left so from the
War Between the States. Notwithstanding the
sad condition of the failed South, the Recon-
struction Act was passed over the veto of Presi-
dent Andrew Johnson who had always attempted
to befriend her.
It was into this perilous period of carpet-
baggers, scalawags and freed slaves that Edward
Campbell Davis was born on the 11th day of
October, 1867, in Albany- Georgia. His parents
were Ella Catherine Winkler Davis and Dr.
William Lewis Gardner Davis. Thus it came
about that his heritage was the blend of the
blood of England, Scotland and Wales.
Campbell, as his family called him, had dark
brown hair and deep blue eyes that were en-
hanced by a direct straightforward gaze. In
family sequence, he was next to the youngest
of eight children; therefore, he had an oppor-
tunity to profit by the experiences and compan-
ionship of the older ones. In consequence, he
led the happy life most small boys are privi-
leged to experience.
Unfortunately, his father, who had always
maintained a heavy practice, contracted pneu-
monia and died when Campbell was five years
old. His mother shouldered the responsibility
of the family and the large plantation on which
they lived. The trades people of Albany never
hesitated to lend her money or furnish her with
supplies, for well they knew that when her
crops came in, they would have their money.
Therefore, Mrs. Davis had the respect and ad-
miration of her community.
Campbell received his fundamentals of educa-
tion in Albany. Then he entered the University
of Georgia where he received his A.B. degree
in 1888.
Besides having a father who was a doctor,
Campbell also had a brother, W. L., who prac-
ticed in Albany. The medical strain in the
Davis issue was and is a rather dominant one.
Therefore, Campbell decided to study medicine.
He then entered the University of Louisville in
Kentucky for that purpose. It was there he
granduated in medicine in ’92.
From then on Edward Campbell Davis was
professionally known as Dr. E. C. Davis. He
had always liked Atlanta, so there, on a sum-
mer’s day, he came to pursue the practice of
surgery. Without delay. Dr. Davis entered into
an association with Dr. C. D. Hurt.
While Dr. Davis was laying the foundation
Read before the Auxiliary to the Fulton County Medical
Society, January 7, 1949.
The Journal of the Medical Association of Georgia
300
of his practice, he took some time out to fulfill
his social engagements. It was due to this fact
that a very lovely girl, with hair of yellow gold,
eyes the color of the sea, fair of skin and
beautifully curved, met her fortune. She was
none other than Maria Carter, a direct descend-
ed of the famous King Carter of colonial days
in Virginia. Strange as it may seem, tho’
Maria lived on the same street as Dr. Davis
in Albany, they had never met.
Maria was educated at Lucy Cobb and among
the many friends she made there was Carolyn
Sisson, of Wisteria Hall. Kirkwood. These girls
became good friends and continued to keep up
their friendship after leaving college. Carolyn
wrote to Maria of a young surgeon, Dr. E. C.
Davis, of Albany, whom she would like for her
to meet. So, with the aid of Carolyn and
Wisteria Hall, they met.
The setting for the wooing of Maria Carter
by Dr. E. C. Davis was ideal. Hence, it was
in a mellow month, aglow with the fiery flames
of fall subdued only by the light of a harvest
moon, that Venus fanned a smouldering ember
on the altar of love for them. From then on
there arose between them a comfortable corre-
spondence, but. due to Maria’s indecision, it
dwindled and disappeared.
While Maria remained thus in maiden medita-
tion. Dr. Davis was asked to join Governor
Atkinson’s party on a good will trip to Mexico.
Although he was delayed and missed the
Governor’s train, he managed to catch up with
the party in Louisiana and made a memorable
trip of it. In this manner and in other pursuits,
he was able to bide his time as he waited around
for Maria.
Destiny now played her hand for this young
couple. The Maine, while lying languidly in
the waters of Havana harbor, was sunk. So,
then, there was the Maine for the Americans
to remember. Of course, war was declared.
Governor Atkinson immediately appointed Dr.
Davis as Captain of the Second Georgia Volun-
teer Infantry in 1898.
On his way to serve his country in the
Spanish-American War, Captain Davis was sent
by way of his home, Albany, to his station in
Florida. Here, Maria, with many others of his
town’s people, was there to wish him God’s
speed. Then it was that the sight of dashing
Dr. Davis in the decorative uniform of his
country began to make up Maria’s mind for
her and win her heart. Therefore, their dis-
continued correspondence was resumed in earn-
est. Dr. Davis often laughingly said he had to
go to Cuba to get her for his wife.
While he was stationed near Tampa, an
epidemic of typhoid fever raged among his
soldiers. He immediately began the organiza-
tion of a hospital to give adequate care to the
sick. He worked tirelessly day and night only
taking a few hours of rest and these limited by
the clock or the call of his orderly. During
the peak of this crisis. General O’Reilly sent
word for him to report to his office for some
routine matter. Dr. Davis sent the general a
message stating he would come only if a doctor
was sent to relieve him. There was marked
apprehension by the staff that he might be
severely reprimanded or even court martialed.
However, he was not. Dr. Davis was a firm
believer in doing his duty no matter what the
cost to himself. A promotion to Major was
given Captain Davis for his outstanding work
during this time.
A grateful brother of one of the doctor's
patients presented him with a United States
flag. This flag is now a Davis family treasure.
Major Davis served his country from the
spring until fall; he was then mustered out at
Piedmont Park.
Back again he went to his Atlanta practice
now working with Dr. J. B. S. Holmes at his
sanatorium on Cain Street.
In June, the month of brides and roses, in
the year 1899, Dr. E. C. Davis took Maria
Carter for his wife. After their honeymoon
they lived for a short time at the Sanatorium.
From there, they moved into their first home
on Pine Street. With these two there was such
a perfect surrender to their love that the beauti-
ful words of Edgar Allen Poe’s poem “Annabel
Lee” are comparable, thus quoting “But we
loved with a love that was more than love —
I and my Annabel Lee”.
Dr. Davis’ practice continued to grow rapidly.
After a short period of being out for himself,
Dr. L. C. Fischer became associated with him.
Their offices were located in the English Ameri-
can Building at Peachtree and Broad Streets.
There it was that these two young surgeons had
the vision of their great hospital to serve the
sick as a haven of help, health, hope and hap-
piness. Drs. Davis and Fischer opened their
hospital on Crew Street in 1908. From this
cornerstone, Davis-Fischer Sanatorium arose. A
few years later they moved their hospital to
Linden Street and the growth of Davis-Fischer
Sanatorium was miraculous. Their hospital,
still located on the same site in this year of
1949, occupies almost an entire city block in
the heart of Atlanta. However, it is now known
as the Crawford W. Long Memorial Hospital.
The skill of Dr. Davis was such that even
his family would have no other doctor to operate
upon them. Mrs. Davis’ sister had had an attack
of appendicitis while on a stay in Paris but
refused surgical aid so as to have him remove
her appendix. During the same week of her
operation, he also operated on his own sister.
Dr. E. C. Davis always kept pace with the
progress of his profession. He bought the first
Kimble tube used here for direct transfusion.
It was immediately put into use where a life
was despaired of, resulting in the recovery of
July, 1950
301
the patient. He also bought and installed the
first freezing microtome used here. Hence-
forth. fresh tissue sections could immediately
be prepared and diagnosed on all cases of sus-
pected cancer, to determine the extent of the
surgery needed while the patient was still on
the operating table.
Furthermore, he was one of the earliest be-
lievers in and users of the aseptic and antiseptic
technic in surgery. He learned to use rubber
gloves with dexterity while most surgeons of
those days felt clumsy and deprived of the
sense of feeling during an operation when wear-
ing them, on account of their thickness.
His greatest feats were accomplished by his
skill and originality in gynecologic and ab-
dominal surgery.
Dr. Davis was always prompt in the operating
room. He began his surgery at or before 8
o’clock each morning. He could easily conclude
five or more operations before noon. In addi-
tion. he would have numerous emergencies car-
ried in day or night from a radius of 300
miles or more. It was not uncommon for him
to operate on a patient brought from a great
distance with an acute suppurative appendix.
During the day Dr. Davis would take lime
out only for a short lunch. Then, back to work
again. He was constantly surrounded by doctors,
interns and nurses as he made his rounds where
he not infrequently had 20 or more patients
in the hospital. Besides being one of the South’s
most distinguished surgeons, he was one of
the best loved of his time. To the young doctors
he meant much for not only was he their sur-
gical hero, but friend as well.
Next to surgery his greatest medical love was
obstetrics. This he practiced with the strictest
adherence to cleanliness and antiseptic technic
in both the home and delivery room. He was
almost uncanny in recognizing the signs of
eclampsia and other toxemias of pregnancy.
The expectant mother under his care had con-
stant supervision administered through obser-
vation, examinations and laboratory checks on
both urine and blood at regular intervals.
Besides Dr. Davis’ practice he held the posi-
tion of Professor of Obstetrics and Gynecology
for 20 years at the Atlanta School of Medicine,
which is now a part of Emory University.
He was nearly always in attendance at the
medical meetings held by the county, state and
the national societies. Being a master of pre-
cision. he wrote many scientific papers and was
a much sought after speaker at the medical
meetings.
In 1914, Dr. Davis took part in a Clinical
Congress held in London. While he was there
World War I broke out in Europe. He had to
return home by steerage and was landed at
Quebec. Little then did he know that this same
war would return him to Europe with the silver
leaf of a Lieutenant-Colonel on his shoulder.
Dr. Davis was quite a family man. He and
Mrs. Davis had eight children, namely, Shelley
C., Catherine, Page, E. C., Jr., Ria, Robert
Carter, Sarah and Teddy. Never was he happier
than when his children were clustered around
him. Another pleasure enjoyed by the doctor
and his children were their expeditions to Kamp-
er’s where he bought them just anything they
wanted.
As an aid to Dr. and Mrs. Davis, their nurs-
ery was adequately staffed by a competent
colored woman, who was affectionately called
“Nursie” by her charges.
Dr. Davis’ whimsical sense of humor was
shown by the names of his three horses of his
horse and buggy days. They were Faith, Hope
and Charity. Long after their master was using
a horseless carriage in his practice, these horses
remained in the Davis stables.
At the Davis home there was alwTays a mem-
ber of the family or a friend staying with them.
Once two friends of theirs, a man and his wife,
were in need of housing. The husband asked
Dr. Davis if they could stay for a while with
them. Dr. Davis told him to ask Mrs. Davis.
He did. They stayed five years. There was
only once in the entire married life of Dr. and
Mrs. Davis when they were left alone for a
second honeymoon without family, friends, or
the eight children.
Dr. Davis enjoyed vacationing at Pass-a-
Grille, Florida. He and Mrs. Davis would take
the small children with them and leave the
others at home. During these periods of relax-
ation Dr. Davis asked no more of any one of
them than to catch a tarpon — his favorite sport.
At the outbreak of World War I. Dr. Davis
was asked by the American Red Cross to
organize the Emory Unit. He was chosen on
account of his fine record in the Spanish-
American War. He, of course, took on the job
and the Emory Unit was months in the making.
He was also placed on the examining board.
Dr. Davis was commissioned a Lieutenant-
Colonel of the Unit, and made medical director
of the unit when it was named Base Hospital
43 in its overseas duty.
As a result of Colonel Davis’ capable and
courageous discharge of his duties in the theater
of action, he was awarded a certificate of merit
by General John J. Pershing, decorated by
King Alexander of Greece, and given member-
ship in the Knights of the Ancient Order of
Our Saviour.
On account of Colonel Davis’ strenuous work
in the organization of the Unit and his activity
overseas, he became ill. He returned home and
his ship reached Newport News on November
11, 1918, the day of the signing of the Armistice.
After a brief interlude, Dr. Davis resumed
his practice. He was later joined by his son,
Dr. Shelley C. Davis, who had been thoroughly
trained in surgery at home and abroad.
(Continued on page 307)
302
The Journal of the Medical Association of Georcia
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
July, 1950
A. M. A. PRESIDENT SPEAKS
San Francisco, June 27. — In a hard-hitting
inaugural address here tonight, broadcast Coast-
to-Coast over two radio networks (ABC and
Mutual), Dr. Elmer L. Henderson of Louisville,
Kentucky, new president of the American Medi-
cal Association, charged that “the administrative
arm of our Government has failed us in this
generation.”
The fighting doctor from Kentucky, who took
his oath of office at an open meeting of the
A.M.A. House of Delegates here, and whose
message was heard by millions of the American
people, flatly accused “little men with a lust for
power in the executive branch of the Govern-
ment of seeking to make America “a Socialist
State in the pathetic pattern of the socially and
economically-bankrupt Nations of Europe.”
A Sick Government
The Administration in Washington, asserted
Dr. Henderson, is “sick with intellectual dis-
honesty, with avarice, with moral laxity and
with reckless excesses.”
That condition must be changed, he declared,
“if we are to survive as a strong, free people” —
and he called upon all of the American people to
share the responsibility and to uphold the Na-
tion’s ideals of freedom.
To the 144.500 members of A.M.A., who had
received special invitations to hear their new
president’s address, he said:
Medicine — the Target of Cynical Men
"Tonight I call upon every doctor in the
Lnited States, no matter how heavy the burdens
of his practice may be. to dedicate himself, not
only to the protection of the people’s physical
health, but also to the protection of our American
way of life, which is the foundation of our eco-
nomic health and our political freedom.”
Continued the new A.M.A. president:
American medicine has become the blazing
focal point in a fundamental struggle which may
determine whether America remains free, or
whether we are to become a Socialist State, under
the yoke of a Government bureaueracv domi-
nated by selfish, cynical men who believe the
American people are no longer competent to
care for themselves.
Lnder Socialism, Liberty Dies!
“These men of little faith in the American
people propose to place all our people, doctors
and patients alike, under a shabby, Government-
dictated medical system which they call Com-
pulsory Health Insurance. But it is not just so-
cialized medicine which they seek. Their real
objective is to gain control over all fields of
human endeavor — and to strip the American
people of self-determination and self-Govern-
ment.
“There is only one essential difference between
Socialism and Communism. Under State Social-
ism human liberty and human dignity die a
little more slowly, but they die just as surely!”
Then Dr. Henderson, declaring that “Ameri-
can medicine has led the world in medical ad-
vances, and has helped to make this the health-
iest. strongest Nation on the face of the globe.”
blasted the critics of medicine with this signifi-
cant statement:
“It is not American medicine which has failed
to measure up to its obligations.
“It is not American business nor American
agriculture which has failed — nor the fine, loyal
working people of America who have failed.
“It is the administrative arm of our Govern-
ment in Washington which has failed us in this
generation!”
Press Praised for Leadership
Stressing the fact that many alreadv recognize
the dangerous trend toward concentration of
power in Washington. Dr. Henderson declared:
“If it were not for the leadership of the
American press, in defending our fundamental
liberties, American medicine, even now. might
be socialized — and under the heel of political
dictation.
“The newspapers of America, with few ex-
ceptions, have taken a strong stand, not only
against socialized medicine, but against all forms
of State Socialism in this country — and the
doctors of America are proud to take their stand
beside the fighting editors of America in the
battle to save our freedom and the system of
individual initiative which maintains it."
The Miracle of Medical Progress
Reviewing the great achievements of Ameri-
can medicine at the halfwav mark of the 20th
Century- — with 19 years added to the life span
during the past five decades, with many dreaded
diseases conquered, which were leading killers
at the turn of the century, and with the maternal
death rate in this country now lower than in any
other Nation — the A.M.A. president commented:
“The story of never-ending medical progress
in this country is not just a story of so-called
miracle drugs and miracle discoveries. The real
miracle of American medical progress is the
miracle of America itself — the motivating power
of the American spirit, of free men. unshackled,
with freedom to think, to create, to cross new
frontiers.
“This is the spirit, and these are the very
methods, which Government-domination of medi-
cal practice would destroy.”
July, 1950
303
Voluntary W ay Is American W ay
Declaring that the Nation’s medical care prob-
lems can be resolved “without compulsory pay-
roll taxes and without political pressure,” Dr.
Henderson pointed out that approximately half
the population of the country already has en-
rolled in Voluntary Health Insurance plans “to
take the economic shock out of illness.
Said Dr. Henderson:
“V ithin the next three years, in the opinion
of leading medical economists, 90 million per-
sons will be enrolled in the Voluntary prepaid
medical plans — and when that number has been
reached, the problem will have been largely re-
solved.”
Dr. Henderson concluded his address by
thanking the American people for coming to
medicine s defense when it was brought under
attack, and reported that more than 10,000 Na-
tional, State and local organizations, with many
millions of members, have taken positive action
against Compulsory Health Insurance.
CIVIL DEFENSE A CIVILIAN
RESPONSIBILITY
Opinion has been expressed in some instances
that civil defense preparations are entirely the
responsibility of the military. This was a cause
for concern at a recent meeting of the Council
on National Emergency Medical Service. Repre-
sentatives of the Department of Defense and
the National Security Resources Board empha-
sized that the primary responsibility for
civilian defense must be assumed by civil gov-
ernment, that in time of war the Armed Forces
must be free to concentrate on their primary
missions of repelling attack and carrying the
war to the enemy. Since civilians must per-
form the necessary civil defense functions, they
should be responsible, at all levels of govern-
ment, for the required planning and prepara-
tions. Effective community action during a
wartime disaster will depend largely on this
peacetime development of a sense of commu-
nity responsibility for self-preservation.
Concern was also expressed at the lack of
general realization that civil defense prepara-
tions must be undertaken by not only the metro-
politan but the less populated areas of the
nation. Maine not only has enacted civil defense
legislation that would enable it to furnish assist-
ance to other states if necessary but also has
formulated plans whereby supplies and person-
nel— including physicians — may be dispatched
to areas where resources have been overwhelmed
by disaster. The fact that 32 state and terri-
torial medical societies, after notification that
this meeting of the Council on National Emer-
gency Medical Service would be concerned sole-
ly with the medical aspects of civil defense,
sent representatives indicates an awareness of
the urgent need for immediate initiation of
preparations for civilian protection. This an-
swers charges from those who maintain that
the medical profession has lost sight of its re-
sponsibilities in civil defense fields.
An impressive aspect of this meeting boding
well for the future, since it embodies one of
the cardinal principles of civil defense, was
the obviously sincere desire of those present,
whether they represented state medical societies,
allied professional associations or agencies of
federal or state governments, to share knowl-
edge and experiences in what was realized to
be a common task — self preservation on a na-
tionwide scale. As a result, especially of the
recounted experiences of the medical societies
of the Territory of Hawaii, the District of
Columbia and the states of Georgia and Maine,
it was possible to formulate definite suggestions
which would assist state medical societies in
planning and organizing similar programs. In
the same manner, plans were developed where-
by state societies may soon aid their individual
members in the acquisition of factual knowl-
edge concerning the newer warfare agents.
The representatives of state medical societies
that have organized civil defense programs
stressed the absolute necessity of certain pre-
requisites to such programs and recommended
for immediate action: The formation of emer-
gency medical service committees by state medi-
cal societies that have not yet done so; urging
by the medical profession, through state medical
societies, of the governors of those states not
possessing adequate civil defense enabling legis-
lation to recognize the importance of such legis-
lation; urging governors to appoint state direc-
tors of civil defense, to whom should be dele-
gated the necessary authority and responsibili-
ties, and requesting governors to appoint health
services civil defense advisory councils to the
civil defense directors, since intelligent planning
is impossible without competent medical and
allied professional advice and guidance. Such
programs should go far in the recognition and
utilization of the responsibilities and capabilities
of the medical profession in times of emer-
gency.— Editorial The Journal of the American
Medical Association, June 10, 1950.
Editor’s Note: Dr. Edgar Dunstan, 478 Peachtree
St., N. E., Atlanta, is chairman of the Committee on
Medical Civilian Defense of the Medical Association
of Georgia. Other members are: Drs. ff'm. M. Bartlett,
Chas. E. Dowman, Robert W. Candler and Jos. Skobba,
all of Atlanta. Dr. Dunstan attended and participated
in the A. M. A. conference mentioned in the foregoing
editorial.
FIND MENTAL DEFICIENCY MORE LIKELY
IN CHILDREN BORN TO MOTHERS OVER 40
Any woman who bears a child after the age
of 40 runs a statistical chance of about 1 to 6
per cent of having a child with mongolism, a
congenital mental deficiency.
304
The Journal of tiie Medical Association of Georci*
This is brought out in a report by Dr. J. A.
Book and S. C. Reed, Ph.D., of the University
of Minnesota, Minneapolis, which appears in
the June 24 Journal of the American Medical
Association.
Children with this severe condition commonly
are called idiots. Mongoloid babies are recog-
nized by their marked liveliness, flattened skull
and oblique eyes.
The frequency of mongolism in the general
population is estimated to be between 1 out of
500 and 1 out of 1,500. according to the report.
Risk of having a mongoloid child also in-
creases after a mother has borne one baby with
the deficiency, the researchers found.
“A woman who has borne a mongoloid child
runs a statistical chance of about 4 per cent
of having the next pregnancy result in the birth
of another mongoloid child,” they say, adding:
“This implies a 40 times greater risk than
the average at all ages.”
AUREOMYCIN REDUCES CHILDBIRTH
INFECTION POSSIBILITIES
Aureomycin is effective in lowering the possi-
bilities of infection following childbirth, accord-
ing to a report in the June 10 Journal of the
American Medical Association .
A study on the use of the antibiotic in ob-
stetric patients is presented by Dr. Joseph A.
Guilbeau, Jr., Dr. Emanuel B. Schoenbach,
Isabelle G. Schaub, A.B., and Doris V. Latham,
A.B., of the Johns Hopkins School of Medicine
and Johns Hopkins Hospital. Baltimore.
The normal uterus after birth contains a
wide variety of bacteria which is potentially
disease producing. Such infection may result
in irreparable damage which can jeopardize
future childbearing, the report points out.
Aureomycin hydrochloride was administered
to 109 patients before delivery. Only 13 (11.9
per cent) showed positive cultures two to three
days after giving birth. In a control series of
24 patients who had uncomplicated, normal
deliveries, positive cultures were reported in 18
(75 per cent ) cases.
The researchers also treated a number of
acute childbirth infections during the study.
They report:
“Aureomycin proved effective in various ob-
stetric infections. Patients with acute and
ch ionic infections of the urinary tract treated
during pregnancy responded satisfactorily to
therapy, although several relapsed when treat-
ment was discontinued.
“Aureomycin is a desirable chemotherapeutic
agent because it is effective after oral admin-
istration, it possesses a wide range of anti-
bacterial activity and it is unassociated with
serious toxic manifestations.”
The report also points out that the antibiotic
has the ability to reach the infant by way of
the maternal blood stream in high therapeutic
concentration. This, they say, is a desirable
property.
ONE-DAY AUREOMYCIN TREATMENT
FOR GONORRHEA REPORTED
A 98 per cent cure rate in gonorrhea follow-
ing administration of a one-day treatment with
aureomycin, a newer antibiotic drug, is reported
by an Augusta I Ga. ) research group.
“A series of 100 unselected patients with
gonorrhea was arbitrarily divided into two
groups of 50 patients each. " Drs. Calvin H.
Chen and Robert B. Greenblatt and Robert B.
Cienst, Ph.D., of the ETniversity of Georgia
School of Medicine say in the current June 24
Journal of the American Medical Association.
“Group A was given aureomycin orally three
times daily for two days and group B was
given the same daily dose for one dav. The
results obtained from these two groups were
identical. There was one failure in each group.
Thus, the percentage of cure was 98 in each
group.
“Toxic reactions were few and not serious.
In several patients, the disease, which had failed
to respond to penicillin and other medication,
yielded to aureomycin treatment.
“It is apparent that orally administered
aureomycin in the doses employed in this study
is at least as effective as one injection of peni-
cillin against gonorrheal infections.”
Evaluation of the effect of aureomycin treat-
ment was based on results of a physical examina-
tion given a week after treatment was begun.
Duration of the disease varied from one day to
two months. However, duration of the disease
did not seem to have any influence on the
speed of recovery, the article points out.
Of the entire group of patients, 83 were
men and 17 were women. In 10 of these patients
the condition had failed to respond to penicillin,
chloramphenicol or sulfa drugs.
WHERE ARE OUR LARGE FAMILIES?
Large families are no longer part of our social
pattern, and they are continuing to lose in popu-
larity. The rate at which births of seventh and
higher order occur, has dropped nearly 60 per
cent in the past three decades. Even during the
recent war and postwar period, when rates for the
low orders of birth reached the highest levels in
at least a third of a century, the rates for the
higher orders continued their downward trend.
Nevertheless, large families even now are not
altogether out of the picture. Somewhat more
than 164,000 of the children born in the United
States in 1947 were of the seventh or higher
order. While this is only about 5 per cent of all
births, the number is large enough to merit atten-
tion. The proportion of births in these higher
orders varies considerably with the region of
the country and serves as an index of the geo-
graphic pattern of our large families. The per
July, 1950
305
Percent Distribution of Births, by Order of Birth, Color, and Geographic Area
United States, 1947
WHITE
COLORED
All
All
1st-
4th-
7th-
10th &
1st-
4th-
7th-
10th &
Birth
3rd
6th
9th
Over
Birth
3rd
6th
9th
Over
United States*
100.0
84.2
12.2
2.7
0.9
100.0
66.1
21.4
8.5
4.0
New England*
100.0
85.9
11.3
2.0
0.8
100.0
78.0
15.1
5.1
1.8
Maine
100.0
80.6
14.4
3.4
1.6
100.0
75.7
18.9
2.7
2.7
New Hampshire. .
100.0
84.0
12.8
2.4
0.8
100.0
90.0
0
10.0
0
Vermont
100.0
79.7
15.5
3.6
1.2
100.0
60.0
40.0
0
0
Rhode Island . .
100.0
87.9
10.2
1.4
0.5
100.0
73.1
15.9
7.7
3.3
Connecticut
100.0
89.8
8.8
1.1
0.3
100.0
79.5
14.8
4.4
1.3
Middle Atlantic
100.0
88.1
9.6
1.7
0.6
100.0
78.8
15.6
4-2
1.4
New York
100.0
89.3
9.0
1.3
0.4
100.0
81.6
14.2
3.2
1.0
New Jersey
100.0
90.5
8.2
1.0
0.3
100.0
75.3
17.4
5.3
2.0
Pennsylvania
100.0
85.6
11.2
2.3
0.9
100.0
76.5
16.6
5.0
1.9
East North Central. .
100.0
85.1
12.0
2.2
0.7
100.0
75.3
17.8
5.2
1.7
Ohio
100.0
85.6
11.5
2.2
0.7
100.0
76.1
17.2
5.0
1.7
Indiana
100.0
83.5
12.7
2.7
1.1
100.0
72.3
18.2
6.4
3.1
Illinois
100.0
87.6
10.2
1.7
0.5
100.0
76.1
17.5
5.0
1.4
Michigan
100.0
84.0
12.9
2.3
0.8
100.0
74.5
18.9
4.9
1.7
Wisconsin
100.0
82.2
14.2
2.7
0.9
100.0
70.2
18.6
7.7
3.5
W'est North Central .
100.0
82.6
13.6
2.8
1.0
100.0
69.1
204
7.2
3.3
Minnesota
100.0
81.5
14.8
2.8
0.9
100.0
66.1
21.1
9.8
3.0
Iowa
100.0
83.0
13.6
2.6
0.8
100.0
72.0
17.5
6.7
3.8
Missouri
100.0
83.5
12.3
3.1
1.1
100.0
70.5
19.5
6.7
3.3
North Dakota
100.0
76.7
17.1
4.4
1.8
100.0
50.2
30.6
13.4
5.8
South Dakota
100.0
79.3
16.2
3.2
1.3
100.0
57.1
27.7
10.6
4.6
Nebraska
100.0
83.6
13.2
2.4
0.8
100.0
71.6
20.2
6.4
1.8
Kansas
100.0
84.8
11.8
2.5
0.9
100.0
71.3
19.9
6.1
2.7
South Atlantic
100.0
81.2
13.5
3.9
1.1,
100.0
62.1
2i.2
9.8
4.9
Delaware
100.0
86.2
10.9
2.2
0.7
100.0
66.3
20.8
8.5
4.4
Maryland
100.0
86.0
11.0
2.3
0.7
100.0
68.2
20.7
7.7
3.4
Dist. of Columbia
100.0
93.3
6.0
0.6
0.1
100.0
79.7
15.1
4.0
1.2
Virginia
100.0
81.4
13.0
4.0
1.6
100.0
64.1
22.9
8.7
4.3
West Virginia
100.0
74.5
16.4
6.3
2.8
100.0
63.5
21.2
10.3
5.0
North Carolina ...
100.0
79.1
15.0
4.3
1.6
100.0
59.8
24.0
10.8
5.4
South Carolina .
100.0
78.7
15.5
4.4
1.4
100.0
56.2
25.9
12.1
5.8
Georgia
100.0
81.1
13.8
3.8
1.3
100.0
60.2
23.5
10.6
5.7
Florida
100.0
84.9
11.6
2.7
0.8
100.0
63.5
23.6
8.8
4.1
East South Central
100.0
76.8
15.8
5.3
2.1
100.0
59.0
23.9
11.1
6.0
Kentucky
100.0
74.6
16.5
6.2
2.7
100.0
72.6
17.6
6.6
3.2
Tennessee
100.0
77.4
15.6
5.1
1.9
100.0
66.3
21.7
8.2
3.8
Alabama
100.0
77.6
15.7
4.9
1.8
100.0
57.8
24.5
11.6
6.1
Mississippi
100.0
79.0
15.1
4.4
1.5
100.0
55.2
25.0
12.6
7.2
West South Central .
100.0
83.1
13.0
3.0
0.9
100.0
65.1
21.9
8.9
4-1
Arkansas
100.0
76.8
16.1
5.2
1.9
100.0
55.0
25.3
11.8
7.9
Louisiana
100.0
81.3
14.3
3.3
1.1
100.0
61.1
23.9
10.3
4.7
Oklahoma
100.0
81.6
13.5
3.7
1.2
100.0
66.5
20.5
9.0
4.0
Texas
100.0
85.5
11.7
2.3
0.5
100.0
75.4
17.8
5.4
1.4
Mountain States
100.0
79.7
15.1
3.7
1.5
100.0
6 1.5
23.9
10.7
3.9
Montana
100.0
83.0
14.0
2.2
0.8
100.0
56.0
25.9
12.9
5.2
Idaho
100.0
80.7
15.5
3.0
0.8
100.0
71.2
10.8
10.1
1.9
Wyoming
100.0
82.7
13.7
2.7
0.9
100.0
56.4
22.1
13.5
8.0
Colorado
100.0
82.6
12.5
3.4
1.5
100.0
77.3
16.0
4.9
1.8
New Mexico
100.0
70.2
18.3
7.7
3.8
100.0
56.5
26.1
12.3
5.1
Arizona
100.0
78.3
15.8
4.3
1.6
100.0
59.7
25.3
11.5
3.5
Utah
1000
79.6
17.1
2.6
0.7
100.0
74.9
19.6
3.9
1.6
Nevada
100.0
86.2
12.2
1.3
0.3
100.0
G2.6
25.5
8.8
3.1
Pacific
100.0
87.9
9.9
1.6
0.6
100.0
77.1
17.4
4.3
1.2
Washington
100.0
87.0
11.1
1.6
0.3
100.0
74.4
18.2
5.4
2.0
Oregon
100.0
86.4
11.5
1.6
0.5
100.0
74.9
16.5
5.7
2.9
California
100.0
88.3
9.5
1.6
0.6
100.0
77.4
17.4
4.1
1.1
"Excludes Massachusetts, which does not require reporting by birth order.
Source for basic data: Vital Statistics of the United States , 1947, Part II, tables 6A and 6B.
cent distribution of birth by order and color, for
the individual States, is shown in the table on
page 305.
Large families are most frequent in the South.
The East South Central States rank first in this
regard, births of seventh or higher order con-
stituting 7.4 per cent of all births among white
women in that area in 1947; births of 10th and
higher order alone comprised 2.1 per cent of the
total. The South Atlantic and the Mountain
regions follow in sequence. At the other end of
the scale are the Middle Atlantic and Pacific
States; in the last named, white births of seventh
and higher order were only 2.2 per cent of all
the births, and births of tenth and higher order
merely 0.6 per cent of the total.
Interesting variations can be seen within re-
gional groups. In general, large families are
more common in the agricultural States than in
the industrial areas. In New England, for exam-
ple, the proportion of white children of seventh
and higher order in Maine and Vermont was 3 l/o
306
The Journal of the Medical Association of Georgia
times that in Connecticut. I ndoubtedly factors
other than urban-rural differences play a part.
I bus. large families are relatively 2' j times as
frequent in Pennsylvania as in the neighboring
State of New Jersey. The highest proportion of
white births of seventh and higher order occurred
in i\ew Mexico, where they constituted 11.5 per
cent of the total. Yet in Nevada, which is also
in the Mountain Region, the proportion was only
1.6 per cent.
Colored women, in general, hear larger fam-
ilies than do the white. In the country as a whole
in 1947. births of seventh and higher order con-
stituted 12.5 per cent of all births among colored
mothers, but only 3.6 per cent of the total among
the white; for tenth and higher orders, alone, the
relative proportions were 4.0 and 0.9 per cent.
Among the colored, as among the white, the larg-
est families are found in the East South Central
States, births of seventh and higher order ac-
counting for 17.1 per cent of the births among
the colored in that area. It is noteworthy that
the difference between white and colored in the
relative frequency of large families has been grad-
ually widening in the past few decades. — Statis-
tical Bulletin, Metropolitan Life Insurance Com-
pany, May 1950.
GOOD PUBLIC RELATIONS
The following tribute to a Georgia physician
appeared in the Atlanta Constitution June 13,
1950. Written by Associate Editor Doris Locker-
man of the Constitution staff, it not only portrays
a life well lived but also tells of the fine rela-
tionships this physician experienced with his
public. I rue, there are many physicians in Geor-
gia and elsewhere whose lives and work parallel
that of our beloved deceased brother, the subject
of this sketch. It is this kind of living and this
kind of work that build good public relations.
ACCT. DR. BUTLER:
PAID IN FULL
AUGUSTA — A fine old doctor died here last week,
leaving his wife a stack of loving testimonial letters,
his daughter enough philosophy to guide her for a
lifetime, his brothers and sisters a reservoir of pride
and memories, and an unnumbered list of friends the
gift of a living father, mother or child, instead of an
aging epitaph in the family burial ground.
In a way the career of Dr. Janies Harvey Butler may
have been the story of many doctors who are called
into their profession as if by a mystic sign, and who
serve it without publicity or fanfare, with their whole
souls.
Dr. Butler had done his share of probing the mys-
steries of life. He had been a leader in the treatment
of diseases of the heart, and his original techniques
in the treatment of pneumonia and tuberculosis had
led many young rqen onward to a fuller understanding
of these afflictions.
Somewhere along the line of his long practice, he
had become familiar enough with the human body to
understand its cycles and vagaries and to become a
notable internist, and of late, his practice had become
more and more general, with emphasis on his skill
as a diagnostician.
For many years he had taught medicine to the senior
class of the School of Medicine at the University of
Georgia, the school of his deepest affection, and students
of his classes say they came under his influence when
they needed his inspiration most.
These facts are matters of record.
The story behind them is far more revealing, its
texture the rough, colorful, salty warp of a Southern
farm hoy who was somehow always master of his own
fate.
At 18. Harvey Butler was a strong, fair-minded man.
the youngest County Warden in Georgia, operating a
firm hand in the administration of convict camps in
Dooly County, where he had grown up on his father’s
farm near Lilly. Walter George of Vienna had been
his lifelong neighbor and his friend.
Young Butler was, as they say, “uneducated,” but
be was quick and forthright and honest. From time
to time his friends recall he had “spells” of wishing
to become a doctor, and he saved his money carefully,
working hard on the land, and holding the unruly reins
of his job with human recalcitrants.
Finally, at 25, came the day of choice. Turning down
an offer of partnership in a planing mill, Butler left
the farm and headed for Augusta to enter the School
of Medicine.
The day after he arrived there, a young Negro man
showed up on the campus. "Ise gwine to be here from
now on, Mr. Harvey,’" the man said succinctly and put
down his little bundle of clothes. He was a convict,
just released, and he had found his master. He never
left him through lean years and rich. He was a
chief mourner at the funeral services Saturday.
World War came just as Harvey Butler added a
Dr. to his name, and he became a Major in the Army
Medical Corps, coming back to begin practice at an
age when other men had already built themselves
thriving and renowned reputations.
From the first, his practice had an air of dedication.
He worked day and night, answering calls anywhere.
He prospered in reputation and in means.
Then, somewhere in his mid-forties, he married Miss
Eleanor Keith, supervisor of nurses at the University
Hospital, and they began a home.
Symbolic of their capacity, they invited a sister.
Anile Butler, to come to live with them. She, too.
never left.
There was a daughter, Eleanor, whom they called
Bootsie. They showered her with rocking horses, stuffed
toys, a yardful of hunting dogs, a horse or two and
every loving kindness a pair of parents could provide.
Bootsie learned to fish with her father, to ride with
him. to climb trees, walk in the woods and to hunt with
the dogs that obeyed her even as a child.
With a deep personal loss, her father let her go off
to Brenau to school, and lest she grow homesick, he
sent her horse. Major, to college with her.
Two years ago, relieved at last of the harried demands
of wartime practice. Dr. Butler suffered a heart attack
and his health forced an ever narrowing of his work.
His strength was misered in every way by bis wife,
and his sister.
“If I can just live to see Bo graduate,” he said often,
“I will be happy.”
Last Monday night, Bootsie was graduated from
Brenau College, and her father was in the audience.
He saw her in her cap and gown, receive her diploma,
and they drove home together.
“Daughter,” he said the next day, “I have given you
everything I could. It has cost your Mother and me
a great deal. Now you must give to others. You must
never be selfish. What you have received was only
given to you to be passed on. Never let a day pass
that you do not do something kind and thoughtful
for others.”
The next day he went to his office as usual, and
on his way home asked his wife to drive him to the
July, 195U
307
home of a patient who lay ill in an upstairs room.
She begged him not to climb the stairs, hut he
insisted. “I had given my word.” he said, ‘"and they
expect me.” He climbed the stairs.
Sometime that night, in the quiet of the old house
on Milledge Road where there had been such peace
and fulfillment, death came to Dooly County's young
warden and Augusta's devoted doctor. His women folks
found him sleeping when they came up with his morn-
ing cup of coffee.
Beside his bed there was a little packet of bills for
small gifts and remembrances to needy people whom
he had befriended anonymously. They had all been
paid in full.
RECOMMENDS EARLY TREATMENT
FOR CHILDREN WHO STUTTER
Every preschool child who show's early signs
of stuttering should receive immediate treat-
ment, points out Dr. Isaac W. Karlin of the
Speech Clinic of the Jewish Hospital of Brook-
lyn.
Stuttering occurs in about 1 to 2 per cent
of the population, Dr. Karlin says in an article
in the June 24 Journal of the American Medical
Association.
The condition always begins in early child-
hood and is approximately four times as com-
mon among boys as among girls, he adds.
“A child of about three or four may begin
to repeat words or sounds,” Dr. Karlin says.
“He may show7 only an occasional slight hesita-
tion in his speech and while speaking may stop
suddenly as if groping for a word.
“There are no drugs today for the treat-
ment of stuttering. The treatment is through
the parents. The child’s attention should not
be drawn to his speech difficulty. In his pres-
ence the parents should talk in a simple, easy
manner. They should not try to increase or
improve his vocabulary. They should notice the
situations or circumstances during which he talks
best, and these conditions should be encour-
aged. Conditions under which he stutters more
should be discouraged.
“Self-reliance should be encouraged, especial-
ly in eating and playing. A period of relaxation
should be provided every day during which
the mother reads to the child in a calm and
easy manner.
“A question frequently is posed about the
relationship between handedness and stuttering.
There would appear to be no reason to believe
that there is any. However, every child with
a speech disorder should be encouraged to
develop his dominant hand, be it left or right.”
FINDS PERSONS WITH BLUE EYES SUSCEPTIBLE
TO CANCER CAUSED BY SUNLIGHT
Blue-eyed persons are more susceptible to cancer
caused by exposure to the sun’s rays than are brown-
eyed persons, a study made by a Santa Monica (Calif.)
doctor shows.
Racial stock apparently is an important factor in
determining the amount of sunlight to which a person
can be exposed safely, Dr. A. Fletcher Hall of the
Graduate School of Medicine, University of Southern
California, says in Archives of Dermatology and
Syphilology. published by the American Medical
Association.
Dr. Hall bases his conclusion on study of 100
persons with skin cancer.
"There are certain racial stocks and hereditary
complexion patterns in which sunlight is not an im-
portant, if any, factor in skin carcinogenesis,” Dr.
Hall says. "These include certainly the Negro and
Oriental races, probably the Mexican and Mediterranean
and possibly all homozygous brown-eyed persons (those
who inherited brown eyes front both parents).
“There are certain racial stocks and hereditary com-
plexion patterns in which sunlight is by far the most
important carcinogenic factor when repeatedly en-
countered in erythema-producing quantities. These in-
clude certainly those of Irish-Scotch-English ancestry,
probably the blue-eyed North Europeans and possibly
all homozygous blue-eyed persons.
“Observations suggest that the more brown-eyed
inheritance a person possesses, the better protected he
is from the carcinogenic rays of the sun. Blue-eyed
children of blue-eyed parents are, in general, the most
susceptible, but many of these are capable of tanning
without repeated burning and thus acquire a fair
degree of immunity.”
(Continued from page 301)
Dr. E. C. Davis received many deserved honors.
He was President of the Fulton County Medical
Society and the Medical Association of Georgia.
He was early made a Fellow of the American
College of Surgeons. His L niversity of Georgia
called upon him for a Commencement Oration.
Emory University conferred upon him an LL.D.
Base Hospital 43 gave his portrait in uniform
to the Emory Hall of Fame.
Dr. E. C. Davis retired from the active prac-
tice of medicine in 1929 due to his failing
health. He finally lost his eyesight but in the
home he loved so well he could move about at
ease with Mrs. Davis seeing to it that every-
thing was left just as he remembered it.
In his last illness Dr. Davis was a patient at
Davis-Fischer with Mrs. Davis constantly at his
side. Despite his illness. Dr. Davis, always the
acute diagnostician, heard of the severe sick-
ness of one of his nurses. Her case had re-
mained undiagnosed. On hearing of her symp-
toms he recognized them as those of diphtheria
and saw7 to it that she had immediate attention.
Dr. E. C. Davis died at Davis-Fischer Sana-
torium, Atlanta, on March 11, 1931.
He left many legacies: to his country, eight
children and twenty-four grandchildren; to his
profession, his devoted disciples and two sons,
Dr. Shelley C. Davis, surgeon, and Dr. Robert
Carter Davis, internist, both practicing in At-
lanta; to his children, intelligence, individuality
and integrity, and to his wife, the sweetest mem-
ory ever treasured.
To Dr. E. C. Davis, a monument to his profes-
sion and a dutiful son to his country, there can
be no better tribute paid than this quotation
from the Star-Spangled Banner:
“ 'Tis the star-spangled banner, Oh long may it wave.
O'er the land of the free and the home of the brave.”
308
The Journal of the Medical Association of Georgia
GEORGIA DEPARTMENT OF PUBLIC HEALTH
BIOLOGIC ACTI\ ITIES OF THE GEORGIA
TYPHUS CONTROL PROGRAM
Rodent investigations performed in the bio-
logic section of the Typhus Control Service,
together with the investigation of reported
human typhus fever cases are the principal
means of pre-determining the needs for and
ascertaining the effectiveness of typhus fever
control measures. The typhus fever case in-
vestigational phase of the Typhus Control Pro-
gram has been previously reported.1 Rodent
investigations include rat ectoparasite and rat
blood serologic studies.
Field activities include trapping, combing,
and bleeding of an adequate sample of the rat
population in order to determine the rat ecto-
parasite infestation, the prevalence of murine
typhus fever in rats, and the geographic dis-
tribution of rats.
Laboratory activities include identification of
rat ectoparasite specimens, examination of rat
blood specimens and the completion of biologic
reports. The examination of rat blood speci-
mens consists of the complement-fixation test
for murine typhus fever. This test is made by
F . S. Public Health Service Serology Laboratory
at Chamblee, Ga. Results of these tests are con-
solidated with rat ectoparasite data in order to
determine the type and extent of control meas-
ures to be applied.
File rodent investigative phase of the Typhus
Control Program was organized in January,
1946. During the first year rodent surveys were
made at intervals of about one week out of
every six in counties participating in the Typhus
Control Program. This method of making rodent
surveys resulted in only a very small percentage
of the rat population being sampled.
1 he second year, larger areas were covered
by the biologic personnel, and in 1948 trapping
stations were more numerous. The present
rodent survey program was inaugurated in
1949. I he biologic teams operate through the
heavier reported typhus areas of the State. For
trapping purposes, county maps are arranged
to show the militia districts which are divided
by grid lines into smaller areas and with all
premises indicated on the maps. This planning
makes it possible to obtain adequate samples
of the rat population from each militia district
within the county.
Traps are placed on at least 10 per cent of
the premises as determined by the formula for
sampling a “finite universe”. This formula for
determining the size of sample is as follows:
n = N (Pq)
S- (N-l ) + Pq
n = Size of sample = number of rats to be
trapped in each militia district sampled.
N = Estimated number of rats in sample
area.
P — Expected per cent of rats infected with
typhus fever in sample area.
q= (1-P) or per cent of rats not infected.
S = Proposed standard deviation.
From the value of //, the number or pey cent
of premises on which traps are to be set may
be determined by using the following assump-
tions:
( 1 ) The number of rats in a given area is
estimated to be approximately that of the
number of persons within the given area.
1 2 1 The estimated number of dwellings has
been one ( 1 1 for each five ( 5 1 persons, based
on the average size families in Georgia.
This method of determining the size of sample
provides a uniform system for determining the
number of premises within the county from
which rats are to be trapped.
The location of rats infected with murine
typhus fever and of rats infested with possible
vectors of the disease enables the operation
crews to properly place the DDT dust for the
best results in the control of rat ectoparasites.
Currently posting the biologic data on county
maps, a more complete picture may be had of
the need for control measures in the individual
counties. These maps show the distribution of
the rat population by species, the location of
rats infected with typhus fever, and the loca-
tion of human typhus fever cases. From these
maps, the suspected foci of typhus fever infec-
tion in humans and rodents may be indicated.
Control measures, such as DDT dusting and
rat eradication, when applied at the suspected
foci of infection is more effective and less
expensive than applying control measures on
a county-wide basis.
Rodent investigations are made in areas that
have been dusted previously with DDT and
those that have never been dusted. The inspec-
tions of premises where traps are to be placed,
in the DDT dusted areas, enables the biologic
personnel to determine if the DDT dust has
been properly applied. Any irregularities are
reported to the immediate supervisor in order
that corrections may be made by the operations
crew.
From 1946 to 1949, the biologic work was
performed in each of the following counties:
Bulloch, Burke, Coffee, Colquitt, Crisp, Dough-
erty, Evans, Ware, and Worth. These counties
actively participated in applying control meas-
ures during this period. While there were more
counties participating in the Typhus Control
Program each year, numbering 24 in 1946,
37 in 1947, 46 in 1948, and 46 in 1949, only
these nine counties were included in the rodent
investigations each consecutive year for the
four-year period.
July, 1950
309
Tables 1, 2, and 3 are based on tbe rats
examined from each of the nine counties as
previously listed. In these evaluations the DDT
dusted areas are those areas that were dusted
with DDT from 1-180 days previous to the date
that the rats were trapped. The non-dusted
areas are those areas that have never been
dusted with DDT and those that have not been
dusted for a period of one year or longer.
TABLE 1
Presence of Antibodies in Commensal Rats by Years
Year
No. of
Rats
Examined
No. of Rat
Bloods
Examined
Per Cent of
Rat Bloods
Positive to
Typhus Fever
1946
.... 1477
1172
35.6
1947 —
... 1036
849
26.8
1948
.... 819
566
16.8
1949
1943
1555
7.7
The percentage of typhus infected rats ex-
amined in the biologic work has shown a marked
decrease since 1946, as shown in Table 1. This
decrease from 1946 through 1949 was 78.4
per cent. This percentage decrease in the num-
ber of typhus infected rats compares favorably
with the 70.8 per cent decrease in reported in-
cidence of human typhus for the same nine (9)
counties and for the same period. The reported
incidence of human typhus cases was 103 in
1946 and 30 in 1949, or a decrease of 70.8 per
cent.
TABLE 2
Average Number of Fleas (All Species ) Per Rat
Examined in the DDT Dusted and N on-Dusted Areas
No. Rats
Examined
Total All Rat
Fleas Recov’d
Rat Flea
Index
DDT
Dusted
Year Area
Non-
Dusted
Area
DDT
Dusted
Area
Non-
Dusted
Area
DDT
Dusted
Area
Non-
Dusted
Area
Reductioi
Flea In<
Columns
5 & 6
(i)
(2)
(3)
(4)
(5)
(6)
(7)
1946 ... 702
775
1915
6355
2.73
8.20
67.0%
1947.... 544
492
803
2061
1.49
4.19
65.0%
1948.... 552
267
780
624
1.41
2.34
39.8%
1949— .1390
553
2703
2261
1.94
4.09
52.5%
The effectiveness of DDT dust on the destruc-
tion of rat fleas is shown in Table 2 by com-
paring the rat flea index for the DDT dusted
areas and non-dusted areas. This degree of
effectiveness varies with the species of fleas.'
The effect of DDT dust is greater on the non-
sticktight flea than on the sticktight flea (Echid-
nophaga gallinacea).
In Table 3 it may be noted that the per cent
reduction of the X. cheopis flea index from the
non-dusted to the DDT dusted area is greater
than the reduction shown in Table 2 for all
species of rat fleas. The X. cheopis rat flea is
the principal vector of murine typhus fever and
is a non-sticktight type of flea.
On the basis of the biologic activities, it has
been shown that DDT dusting and rat eradica-
tion when applied as typhus control measures
TABLE 3
Average Number of X. Cheopis Fleas Per Rat Examined
in the DDT Dusted and Non-Dusted Areas
No. Rats No. X Cheopis X. Cheopis
Examined Fleas Recov’d Flea Index
Year
DDT
Dusted
Area
Non- DDT
Dusted Dusted
Area Area
Non-
Dusted
Area
DDT
Dusted
Area
Non-
Dusted
Area
Reductio
Flea Inc
Columns
5 & 6
at
(2)
13)
(4)
(5)
(6)
(7)
1946
... 702
775
471
2373
.67
3.06
78.2%
1947
_. 544
492
96
595
.18
1.21
85.1%
1948
... 552
267
129
134
.23
.50
54.0%
1949
1390
553
653
647
.47
1.17
59.9%
have produced definite results in the lowering
of the human and rodent typhus infection rates.
ROY J. ' BOSTON, Director
Typhus Control Service.
REFERENCE
1. Boston, Roy J.: Case Investigations and Control of
Murine Typhus Fever in Georgia, J. M. A. Georgia 38:308-
309 (July) 1949.
NEWS ITEMS
Dr. Frank K. Boland, Sr., Atlanta, was recently
elected president of the Georgia Hygiene Council.
Dr. C. D. Bowdoin, Atlanta, venereal disease control
director of the Georgia Department of Public Health,
is the new secretary-treasurer. Objectives of the coun-
cil include building of healthy, happy home life;
protection of young people from prostitution and
sexual exploitation; prevention of promiscuous con-
duct which spreads venereal disease; preparation of
young people for marriage and parenthood, and promo-
tion of the highest standards of public and private
morals.
* * *
Dr. James M. Bryant, Newnan, was recently re-
leased from the Medical Corps of the U. S. Army,
after serving two years in service, one of which was
spent in the Philippines. Dr. Bryant will again be
associated with Dr. R. H. McDonald in the practice
of medicine, with whom he was formerly associated
before his Army service.
* * *
Dr. T. Luther Byrd, Atlanta, was elected president
of the American Association of Milk Commissions,
Inc., at the annual meeting held in New York City,
June 18-20.
* * *
Dr. R. Frank Cary, Macon, head of the Macon-Bibb
Health Center, recently declared that the biggest single
problem confronting Macon today is tuberculosis. Dr.
Cary said two steps need to be taken in Bibb County
immediately to arrest the spread of the disease — the
establishment of a mobile x-ray unit and a local sani-
torium. He said there are 68 persons in Bibb County
today with positive cases of tuberculosis — meaning
that they are carriers and spreaders of the disease and
are ‘‘endangering the public.” Most of these persons
have advanced stages of TB and don’t stand a chance
of getting into Battey State Hospital at Rome, Dr.
Cary said. In addition, there are about 180 other
cases in Bibb County that aren't positive yet but
"ought to go” to Battey, Dr. Cary said. "If we had
68 people in Macon apt to spread polio,” Dr. Cary
said, “everybody would be alarmed.” He added quickly:
"TB is a bigger health ’ menace than polio.” Dr.
Cary said lack of funds is holding back the fight
against tuberculosis across the State.
* * *
Dr. C. P. Cobb, Jr., graduate of the University of
Georgia School of Medicine, Augusta, announces the
310
The Journal of the Medical Association of Georgia
opening of hi# office for the practice of medicine in
Douglasville. Dr. Cobb interned at tbe Baptist Hospital,
Memphis, Tenn. and lias just completed his residency
at Lawson \ V Hospital, Chamblee.
* * *
The Crawford Vi. Long Memorial Hospital staff
held its regular monthly dinner meeting at the hospital,
Atlanta. May 9. Program: “Tumors in Children .
Case Presentations and Statistics in Crawford Long
and Jessie Parker Williams hospitals. The pediatric
section met in Clinic Lecture room: Mortality Sta-
tistics”. Dr. Edwin Webb. Medical section in Medical
Library: "Some Clinical Aspects of Rheumatic Heart
Disease". Dr. William Fackler. Surgical section in
Clinic Reception room: “The Neurogenic Bladder ,
Dr. James H. Semans. General practitioners in Nursing
School Auditorium: “General Adaptation Syndrome”,
Dr. F. C. Miles.
* * *
Dr. Raymond L. Crispell. Atlanta, chief of neuro-
psychiatry for the Veterans Administration in seven
Southeastern states, discussed human emotions at a
mental health institute sponsored by the Georgia
League of Nursing Education held recently in Atlanta.
Emotional factors can cause ailments ranging from
high blood pressure to skin rash in “this neurotic
age”. Dr. Crispell said. “We're living in an age of
neurosis,” he asserted. “The pace of life has been
stepped up. We're confronted with all sorts of stresses,
which may cause — or complicate — physical disorders.”
He said a doctor could make countless x-rays and
laboratory tests and not discover the cause of a
patient's illness. He also must consider the patient's
mind, emotions and environment. Dr. Crispell added.
He told the nurses they should be tolerant,
tactful, understanding, confidential, self-assured, loyal
and personal. “What is worse than an impersonal
doctor or nurse?” he asked.
* * *
Dr. Schley Gatewood, Americus, recently attended
the International Congress of Obstetricians and Gyne-
cologists held in New York City.
* * *
The Georgia Baptist Hospital Medical and Surgical
Staff held its regular dinner meeing at the hospital,
Atlanta. June 20. The clinicopathologic program was
very interesting. Dr. J. G. McDaniel, secretary.
* * *
The Georgia Heart Association. Inc., will hold its
second annual meeting in Atlanta, September 15 and
16. Tentative plans call for committee meetings and
a meeting of the Board of Directors on Friday eve-
ning, September 15. The program for Saturday,
September 16, will include an outstanding scientific
session, a panel for laymen, and a business meeting.
A dinner meeting will conclude the program Saturday
evening. A ou w ill be advised w hen the program is
completed. In the meantime, circle the dates on
your calendar and plan to attend. Dr. J. Gordon
Barrow, secretary.
* * *
The Georgia Medical Society held its regular meet-
ing at 612 Drayton Street, Savannah, June 13. Pro-
gram: “Doctors’ Role in the Rehabilitation Program”,
Mr. H. B. Cummings, Atlanta, regional representative,
Federal Security Agency, with movie “Comeback”.
Dr. Sam Youngblood, Jr., secretary.
* * *
The Georgia Orthopedic Society held its annual
meeting at the Cloister Hotel, Sea Island, May 20.
Dr. Peter B. Wright, Augusta, was elected president
to succeed Dr. Thomas P. Goodwyn, Atlanta, and Dr.
J. I. Hall, Macon, was named secretary. The following
physicians read papers dealing with orthopedic prob-
lems at the meeting: Dr. C. E. Irwin, Warm Springs;
Dr. Paul Rieth, Atlanta; Dr. Jack Hughston, Colum-
bus; Dr. Thomas P. Waring, Savannah; Dr. Joseph
H. Boland, Atlanta, and Dr. Peter B. Wright, Augusta.
The meeting adjourned at 12:30 and afterwards the
physicians and their wives gathered for a luncheon
at the hotel. Twenty-five physicians attended the
session and voted to meet again at the Cloister next
year.
* * *
Dr. J. W. Ellis, Kennesaw physician, at 82, will
be the oldest active member of the medical staff when
Kennestone Hospital begins admitting patients on
Campbell Hill near Marietta's northern limits. Dr.
Ellis is Kennesaw’s only full-time physician. He
will open a new chapter in an arduous half-century
career as staff member of Kennestone. He has brought
most of Kennesaw’s 600-odd souls into the world and
intends to avail himself of the new plant's full re-
sources. He is one old timer who lets go of the past
without crying about it. Dr. Ellis graduated from the
Georgia College of Eclectic Medicine and Surgery,
Atlanta, in 1900, and became a practicing Georgia
physician April 4, 1900. He is also a farmer. He
owns three farms in the immediate Kennesaw area
and confided. "I also keep tab on five tractors and nine
mules.”
* * *
Dr. Murdock Equen, Atlanta, was elected vice-
president of The American Broncho-Esophagological
Association at the recent annual meeting held in San
Francisco, Cal., which he attended.
* * *
The Georgia Tuberculosis Association recently held
its annual meeting in Macon. Dr. H. C. Schenck.
Atlanta, director of the division of tuberculosis con-
trol of the Georgia Department of Public Health, was
re-elected president. I nder the group’s newly-adopted
constitution, the office of vice president was tossed
out and Julian C. Sipple, Savannah, who had been
serving as vice president, was chosen president-elect.
The board of directors is composed of one member
from each of Georgia’s ten congressional districts.
Dr. Schenck was one of the principal speakers at the
convention which attracted about 125 representatives
of 50 Georgia counties. Other speakers included Edward
Sierks, the health education consultant for the National
Tuberculosis Association and William A. King of
the Llniversity of Georgia.
* * *
Dr. Thomas M. Hall, Milledgeville, and Dr. Charles
E. Sax. Savannah, both officers in the Air Force Medical
Reserve, recently completed a 15-day tour of active
duty at Chatham Air Force Base. Savannah. They
took advantage of the current Air Force reserve train-
ing program which entitles them to take short active
tours of duty in either the Llnited States or abroad.
* * *
Dr. Seale Harris. Birmingham physician, was hon-
ored with a tea at Rich's Department Store in Atlanta
on June 2, at which time he gave a review of his
new book, “Woman’s Surgeon”, the life story of Dr.
Marion Sims.
* * *
Dr. Willis M. Hendricks, LaGrange. recently attended
the International Congress of Gynecologists and Obste-
tricians held in New York City.
* * *
Dr. Shannon Mays, Macon, was the guest speaker
at a joint meeting of the Chatham-Savannah Health
Council and the Savannah Mental Hygiene Society
held at the DeSoto Hotel, Savananh, May 16. His
subject was "Howr Grown Up Are You, Anyway?”
Following the address the Mental Hygiene Society
elected its officers for the coming year.
* * *
At a recent meeting of the Florida Second District
Medical Association held at Quincy, Fla., Dr. J. C.
Patterson, Cuthbert. spoke on the subject “Gastrojejuno-
July, 1950
311
colic Fistula.” He also displayed and described the
much discussed Rush pin used for holding bone frac-
tures in place.
* * *
Dr. James E. Paullin, Atlanta, was honored at a
dinner of Emory University medical alumni held on
June 2. In tribute to him two projects were adopted
by the alumni: a James E. Paullin scholarship fund
was established to help needy and worthy medical
students finish their education, and a portrait of Dr.
Paullin will be placed in an appropriate place in the
university.
* * *
Valdosta State College announced the appointment
of Dr. R. E. Perry, Valdosta, as college physician
for next year. Currently Dr. Perry is filling out the
unexpired term of the late Dr. Marian E. Farbar.
* * *
The Ponce de Leon Infirmary, Eye, Ear, Nose and
Throat, announces the association of Dr. Morgan
Raiford as director of the eye department, 144 Ponce
de Leon Avenue, N. E., Atlanta.
* * *
Dr. Louis C. Rouglin, Atlanta, was recently honored
for a half century of medical practice at a testimonial
given by close friends and members of the medical
profession. The occasion included a cocktail party
and later a dance at the Mayfair Club in Atlanta. Dr.
Irving Greenberg was the toastmaster.
* * *
Dr. Albert F. Saunders, Valdosta, announced recently
that he would practice medicine in Lakeland at the
Louis Smith Memorial Hospital which he leased a
short time ago. He stated that as his practice in
Lakeland demanded it he would devote more of his
time to the community and the hospital.
* * *
At an all-day conference of the Savannah Tubercu-
losis Association held on May 15 at the DeSoto Hotel
a goal of 60,000 x-ray pictures during 1950 was set.
This would be the biggest detection program ever
conducted in Savannah, except in 1945 when the
federal government cooperated with the state and
local governments and 71,000 pictures were taken.
Delivery on the association’s new mobile x-ray unit
is expected within a short time.
* * *
The Sixth District Medical Society held its summer
meeting at the high school auditorium, Sandersville,
on June 28.' Program: Address of Welcome by Dr. F.
T. McElreath, Jr., Tennille; “Erythema Multiforme
Following Herpes Simplex,” Dr. R. M. Reifler,
Macon; “Disease of the Biliary Tract,” Dr. J. Benham
Stewart, Macon; “Chronic Stenosis of the Larynx — ■
Case Report,” Dr. W. L. Barton, Macon; “The Com-
plications of Myocardial Infarction,” Dr. Tom Ross,
Macon; Official Remarks by Dr. L. D. Porch, Macon,
first vice-president of the Medical Association of Geor-
gia. Officers are Dr. J. I. Hall, Macon, president;
Dr. George Alexander, Forsyth, vice-president; Dr.
A. M. Phillips, Macon, secretary-treasurer.
* * *
Dr. Clifton H. Smith, manager of the Peachtree
Road VA Hospital in Atlanta, has been appointed
manager of the new VA hospital in Augusta, which
the Veterans Administration took over from the Army
June 30. Accompanying his move were 225 patients
who were transferred from Atlanta to the new VA
hospital in Augusta. The new hospital is connected
with Oliver General Hospital.
* * *
Dr. R. A. Vonderlehr, Atlanta, medical director
of the Communicable Disease Center, U. S. Public
Health Service, announced that studies on the com-
mon eye gnat of the southern United States were re-
cently undertaken at a field station at Thomasville.
Intensive field work will be carried on during the
summer months, when the eye gnats are most prevalent.
The Public Health Service is trying to discover if
the abundance of these insects has any relation to the
prevalence of a conjunctivitis, commonly called “gnat
sore eye,” or “pink-eye,” which occurs in the same
areas.
* * *
Dr. W. L. Pomeroy, Waycross, was the principal
speaker at the monthly meeting of the Ware County
Medical Society held May 4 in Blackshear with Pierce
County doctors as hosts. Dr. Pomeroy told the doctors
that the prepayment medical and hospital program
effectively administered would eliminate all talk of
need for socialized medicine. Dr. W. F. Reavis, Way-
cross, president-elect of the Medical Association of
Georgia, was congratulated on his recent election and
spoke briefly.
* * *
Dr. Alexander T. Murphey, Augusta, recently wa9
awarded a Damon Runyon cancer research fellowship.
The grant, which amounts to $4,200, was given in recog-
nition of the work now in progress in the Department
of Oncology of the Medical College of Georgia, which
is headed by Dr. Hoke Wammock. Dr. Murphey will
assist Dr. Wammock in research connected with
metabolic disturbances in cancer and the behavior of
cancer. The fellowship award was made through the
medical and scientific committee of the American
Cancer Society.
* * *
Dr. M. E. Winchester, Brunswick, administrator of
the Brunswick City Hospital, was elected chairman
of a Southeastern Council of the Georgia Hospital
Association organized May 19 at a meeting at the
Oglethorpe Hotel, Savannah. Managers of institutions
in Brunswick, Savannah, Folkston, Waycross, Jesup,
Valdosta, Alma, and Douglas will serve as members
of the council. The general aims of the organization,
said Dr. Winchester, are to increase cooperation among
the member hospitals, to raise the level of efficiency,
and to seek a general expansion of hospital services
in South Georgia.
* * *
Dr. Tom D. Spies, Dr. Robert E. Stone, Dr. Samuel
Dreizen, and other members of the staff of the Nutri-
tion Clinic, Hillman Hospital, Birmjn.gham, conv
ducted on June 13, an all-day conference on cortisone,
the first of its kind ever to be held. Some four
hundred physicians attended the conference from Ala-
bama, Arkansas, Florida, Georgia, Kentucky. Louisiana,
Mississippi, North Carolina, South Carolina and Ten-
nessee.
* * *
The Crawford W. Long Memorial Hospital Staff
held its regular monthly departmental meetings at
the hospital, Atlanta, June 13. Medical section: “The
Pulmonary Symptoms of Cardiac Decompensation,” Dr.
James V. Warren. Pediatric section: “Mortality Sta-
tistics,” Dr. J. C. Flanagan. Surgical section: “Inguinal
Hernias,” Dr. William Whitaker. General practitioners:
“My Experience in Treating Alcoholics With Antibus,”
Dr. Luther M. Vinton.
* * *
Dr. Wm. Pruitt Woodall, Thomaston, recently spent
several weeks at Mayo Clinic, Rochester, Minn., where
he observed surgery and attended lectures on surgery
and gynecology. He also spent some time at Lahey
Clinic, Boston, Mass., where he studied gynecology
and again observed surgery.
* * *
Dr. Joseph Yampolsky, Atlanta pediatrician, who
laughingly insists babies make the best patients “be-
cause they never lie” recently left to attend the Inter-
national Pediatric Congress in Zurich, Switzerland.
Dr. Yampolsky, member of the staff of the Baby Clinic
312
The Journal of the Medical Association of Georgia
at Central Presbyterian Church, Atlanta, for 28 years,
also will inspect baby clinics and hospitals throughout
France. He will visit Norway, Sweden. Denmark,
France and England as well as Switzerland, and will
take part in a panel on congenital syphilis in Zurich.
"And 1 plan to observe first-hand, be said, the widely
discussed system of medicine in Britain. Dr. T. F.
Davenport, Atlanta, medical director of the Baby
Clinic at Central Presbyterian Church, lauded the long
service of “our universally beloved Dr. Yam.” A native
of Russia. Dr. Yampolsky came to Georgia when he
was 14 years old. He studied at Boys’ High School
and the University of Georgia and was graduated from
Columbia University College of Physicians and Sur-
geons, New York City, in 1917. He long has served
as associate professor of pediatrics at Emory University
School of Medicine.
OBITUARY
Dr. Benjamin Bashinski, aged 64. prominent Macon
pediatrician, died unexpectedly while on a fishing trip
at Atkinson, May 20, 1950. He was a native of Ten-
nille and graduated at Tulane University of Louisiana
School of Medicine, New Orleans, La., in 1916. He
interned at Touro Infirmary in Newr Orleans and
taught at Tulane. He practiced in New Orleans for
a time and served as assistant to the chief of pediatrics
at Tulane. He was later appointed resident physician
at the Boston Floating Hospital. Boston, Mass. He
served in World War I, and following his discharge
returned to Macon. Dr. Bashinski was a member of
the Bibb County Medical Society, the Medical Associa-
tion of Georgia and a fellow of the American Medical
Association. He was a past president of the Georgia
Pediatric Society, and was a charter member of the
American Academy of Pediatrics. He served for a
number of years on the staff of Macon Hospital. Dr.
Bashinski was one of eight Macon physicians who
purchased the old Williams Sanitarium and changed
the name to Middle Georgia Sanitarium. This later
became the Middle Georgia Hospital, Macon. He
was also a member of the Congregation Beth Israel,
was a charter member of the Macon Kiwanis Club
and the Idle Hour Country Club, was a member of
the Elks Club and the Satilla R iver Club. He is
survived by his wife, the former Miss Bernice Rosen-
berg, Macon; a daughter, Mrs. Edwin Odom, and a
son Benjamin Bashinski, Jr.; two grandchildren, Linda
Odom and Edwin Odom, Jr.; one sister, Mrs. J. M.
Witman, Macon. Funeral services were held at Hart's
Mortuary with Dr. I. E. Marcuson officiating. Burial
was in William Wolff Cemetery, Macon.
* * *
Dr. If ave If ilbur Blackman, aged 69, Atlanta physi-
cian. died in a private hospital, June 16, 1950. Dr.
Blackman was born in Wauseon, Ohio, and graduated
from Georgia College of Eclectic Medicine and Surgery,
Atlanta, in 1913. When he first moved to Atlanta, Dr.
Blackman purchased Robertson Sanitarium, which was
renamed Blackman Sanitarium. He had practiced medi-
cine in Atlanta for more than 44 years. He was a
member of the Fulton County Medical Society, the
Medical Association of Georgia, and a fellow of the
American Medical Association. He was also a member
of the Phi Delta Theta fraternity. Dr. Blackman was
a Mason and a Shriner. Surviving are bis wife. Mrs.
Wave W ilbur Blackman; a son, Edwin T. Blackman,
Carrollton; a daughter-in-law, Mrs. Wilbur L. Black-
man; two sisters, and five grandchildren. Funeral ser-
vices were held at Spring Hill with Dean John B.
W althour and Mr. D. W. Durden, Jr., officiating.
* s k *
Dr. George Hess, aged 49, Chief Medical Officer of
the U. S. Penitentiary Hospital. Atlanta, died May
12, 1950. The cause of death was coronary thrombosis.
Dr. Hess was born in Beaufort. S. C„ July 16, 1900.
and spent his childhood in Hampton, \ a. He gradu-
ated from the Medical College of \ irginia, Richmond,
in 1928. Internship was in the U. S. Marine Hospital.
U. S. Public Health Service, Norfolk, Va. He remained
in the U. S. Public Health Service his entire career,
and was assigned to the Department of Justice, Bureau
of Prisons, after his internship. His first assignment
was at the Federal Reformatory, Chillicothe, O., where
he specialized in mental hygiene.
In 1933. Dr. Hess was assigned to the U. S.
Penitentiary, Atlanta. He was transferred to the Fed-
eral Prison at Alcatraz Island, Calif, in 1934. when lie
was transferred to Terminal Island. Calif., and since
1941 he has been the Chief Medical Officer of the
U. S. Penitentiary. Atlanta. His rank at the time of
his death was Medical Director (R).
Dr. Hess was a member of the Fulton County Medical
Society, the Medical Association of Georgia, a fellow
of the American Medical Association, a fellow of the
American College of Surgeons, a member of Military
Surgeons and of the Southern Medical Association. He
is survived by his wife, the former Miss Phyllis
Park. Richmond, Va.; a daughter, Miss Phyllis Hess;
and a sister, Mrs. Joseph Rowe, Hampton, Va. Funeral
services were held at Spring Hill. Atlanta, with the
Rev. J. Milton Richardson of St. Luke Episcopal Church,
and Father Henry Phillips, U. S. Penitentiary Chaplain,
officiating. Burial was in Arlington National Cemetery'.
Washington, D. C., with full military honors.
* * *
Dr. Edward Bailey Hutcheson, aged 93, widely known
Buchanan and Haralson County physician and surgeon,
died at the home of his daughter, Mrs. Josh Cody, at
Moorestown, N. J„ May 12, 1950. Dr. Hutcheson was
born in Haralson County, the son of the late Robert B.
and Ellen Hogue Hutcheson. He graduated from Emory
University School of Medicine, Atlanta, in 1891. Dr.
Hutcheson served the people of Haralson County for
over half a century, never turning down a call, no
matter how bitter the night or what the distance. In
the course of his career. Dr. Hutcheson used several
modes of transportation, starting out by riding a
horse, later using a horse and buggy, and when the
automobile industry was in its infancy, driving a one-
cylinder Brush automobile. He was an honorary mem-
ber of the Carroll-Douglas-Haralson Medical Society,
the Medical Association of Georgia; and the American
Medical Association. He was a member of. the Buchan-
an Baptist Church. He was a power in Haralson County
politics for many years, and had served his constituents
in the House of Representatives. He is survived by a
daughter, Mrs. Josh Cody, Moorestown, N. J.; two sons.
A. V. Hutcheson and A. D. Hutcheson, both of Buchan-
an; one brother; one sister; 21 grandchildren and 27
great-grandchildren. Funeral services were held at
Buchanan Baptist Church with the Rev. M. F. Roberts.
Decatur, officiating. Burial was in Buchanan Cemetery,
Buchanan.
* * *
Dr. James Harvey Butler, aged 56, well known
Augusta physician, died at his residence June 8. 1950.
A native of Dooly County, Dr. Butler graduated from
the University of Georgia School of Medicine, now the
Georgia Medical College, Augusta, in 1914. Dr. Butler
was associate professor of clinical medicine at the
Medical College of Georgia. He was a member of
the Richmond County Medical Society, the Medical
Association of Georgia, and a fellow of the American
Medical Association. He is survived by his wife. Mrs.
Eleanor Keith Butler; a daughter. Miss Eleanor Butler;
three sisters, a brother, and several nieces and nephews.
Funeral services were held at Platt’s Chapel with the
Rev. Allen B. Clarkston officiating. Burial was in
Westover Memorial Park Cemetery. Augusta.
The Journal of the Medical Association of Georgia
“ Dramamine . . . has been found
to exert a temporary
therapeutic and prophylactic
action in motion sickness.”1
Dramamine
for the Prevention
or Treatment of
Motion Sickness
Unusually satisfactory results
have been obtained with Dramamine*
(brand of dimenhydrinate) as a pro-
phylactic or active therapeutic agent
for the relief of nausea, vomiting or
dizziness, which many individuals
experience in travelling by ship, air-
plane, train and other vehicles.
1. Council on Pharmacy & Chemistry: New and Non-
official Remedies, 1950, Philadelphia, J. B. Lippincott
Co., 1950, p. 460.
*Trademark of G. D. Searle & Co., Chicago 80, 111.
IN THE SERVICE OF MEDICINE
Please mention this Journal when writing advertisers.
XVI
The Journal of the Medical Association of Georgia
THE WIERICAN CONGRESS OF
PHYSICAL MEDICINE
W ill hold its twenty-eighth annual scientific and
clinical session August 28, 29. 30, 31 and September 1,
1950 inclusive, at the Hotel Staller. Boston. Scientific
and clinical sessions will be given on the days of
August 28, 29. 30, 31 and September 1. 1950. All
sessions will he open to members of the medical pro-
fession in good standing with the American Medical
Association. In addition to the scientific sessions, the
annual instruction seminars will be held August 28,
29, 30 and 31. These seminars will be offered in two
groups. One set of ten lectures will consist of basic
subjects and attendance will be limited to physicians.
One set of ten lectures will be more general in char-
acter and will be open to physicians as well as to
therapists, who are registered with the American Reg-
istry of Physical Therapy Technicians or the American
Occupational Therapy Association. Full information
may be obtained by writing to the American Congress
of Physical Medicine, 30 North Michigan Avenue,
Chicago 2. Illinois.
The Journal would like to record the scientific
work of Georgia physicians. It earnestly requests,
therefore, that each physician in the State who
publishes a contribution in some other medical
periodical submit an abstract of the article jor
these columns.
WANTED — Roentgenologist for mental
hospital. Attraetive salary and partial
maintenance. Two excellent colleges in
immediate vicinity. Submit full informa-
tion, three references and small photo-
graph in first letter. Address Superintend-
ent, Box 325, Milledgeville. Ga.
LONG established hospital for immediate
sale in South Georgia — Surgeon in
charge retiring. Well equipped and fully
accredited by College of Surgeons. Nurses
home and doctors’ apartments joining hos-
pital. Contact Journal Medical Association
of Georgia, 478 Peachtree St., N. E., At-
lanta, Ga.
WANTED — County Health Officer for
Lowndes County. A oung man with public
health experience preferred. For details
write Dr. J. L. Campbell, Jr., Valdosta, Ga.
WANTED — Young man, general practi-
tioner, in West Middle Georgia, Georgia
License required. Will guarantee $6500.00
first year, possible to make $10,000 to
$12,000. Write or contact MAG, 478
Peachtree St., N. E., Atlanta, Ga.
BALLARD'S
CDispensinq Opticians
WALTER BALLARD OPTICAL CO.
THREE STORES
105 PEACHTREE STREET, N. E.
MEDICAL ARTS BUILDING
W. W. □ R R DOCTORS BUILDING
Please mention this Journal when writing advertisers.
THE JOURNAL
OF THE
Medical Associa tionof Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia, August, 1950 No. 8
TODAY’S INDICATIONS FOR
CESAREAN SECTION
M. M. Schneider, M.D.
Savannah
The controversy as to the proper indica-
tions and contraindications relative to the
performing of cesarean section rages una-
bated from one end of our country to the
other. It would seem that the heads of cer-
tain clinics are able to find more indications
than others. Although the results seem to
justify their actions, it is my belief that a
review of the subject is in order.
Because there are certain variations in
human beings, it is impossible to treat pa-
tients along the line of set mathematical
principles. It is the ability to judge and
measure the various disease factors by new
methods that gives us today’s indications for
cesarean section.
For centuries cesarean section on the
dead has been performed and this operation
has been referred to in the myths and folk-
lore of European races. The Lex Regia of
Numa Pompilius, 715 B.C., Buddha, and
the ancient Jews expressly commanded the
removal of the child before the burial of the
mother.
Cesarean section on the living is of more
recent date. That the Jews did the operation
successfully is shown by their laws. In the
Mischnejath (before 140 B.C.,), the rights
of twins delivered by section are gravely
considered and in the Talmud (400 A.D.)
From the Department of Obstetrics and Gynecology, St.
Joseph’s Hospital, Savannah, Ga.
Presented before the First District Medical Society, States-
boro. Dec. 1, 1949.
the law reads: “A woman need not observe
the usual days of purification after abdom-
inal delivery.” In the heart of Uganda in
1879, Felkin witnessed cesarean section per-
formed by a native. The operator washed
his hands and the operative field with ba-
nana wine, part of which had been given
to the patient to drink. A quick incision
opened the uterus. After cutting the cord
and removing the placenta, the cervix was
dilated from above, the uterus massaged and
compressed; the peritoneal cavity cleansed
by raising the woman up, then the abdomen
was closed by pin and figure eight sutures,
and the wound was dressed with a paste of
crushed herbs. These savages must have
been performing this type of operation for
hundreds of years to have developed such
good technic. The cesarean operation be-
came definitely established in the sixteenth
and seventeenth centuries in spite of the
high mortality and the resulting opposition;
the operation was performed only in those
cases where to leave the parturient alone
would certainly have resulted in her death.
There is hardly an obstetric complication
that has not been treated by cesarean sec-
tion. Indeed, many surgeons know of but
one way out of a difficult obstetric situation;
namely, suprapubic delivery. However, with
the increased knowledge of surgical technic
and care, both pre- and postoperative, we are
able to spread the indications for abdominal
delivery over a wider field, and at the same
time give the baby a better chance for sur-
vival.
With the so-called modern era in surgery,
we are now able to take advantage of ad-
314
The Journal of the Medical Association of Georgia
vances in anesthesiology, blood transfusions,
newer oxytocics and antibiotics and thus
reduce the chief dangers of cesarean sec-
tion; namely, infection and hemorrhage.
Due to the false sense of security, we must
he careful not to lean too heavily on this op-
erative procedure and thus become a “one
operation” obstetrician. On the other hand,
we should be able to evaluate closely enough
so that we do not cause the mother to become
an “obstetrical cripple” because of a maim-
ing delivery through the vagina. With this
in mind, we must not forget that there is the
“cesarean cripple” due to a mismanaged
case. In addition to all this, the breakdown
of safety factors in the operating room may
lead to the death of either the mother or the
infant. The risk in a cesarean operation,
we must remember, is still five to ten times
greater than with the vaginal delivery.
Consideration of Indications
Inlet contractions : Contractions of the
pelvic inlet, in many instances, may be rec-
ognized before the onset of labor by a high
presenting part, premature rupture of
membranes, overriding of the presenting
part and pelvic mensuration. In diagnosing
this, the work of Caldwell, Moloy, Thoms
and Torpin in roentgen pelvimetry and
cephalometry has come to the aid of the
obstetrician. However, in no instance should
the burden of the decision be placed upon
the roentgenologist. The clinical picture
must be evaluated along with the measure-
ments.
The following criteria should be evalu-
ated with a contraction of the pelvic inlet:
1. Shape of the inlet.
2. Anteroposterior diameter ( true conjugate) .
3. Transverse diameter.
4. Size of the head.
The shape of the inlet is of great impor-
tance. The android and anthropoid pelves
offer greater resistance to the passage of
the fetus than a similar contracture of a
gynecoid pelvis.
T he anteroposterior diameter or true con-
jugate is still the greatest determining factor
to be considered. The usual standards for
determining management are: True conju-
gate above 9.5 cm. will probably deliver
through normal channels; true conjugate 7
to 9.5 cm. should have a test of labor; true
conjugate 7 cm. or less should have a ce-
sarean section.
However, the above measurements are
not the only ones to he considered. Another
measurement of equal importance is the
transverse diameter of the inlet. If this
diameter is shorter than 12 cm. it is defi-
nitely contracted. When a shortened true
diameter is present with a transverse diam-
eter of 11.5 cm. or less, a cesarean operation
is usually indicated.
The size of the fetus is always a factor to
be considered. One must remember that the
premature fetal skull will mold more readi-
ly than the fetus at term, but just how much
molding the head will tolerate must be taken
into consideration.
Th us it will be seen that in any given case,
a particular fetus must be projected against
a particular pelvis, and while general con-
siderations apply, individual study and phy-
sical examination of each patient must be
the rule.
The Miil ler-Hi 1 lis maneuver is probably
the best method of studying the individual
fetus and pelvis. This is done by placing
the finger in the rectum or vagina, while
the other hand presses on the fundus. In
this way the head is brought down to engage-
ment, or below, if there is no disproportion.
The most dependent portion of the skull
should reach an imaginary line drawn be-
tween the ischial spines. The chief sources
of error in this maneuver are: the presence
of a thick lower uterine segment and unef-
faced cervix, estimating the descent of the
head lower that it actually comes, and the
presence of a breech presentation; never-
August, 1950
315
theless, it is a useful test and should he
applied to every pregnant woman.
Midpelvic Contraction
Midpelvic contractions are not infre-
quently seen in the android and anthropoid
type pelves. This is usually demonstrated
during physical examination when the ex-
aminer finds unusually prominent ischial
spines. The width of the sacrosciatic notch
should then he palpated and, if normal,
should be at least two to two and one half
finger breadths. Roentgen pelvimetry should
be done on these patients, and if the inter-
ischial diameter is less than 9 cm. and this
is combined with a shallow sacrum, a sec-
tion is usually indicated.
Outlet Contractions
Contractions of the pelvic outlet should
be accurately determined before the onset of
labor. It is rare that a contracted outlet is
severe enough to require a cesarean section;
but if so, and the baby is permitted to de-
scend to the outlet where an arrest takes
place, not infrequently a destructive opera-
tion may have to be performed or some type
of maiming forceps procedure may have to
be used.
In cases with a short intertuberous trans-
verse diameter, and a short posterior sagit-
tal diameter, the rule of 15 may hold true.
That is, if the total of these diameters adds
up to less than 15 cm. a cesarean section is
usually indicated, whereas if the total of
these diameters is 15 cm. or more the infant
can usually be delivered from below.
Soft Tissue Obstruction
Cervical stenosis is most frequently the
main cause of soft tissue obstruction. This
may be due to dense scar tissue forming as
the result of a deep thermocautery or radia-
tion therapy to the cervix. Women who have
had either type of treatment and develop a
rigid cervix should receive an elective
cesarean section. The same type of scar may
develop as the result of an extensive tra-
chelorrhaphy followed by postoperative in-
fection.
As a general rule, light cautery or a short
trachelorrhaphy will not result in a suffi-
ciently dense scar to warrant the considera-
tion of a section.
Patients that have had trachelorrhaphies
and deliver from below will not infrequently
tear the cervix again. This is not a serious
complication because the torn ends may be
approximated immediately following de-
livery with good results.
Conization of the cervix shallow or deep
will, as a rule, not hinder cervical dilatation
and delivery from below. In this respect,
conization is to be preferred to deep thermo-
cautery.
Extensive vaginal plastic repair work
quite frequently leads one to perform an
elective cesarean section. This is particu-
larly true where the repair of a large cysto-
cele has been done. It is relatively impos-
sible to protect the base of the bladder from
injury during delivery, and because of this
a cesarean is usually indicated. In cases
where the vaginal plastic has only been a
perineorrhaphy, usually deep episiotomy
will take care of the perineum. This may
be repaired quite accurately following de-
livery with even better results than during
the interim between babies.
A secondary repair of a complete tear
of the rectal sphincter should, in my mind,
automatically mean an elective section. In
so many instances, secondary repairs of
the rectal sphincter must be done five or six
times before a good repair is achieved, that
the possibility of another breakdown may
be avoided.
The same line of judgment should follow-
extensive pelvic operations for retroflexion
and prolapse of the uterus. If in the judg-
ment of the obstetrician, a vaginal delivery
would mean the undoing of all the work,
then an elective section should be consid-
316
The Journal of the Medical Association of Georgia
ered. Most frequently, however, in these
cases, with good care, the patient may he
delivered quite safely from below. In these
cases, it is always advisable to do a wide
episiotomy, and to inspect and repair the
cervix immediately postpartum.
Tumors
Cystic ovaries and fibroid tumors are
usually the chief offenders in this category.
Some authors recommend removal of uter-
ine myomas at about the fourth month of
pregnancy if they are pedunculated and if
the obstetrician feels that it will interfere
with delivery. However, most cases usually
proceed to term and then if the fibroid or
cystic tumor is obstructing the birth canal, a
cesarean is performed. At this time the
tumor can be removed if the procedure is
not too extensive and time-consuming so
that it will endanger the patient or precipi-
tate the so-called “crush syndrome". It must
he remembered that while fibroids grow with
pregnancy, frequently the involution of the
uterus will proceed so rapidly that the blood
supply of the fibroid may he interfered with
and cause degeneration of the tumor. There-
fore, it is probably wiser to remove the
tumor at the time of section rather than
risk a subsequent laparotomy a few days
later. Here, too, one must be cautioned
about an adequate closure of the defect in
the uterine wall in order to lessen the risk of
rupture of the uterus in subsequent preg-
nancies.
Carcinoma of the cervix should be an in-
dication for cesarean section. The fetus
should not be permitted to pass through and
dilate the cervix. Once the fetus is deliv-
ered, treatment of the carcinoma should take
place as planned.
Congenital Anomalies
Many malformations of the vaginal tract
and uterus require cesarean section for de-
livery wherever they cause obstruction or
stenosis. The double uterus is of particular
trouble and one should be very cautious.
The nonpregnant half of the uterus may fall
in front of the fetus and block the pelvis as
effectively as a tumor.
Hemorrhage
This topic is the subject of many lengthy
discussions, justly so because it is one of
the commonest causes of cesarean section.
Placenta previa and abruptio placenta are
the two chief factors involved. Here the
amount of cervical dilatation and the
amount of hemorrhage must be considered.
In the primapara with the long uneffaced
cervix, one has very little alternative but to
do a cesarean section. In the face of active
bleeding, the most rapid way of stopping
the hemorrhage is to deliver the baby and
placenta. In the marginal placenta previa,
many times simple rupture of the mem-
branes with or without the application of
Willett’s scalp traction may effectively con-
trol the bleeding by having the fetal head act
as a tampon. With the use of scalp traction,
enough pressure is exerted against the cer-
vix to stimulate contractions and labor usu-
ally proceeds rapidly.
In partial a b ratio placenta, the decision
is somewhat more difficult to make. Where
the infant is dead, the use of transfusions
and a Spanish windlass may prevent the
necessity of a section.
In a case where the infant has just reached
the stage of viability and bleeding is not
profuse, it may be wise to assume an atti-
tude of watchful waiting in the hope that
the bleeding area may clot over. The avail-
ability of blood from the regional blood
bank may help the obstetrician lean towards
conservative therapy in this instance.
Toxemia
This condition causes quite a bit of con-
troversy as to therapy. In the case of a con-
tracted birth canal, the matter of decision is
simply to decide which is the propitious
moment for surgery. However, in the case
August, 1950
317
of a patient with a fulminating toxemia or a
rapidly progressing toxemia and an unef-
faced primiparous cervix, the decision is
more difficult. At one time all of these cases
were handled by cesarean. Now, with more
advanced means of treatment at our dis-
posal, we are more inclined to treat the pa-
tient conservatively and induce labor. It is
likely that soon toxemia will cease to be an
indication for cesarean.
Heart Disease
The following criteria as set forth by
Hamilton at the Boston-Lying-In Hospital
may be set up as the proper procedure to
follow in heart disease:
1. Normal labor with the late first stage analgesia
and outlet forceps offers the least amount of heart load.
2. Cesarean section puts a greater strain on the
heart.
3. Dystocia puts the greatest strain on the heart.
Cesarean section would, therefore, only
be indicated when there is some prospect of
obstruction to the normal progress of labor.
In these cases it is possible that caudal or
saddle-block anesthesia may help the car-
diac patient avoid cesarean.
Other Maternal Diseases
As a general rule, whatever the disease,
it should be treated as an entity and the
pregnancy given second consideration. Sec-
tion should be performed only for obstetric
reasons. Pulmonary tuberculosis and thyro-
toxicosis should be treated under the same
general principles as those for heart disease.
Pregnancy and thyrotoxicosis, as a rule, do
not tolerate each other very well, and quite
frequently labor will precipitate a thyroid
crisis. The infant of such a mother should
be watched closely and may need mild
sedation. Rectal stricture due to lympho-
granuloma inguinale may require section.
Newer methods of treating this disease may
soon cause this complication to disappear
almost entirely.
Sterilization per se is not an indication
for cesarean section.
Fetal Indications
Abnormalities of presentation of the fetus
may be reason for cesarean section. A trans-
verse presentation in a primipara with rup-
tured membranes should be sectioned even
if the pelvis is normal, for, as a general
rule, dilatation of the cervix will not proceed
normally, and the fetus can be turned only
with difficulty or not at all. The same con-
dition in a multipara may be treated con-
servatively as long as there is sufficient
water to permit turning the fetus after the
cervix is dilated.
Breech presentations in the primipara, as
a general rule, are no indication for section
unless there is evidence of some contracture
of the pelvis. However, in the elderly primp
gravida with a breech, a section is usually
indicated even with normal pelvic measure-
ments, for here the infant has a high prior-
ity. In this condition there is no way of con-
ducting a test of labor, and a decision must
be reached before the first stage of labor
has been completed.
Monstrosities are not usually indications
for cesarean section. The hydrocephalic
infant presented by the breech can cause
considerable difficulty if not recognized in
time. However, most monstrosities should
he treated by destructive operation after the
cervix is fully dilated. Soft tissue tumors of
the fetus may give rise to difficulty; these
are hard to diagnose because they do not
cast a shadow on roentgen examination.
Irregularities of the fetal heart have re-
cently come to the fore as evidence of fetal
distress and indications for section. Irregu-
larities of the heart usually indicate unusual
moldings of the fetal skull or a short cord.
Many loops of cord may be around the fetal
neck. The fetal heart slows normally dur-
ing a contraction, so this slowing should be
ignored. The primipara with slow dilata-
tion and hard contractions may best demon-
strate this indication. Here the fetus slowly
318
The Journal of the Medical Association of Georgia
gets into distress and demonstrates the dis-
tress by a slowing or irregular heart action.
The primigravida over 40 years of age
should usually be sectioned because of the
high priority of the fetus. It is probably
this mother's only chance for a living infant,
and the conditions present should be
weighed very closely.
The postmortem cesarean should not be
forgotten as a fetal indication. In the mother
that dies rapidly as the result of cerebral
hemorrhage or acute heart failure, it is not
impossible to salvage the fetus if prompt
action is taken.
Repeated Cesarean Section
Many of our country’s leading obstetri-
cians adhere to the dictum: “Once a cesar-
ean, always a cesarean". However, this is
not always true. Each case should be judged
by its own merits. The type of section per-
formed, the indication and the postopera-
tive course should all be considered.
Any case that was sectioned because of a
contracted pelvis will of necessity need an-
other section. However, a case sectioned be-
cause of a toxemia may, with proper care,
be managed conservatively and be delivered
from below. The same may apply to cases
that were sectioned because of hemorrhage.
In cases where an attempt will be made
to permit vaginal delivery following a sec-
tion, the patient should, by all means, be
delivered in a hospital with all the facili-
ties available in case of emergency, and the
obstetrician should be in constant attend-
ance.
Before closing any discussion of this type,
a few words should be said with reference
to “Test of Labor”.
Test of labor is also a problem that differs
in every clinic. One obstetrician states that
an adequate test of labor should run at least
twenty-four hours, while another gives four
to six hours as an adequate time.
Torpin defines test of labor: “Uterine
contractions lasting forty seconds, recur-
ring every two to five minutes over a period
of time of twenty-four hours w ith noticeable
progress, the parturient being supported
meanwhile by administration of water, dex-
trose, vitamins, oxygen and blood transfu-
sions, if necessary, plus sedation and rest”.
By following this rule, Torpin states that
operative delivery can be reduced about
three per cent, forceps delivery approxi-
mately two and one-half per cent, and cesar-
ean section to one in two hundred cases.
Summary
1. Reasons for doing cesarean section
have been presented.
2. There are now fewer indications for
cesarean section, there being fewer indica-
tions for general medical diseases and a
widening indication in local pelvic and
obstetric conditions.
3. There is no substitute for careful
observation of each individual case with
application of all the skill at one’s com-
mand.
REFERENCES
1. Paxson. Newlin F. : Modern Indications for Cesarean
Section, S. Clin. North America 28:1487-1506, (Dec.) 1948,
2. Hamilton, and Thompson: The Heart in Pregnancy and
the Child-bearing Age, Little Brown & Company, 1941.
3. Jondhal. Willis H. ; Banner, Edward A., and Howell,
Llewelyn P. : Management of Pregnancy Complicated by
Toxic Goitre, Proc. Staff Meet., Mayo Clin., 24:358 (June
22) 1949.
4. Hennessy, James P.: Am. J. Obst. & Gynec. 57:1107-
1185 (June) 1949.
5. Quigley, James K. : Am. J. Obst. & Gynec. 58:41-53
(July) 1949.
6. Stevenson, Charles S. : Am. J. Obst. & Gynec. 8:432-
446 (Sept.) 1949.
7. Snow, William: Am. J. Obst. & Gynec. 58:752-757
(Oct.) 1949.
8. Caldwell, W. E. ; Moloy, H. C., and D’Esopo, D. A.:
Am. J. Obst. & Gynec. 28:482-497, 1934.
9. Torpin, R. : A Treatise on Obstetric Labor, Augusta,
Ga., Augusta Obstetric & Gynecology Book Company, Copy-
right, 1948.
10. DeLee, Joseph B. : The Principles and Practice o l
Obstetrics, ed. 7, Philadelphia, W. B. Saunders Company,
1938.
DISCUSSION
DR. DAVID ROBINSON (Savannah) : I had the
pleasure of reading Dr. Schneider’s paper, and I
appreciate this opportunity to discuss it from the view-
point of a roentgenologist. I agree with Dr. Schneider’s
statement that in no instance should the burden of
decision be placed upon the roentgenologist as to
whether cesarean section is indicated or not. How-
ever, this does not excuse the roentgenologist from his
responsibility to the obstetrician and the patient, no
more than the anesthesiologist is relieved of his
responsibility to the surgical patient. The responsibility
of the roentgenologist is to acquaint the obstetric prac-
titioner with those radiographic procedures available
for any particular obstetric complication or problem.
Aucust, 1950
319
As with any other medical or surgical case, there is
variation in obstetric cases. It is here, by direct con-
sultation with the roentgenologist, that such problems
may be solved more easily.
Even prior to conception, the roentgenologist may be
of assistance in determining which cases may be neces-
sarily delivered by cesarean section. This information
can be obtained by ruling out congenital anomalies
of the vaginal tract and uterus by uterosalpingography.
This simple and safe procedure can be used in all
suspicious cases of congenital variations.
The simple flat film of the abdomen yields much
information as to the general shape and size of the
fetus, the presentation, and the presence or absence of
congenital abnormalities which may be present. Dr.
Schneider has mentioned pulmonary tuberculosis and
heart disease as being possible indications for section.
A preliminary flat film of the chest will readily assist
in diagnosing these conditions.
The lateral abdomen film, with good soft-tissue
technic, yields much information, such as placentation
and fetal position and cephalometry. It is especially
useful in these cases of placenta previa where the
technic of Ude cannot be used, such as in breech
presentation.
In those cases of hemorrhage where the diagnosis
is doubtful, the technic of Ude is very helpful in
evaluating a placenta previa. This technic is simple,
and certainly turns a presumptive diagnosis into a
positive diagnosis.
As to roentgen pelvimetry, the method used will
depend upon the experience and training of the roent-
genologist. There are a number of good methods in
vogue. 1 have used the method of Torpin and Thoms
with satisfactory results. It is a method that simplifies
the other technic by giving on a single film the exact
measurements of the superior strait, and the shape of
the pelvic outlet in addition to the relative size of the
presenting fetal head, as well as the interspinous
diameter. The technic of roentgenocephalometry still
presents its problem.
The interspinous measurements can be roughly de-
termined by external mensuration. The roentgenologist,
by experience, is capable of estimating the interspinous
diameters. At present, the information given to the
clinician states whether it is adequate or not. Perhaps
in the near future we will be able to determine this
diameter from a single film. I am interested in Dr.
Torpin’s statement that by using a factor of 0.9 to
the diameters obtained by grid method, the actual
interspinous diameter can be obtained.
From my own experience, I feel that when the
anteroposterior diameter is 9 cm. or less, the obstetri-
cian should be cautioned as to possible disproportion.
I feel, as Dr. Schneider does, that this is the most
important diameter obtained in roentgenpelvimetry. As
to the transverse diameter, I feel that this is of less
importance. The transverse diameter may be less than
II cm., and yet no disproportion is noted. This is
certainly seen in the anthropoid type of pelvis where
the transverse diameter of the superior strait is less
than the A. P. diameter. Some authorities feel that
when the A. P. diameter and the transverse diameter
are less than 23 cm., the possible indications for
cesarean should be considered.
By the Torpin-Thoms technic one can tell by inspec-
tion the presence of deformities of the pelvis and rule
out possible osseous changes as rickets, Paget’s disease,
old osteomyelitis, blood dyscrasias, and residuals of
old tramua. Such information may be taken into con-
sideration as an indication for cesarean.
Finally, 1 should like to discuss the possible dangers
of irradiation to the mother and fetus by using the
above-described technics. As I mentioned in the begin-
ning of this discussion, this is one of the important
phases where the roentgenologist can be of service to
the obstetrician and patient. Careful measurements
of the amount of radiation reaching the vaginal vault
in using these routine exposures. It must be empha-
sized, however, that these exposures were taken from
different positions and only one exposure in the
“sitting" position was made for roentgenpelvimetry. Cer-
tainly this amount of irradiation is not sufficient to
affect the fetus in any manner. However, the danger of
exposure presents itself not to the fetus, hut to the
maternal skin. This is especially seen in the superior-
inferior position where the target skin distance is
relatively short. If one uses the standard technic
adopted for the Torpin-Thoms pelvimetry, the amount
of radiation reaching the maternal skin may approxi-
mate a suberythema dose.
For this reason I would like to emphasize the possible
dangers of a repeated pelvic measurement within a
short time. The technician making this examination
should be trained, and in no case allowed to repeat
the exposure without permission of the roentgenologist.
In order to decrease this possibility, I routinely use an
addition of 1 mm.Al. filter which decreases the inten-
sity of the caustic rays to about one half. Although,
the TFD is recommended at 30 to 32 inches, I use 36
inches, thereby decreasing the intensity of radiation
according to the inverse square law. The latter man-
euver does not affect the measurements obtained ap-
preciably. Recently a high intensity screen has been
developed which decreases the radiation required by
one-half. I have used this screen with success in pelvi-
metry. Therefore, by special attention to these factors
the intensity of irradiation is decreased to less than
one-fourth of the acceptable safety factors, making it
possible to make repeated studies if necessary.
Dr. Torpin has had no case of complication following
irradiation and neither have I seen such case. How-
ever, with such a potent weapon, its indiscriminate use
should be prohibited, its use being limited to the
technician supervised by a physician who is acquainted
with the possible dangers involved.
THE INTERNATIONAL COLLEGE
OF SURGEONS
The International College of Surgeons, United
States Chapter, will hold its fifteenth Annual Assembly
and Convocation in Cleveland, Ohio, October 31,
November 1, 2, 3, 1950 according to George M. Curtis,
M.D., Columbus, Ohio, chairman of the assembly.
The program will included scientific sessions on
subjects in the fields of general surgery; eye, ear,
nose and throat surgery; gynecology and obstetrics;
urology; and orthopedic, thoracic, plastic and neuro-
logic surgery. In addition, an extensive technical
and scientific exhibit will be presented by leading
manufacturers of surgical instruments, x-ray apparatus,
operating room and hospital equipment, pharmaceuti-
cals and others, Dr. Curtis said. Special entertainment
for the doctors’ ladies has been planned.
Arnold S. Jackson, M.D., secretary of the United
States Chapter, has reported from Madison, Wisconsin,
that several hundred surgeons will be received as
Associates and Fellows of the International College
at the Convocation to be held in the Cleveland Public
Auditorium, November 3.
All doctors of medicine interested in surgery and
its advancement are invited to attend, and can obtain
a program upon request to Arnold S. Jackson, M.D.,
Secretary, Jackson Clinic, Madison 4, Wisconsin. For
hotel reservations, contact Committee on Hotels, Inter-
national College of Surgeons, U. S. Chapter, 511
Terminal Bldg., Cleveland 13, Ohio.
320
The Journal of the Medical Association of Georgia
THE DIAGNOSIS OF OBSTRUCTIVE
LESIONS OF THE GASTROINTESTINAL
TRACT OF THE NEWBORN INFANT
M. Hines Roberts, M.D.
Atlanta
Vomiting is the most commonly encoun-
tered symptom in the newborn period. It
may be a warning of grave disease demand-
ing immediate surgery, or may indicate
the presence of some quite insignificant dis-
turbance requiring no therapy. During the
first 24 or 48 hours of life, unless one be
ever alert, it is quite possible that obstructive
lesions of the alimentary tract may be over-
looked. Since the life of such an infant
depends upon an early and accurate diag-
nosis, it seems worthwhile to review the
means at our disposal for making such a
diagnosis.
If vomiting persists for 12 hours after
birth, it is wise to assume that an obstruction
does exist, and to proceed at once with those
studies which will unequivocally establish
the presence or absence of such pathology.
At this age, a careful review of all available
data, including symptomatology, physical
examination and x-ray studies will invari-
ably reveal the presence of complete ob-
struction of the alimentary tract, if such
pathology exists, and almost as certainly
make the diagnosis of partial obstruction
possible.
Chart 1 lists the causes of vomiting in
the newborn period.
Group 1 includes those physiological and
functional disturbances "usually seen during
the first 12 to 24 hours of the baby’s life,
and which may simulate obstructive lesions,
especially in the esophagus or at the pylorus
or duodenum.
In Groups 2 and 3 are enumerated those
From Henrietta Egleston Hospital for Children and the
Pediatric Department of Emory University School of
Medicine, Atlanta.
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
CAUSES OF VOMITING IN THE NEWBORN
I
PHYSIOLOGICAL AND FUNCTIONAL DISTURBANCES
1 ASPIRATION OF AMNIOTIC FLUID AND VAGINAL SECRETIONS
2 GASTRIC DISTENTION- over feeding, saal.'w'NG of Air
3 DIGESTIVE DISORDERS- ALLERGY
I
ORGANIC LESIONS Of ALIMENTARY TRACT
1 SPASM 5 DIVERTICULUM
2 STENOSIS 6 DUPLICATION
3 ATRESIA 7 MALROTATION
4. INTUSSUSCEPTION 8 VOLVULUS
9 CONGENITAL BANDS
10 HERNIATION- DIAPHRAGMATIC. INGUINAL. MESENTERIC, UMBILICAL
II PERITONITIS- PARALYTIC ILEUS. ADHESIONS
12 INSPISSATED MECONIUM- OBSTRUCTION Of PANCREATIC ANC-! =
BILIARY TRACT
IE
LESIONS PRODUCING PRESSURE UPON ALIMENTARY TRACT
1 THYMUS 4 CONGENITAL BANDS
2 LYMPHATIC GLAND 5. ADHESIONS
3 TUMORS
E
LESIONS REMOTE FROM CASTRO-INTESTINAL TRACT
1 CENTRAL NERVOUS SYSTEM-! injury, anomaly.
2 RESPIRATORY TRACT- J INFECTION AND TUMOR
3 CARDIO-VASCUIAR SYSTEM- anomaly, embolism. ThrombCSiS
4 URINARY TRACT- ANOMALY. INFECTION
5 SYSTEMIC INFECTION- SEPSIS. TUBERCULOSIS
6 ENDOCRINE DISORDERS- pancreas, adrenal C0RTEx
organic lesions within or without the ali-
mentary tract which produce complete or
partial obstruction, and about which this
paper is primarily concerned.
Lesions remote from the gastrointestinal
.n °
tract are shown in Group 4. These may
occasionally suggest obstruction and make
differential diagnosis necessary, although
as a rule little difficulty is encountered in
distinguishing the group from mechanically
obstructive lesions.
A careful analysis of symptomatology
may often give sufficient evidence for an
almost certain diagnosis. A study of the gas
pattern usually will confirm or disprove
the presence of the suspected lesion.
Chart 2 indicates the important aspects
of vomiting which must be evaluated. Often
the level of an obstructive lesion may be
accurately placed by the determination of
the muscles of the gastrointestinal tract
which produce the vomiting. For example,
Aucust, 1950
321
DIAGNOSIS OF ATRESIA OF THE CASTRO INTESTINAL TRACT
IN THE NEWBORN.
VOMITINC
THE MECHANICS OF VOMITING
1 Esophageal Immcd.afc overflow type with continuous drooling of saliva, accompanied by
respiratory difficulty
2 Pyloric b Duodenal Explosive type showing action of gastric musculature
3 Small or Large Cut Fecal type, somewhat delayed in onset, and preceded by distention
from point of obstruction
THE CHARACTER OF THE VOMITUS.
1 Esophageal Mucus, sticky detritus b saliva with immediate return of whatever fluid
has been swallowed
2 Pyloric or Duodenal above the Ampulla Gastric contents which arc colorless contair
mucus and occasionally may be blood streaked.
3 Duodenal below Ampulla May be greenish brown or often dark chocolate like in
appearance
4 Small or Large Gut Fecal or Meconium-likc material
the explosive type vomiting of obstruction
at the pylorus or in the duodenum is pro-
duced by the stomach musculature, and is
entirely different in its mechanical aspects
from the vomiting of esophageal obstruc-
tion. It also can usually be distin-
guished from obstructions lower in the small
bowel, although the latter lesions may at
times produce projectile vomiting.
The character of the vomitus is often
very informative. Obstructive lesions above
the ampulla of Vater produce a vomitus de-
void of bile pigment. This vomitus is com-
posed of gastric contents with mucus. It is
usually colorless, although it may occa-
sionally contain bright red blood; rarely
dark blood. Atresia of the duodenum below
the ampulla results in a vomitus which in-
variably contains bile pigments or their end
products. This vomitus varies from a green-
ish-brown to a dark chocolate-like color.
Occasionally there is a foul odor.
Obstructive lesions lower in the jejunum
and ileum, as well as those in the large
gut result in meconium or fecal vomitus.
Chart 3 emphasizes the value of careful
notes on the type of stool. Atresias above
the ampulla are accompanied by normal
meconium stools. Those below the ampulla
are usually grey or white and mucoid in
nature. There appear to be some exceptions
to this rule, especially in atresias of the
third portion of the duodenum. Four in-
fants in our series were so diagnosed, and
DIAGNOSIS OF ATRESIA OF THE CASTRO INTESTINAL TRACT
IN THE NEWBORN
STOOLS
Atresias above the Ampulla yield normal meconium stools
Atresias below the Ampulla b Duodenum yield stools which arc greyish or white and
Fabers Test for squamous epithelial cells swallowed with the ammotic fluid is negative
GAS PATTERN AS INDICATED BY X RAY
Serial studies of the G I tract from birth indicate that gas has reached the sigmoid and
reefumby 7 to 10 hours
Atresia of the esophagus usually gives a normal pattern, since there is generally a fistula
between the pulmonary tract and esophagus Opaque substance may reach stomach
and intestines by way of lungs
Obstructions in the duodenum and high |e|unum are quite characteristic showing a
complete absence of gas below the distended point of obstruction. Malrotafion and
volvulus may simulate this pattern Lesions lower down show evidence of obstruction
but exact location is not so obvious.
yet two of these patients passed what was
reported as normal meconium. One of these
infants was operated on successfully, and
at operation was thought to have a complete
atresia. The other came to autopsy. Instead
of an atresia, actually a stenosis was found.
The gut was patent, but only sufficient to
admit the smallest probe and yet large
enough to permit the passage of some bile.
Complete atresia below the ampulla will
result in abnormal meconium. However, it
must be remembered that an infant may
•exhibit all signs and symptoms of a func-
tional atresia of the third portion of the
duodenum, and yet be suffering with a
stenosis which may result in normal me-
conium stools. Five patients in our series of
obstructive lesions of the gastrointestinal
tract in the newborn were proven by sur-
gery or autopsy to have atresia of the jejun-
um or ileum. All had white or grey stools.
In order to obtain the maximum infor-
mation from symptoms, accurate nursing
notes are essential. A simple check on the
record for a stool, without indicating its
color or character, may delay the diagnosis
of an atresia, and similarly, a bald state-
ment that vomiting occurred without a de-
scription of the mechanics or character of
the vomitus is of little help in diagnosis.
If from symptomatology an obstructive
lesion is suspected, an x-ray of the gas
pattern of the alimentary tract will make
diagnosis absolute in all atresias, with ex-
322
The Journal of the Medical Association of Georcia
30 minutes after birth. 4 hours after birth. 8 hours after birth.
Fij*:. 1. Showing the progress of gas through the gastrointestinal tract in a normal infant from birth to eight hours of age.
ception of those in the esophagus. Since
the latter lesions are usually associated with
a fistula from the proximal end of the distal
portion of the esophagus to the pulmonary
tract, the stomach and intestines are soon
filled with air derived from the lungs, hence
the gas pattern of most of these infants is
normal. Occasionally such a connection
with the pulmonary tree does not exist, in
which case no air is seen below the esopha-
geal pouch.
Given the symptoms and signs of eso-
phageal obstruction, which include the over-
flow type vomiting, cyanosis, respiratory
difficulty and drooling, with a normal gas
pattern, the diagnosis may he immediately
established by the introduction of a catheter.
In atresia of the esophagus, an obstruction
is promptly encountered. The x-ray will re-
veal the catheter coiled in the upper seg-
ment of the esophagus. The use of lipiodol
is unnecessary to confirm this diagnosis — -
indeed some surgeons object to its use.
Barium should never be used, since some of
this material invariably will overflow into
the trachea and set up a pneumonia in a
child already handicapped by respiratory
difficulty.
Physical examination, although not as
informative as the studies already men-
tioned, may prove quite helpful.
The infant with esophageal atresia not
only shows the characteristic vomiting with
its persistent drooling, but almost invariably
exhibits certain changes in the lung caused
by the overflow of the contents of the eso-
phageal pouch into the trachea, resulting-
in bronchial obstruction and/ or infection.
The physical findings, therefore, are those
of atelectasis, or pneumonia most frequently
involving the right upper lobe.
Obstruction at the pylorus or in the duo-
denum reveals the typical gastric peristaltic
pattern invariably exhibited by such path-
ology, and in conjunction with explosive
vomiting accurately indicates the level of
the obstructive lesions.
Examination of the infant suffering with
atresia of the jejunum, ileum or large bowel,
reveals an ascending type of distention from
August, 1950
323
Fig. 3. Atresia of the esophagus with tracheoesophageal
fistula, showing passage of lipiodol from esophagus to
stomach by way of lung.
the point of obstruction, resulting in meco-
nium vomitus. Barium studies of the large
bowel in such lesions show what appears to
be an atrophic colon, sigmoid and rectum
due to non-function. Following successful
anastomosis, however, it is seen that this gut
functions normally.
In studying a newborn infant exhibiting
symptoms of alimentary tract obstruction
during the first 12 hours of life, it is essen-
tial that the gas pattern of normal infants
during this critical period be known. Serial
studies of the gastrointestinal tract made
during the first 24 hours of life indicate
rapid passage of air from mouth to anus.
Figure 1 shows the gas patterns of a
normal infant taken at the ages of 30 min-
utes, four hours, and eight hours, respec-
tively. It will be seen that at eight hours
the gas is already well down in the large
Fig. 4. Atresia of the esophagus without a tracheo-
esophageal fistula.
bowel, distending the sigmoid and rectum.
Therefore, even at this early age, if x-ray
studies show obstruction in duodenum or
jejunum, one may be sure this indicates
pathology and not normal progress of gas
through the alimentary tract.
Figure 2 reveals in the x-ray on the left
the gas pattern of the commonly encoun-
tered atresia of the esophagus, with the
accompanying tracheoesophageal fistula ;
note gas in the stomach and small bowel.
On the right is shown the catheter and lipio-
dol in the blind esophageal pouch.
Figure 3 brings out the point that not
only can gas enter the gastrointestinal tract
by way of the lung through the tracheo-
esophageal fistula, but also lipiodol placed
in the blind pouch may follow the same
route and be observed in the stomach and
intestines. Shown in figure 3 also are the
characteristic pulmonary changes almost
universally encountered in these infants.
Figure 4 exhibits the much more rarely en-
countered atresia of the esophagus, in which
no tracheoesophageal fistula exists — hence
Fig:. 5. Duodenal atresia, showing: obstruction indicated by gas pattern and by barium.
no gas is seen in the alimentary tract below
the blind pouch indicated by the catheter.
Typical pulmonary changes can be detected
in this x-ray also.
Figure 5 reveals in the first two x-rays
the gas pattern of an atresia of the duode-
num as demonstrated in the anteroposterior
and lateral views. In the picture on the right
the obstruction is shown even more clearly
after the ingestion of barium. The use of
the opaque substance, however, is unneces-
sary for diagnosis. The symptomatology in
this case was classical; projectile vomiting
of dark brownish material, accompanied by
the passage of grayish-white stools. A duo-
denojejunostomy resulted in complete re-
covery.
Figure 6 exemplifies that not uncommon
phenomenon of multiple obstructive lesions
of the alimentary tract. The symptomatology
suggested the diagnosis of atresia of the eso-
phagus, which was confirmed by the obstruc-
tion encountered when it was attempted to
pass a catheter into the stomach. The gas
pattern indicated obstruction in the duode-
num and the presence of a tracheoesopha-
geal fistula, both of which were proven at
autopsy. And finally the physical examina-
tion revealed an imperforate anus, which
at postmortem was found to be accompanied
by an absence of rectum.
In figure 7 is seen the gas pattern of an
infant suffering with malrotation and vol-
vulus. The symptomatology encountered
in these patients is variable in time of on-
set and character. This infant vomited occa-
sionally during the first two weeks of life,
then suddenly exhibited signs of obstruction
high in the small bowel accompanied by a
large hemorrhage from the bowel. As will
be noted, the gas pattern of this baby is quite
similar to those seen in patients with atresia
of the duodenum.
Figui'e 8 demonstrates the gas pattern and
the appearance of ingested barium in an
infant suffering with atresia of the jejunum.
This infant vomited dark greenish-brown
foul material occasionally in a projectile
fashion. The stools were white and mucoid
in nature. The gas pattern placed the level
of obstruction in the small bowel below the
duodenum, but did not reveal its exact loca-
tion, although we felt it was definitely in
the jejunum. A jejunojejunostomy resulted
in an uneventful recovery.
Figure 9 demonstrates the gas pattern of
an infant with an atresia of the ileum. The
symptomatology placed the lesion below
August, 1950
325
Fig. fi. Multiple anomalies of the gastrointestinal tract:
namely, atresia of the esophagus, duodenum and rectum.
Fig. 8. Atresia of jejunum as indicated by gas pattern
and barium.
Fig. 7. The gas pattern of an infant with malrotation of
the gut and resulting volvulus.
Fig. 9. On the right the gas pattern of an atresia of the
ileum. On the left, the atrophic condition of the large
bowel is indicated by a barium enema.
the duodenum. The gas pattern indicated
small gut obstruction. Not until operation
were we certain that the lesion was in the
ileum. On the left is the x-ray of a barium
enema, in this case demonstrating the appar-
ent atrophic state of the large bowel due to
disuse. After anastomosis this portion of
the gut functioned normally.
Figure 10 is the study of the gas pattern
of an infant with an imperforate anus. The
x-rays were made with the child held upside
down in order that the gas might fill the
most caudal section of the lower bowel, thus
making possible a more accurate evaluation
of the extent of the anomaly, and serving
as an aid to the surgeon in determining his
approach. The metallic substance placed
over the anus shows that the distance from
the distended rectum is less than 2 cm., and
the obstruction can be relieved from below.
The diagnosis of partial obstruction in
the alimentary tract of the newborn is not
so clear cut, nor so urgent. Congenital stric-
tures or stenoses may involve any portion of
The Journal of the Medical Association of Georgia
326
Fig. 10. Gas pattern of infant with imperforate anus and
atresia of rectum.
Fig. 11. Congenital stricture of first portion of duodenum,
as indicated by gas pattern and barium.
the tract. Their symptomatology in general
is similar to the atresias. The stools, though
frequently constipated, are otherwise nor-
mal. The mechanics of vomiting varies
chiefly as to extent and degree. The char-
acter of the vomitus is determined mainly
hy the presence or absence of bile. The
end products of bile and old blood which
are seen in atresias of the duodenum below
the ampulla are not present in the vomitus
of an infant whose duodenum is only par-
tially obstructed. Fecal or meconium vom-
iting does not occur.
It is well to remember that hypertrophic
pyloric stenosis is not the only obstructive
lesion which may exist in this region. Atre-
sia and stricture have been observed, with
projectile vomiting occuring immediately
after birth, rather than one week to three
weeks after birth, as is usually seen in true
hypertrophic stenosis.
Fig. 12. Congenital stricture of third portion of duodenum
in nine months old infant.
Figure 11 shows on the left the gas pat-
tern of an infant with a congenital stricture
of the first portion of the duodenum. This
baby exhibited projectile vomiting from
birth; the vomitus was clear, the meconium
normal. The x-ray on the right indicates the
progress the barium meal has made at the
end of six hours. This obstruction was re-
lieved by a gastrojejunostomy. At operation
no evidence of a pyloric tumor was found.
Figure 12 demonstrates a congenital
stricture of the third portion of the duode-
num in a nine months old infant. This baby
had exhibited projectile vomiting once or
twice daily since birth. Stools had been
rather constipated. When solid food was
added to the dietary, vomiting was aggra-
vated. A duodenojejunostomy relieved this
partial obstruction.
The diagnosis of the rarer lesions pro-
ducing complete or partial obstruction of
the alimentary tract, such as duplication,
malrotation, volvulus, congenital bands,
herniation, etc., can not usually be made
Aucust, 1950
327
with certainty. The symptomatology is vari-
able as to time of onset, and is capricious
in its manifestations. Periods, of obstruc-
tion or partial obstruction may be relieved
by days when the bowel appears to function
normally. Malrotation, with resulting vol-
vulus, exhibits a gas pattern quite similar
to that of duodenal atresias, yet the impor-
tant symptom may be massive hemorrhage
from the bowel, which frequently masks
completely the presence of obstruction. Du-
plication of the gut may not become evident
until many years after birth, when growth
of the cyst-like mass encroaches on the
bowel, producing symptoms of obstruction.
In such lesions as those mentioned, one
must usually be content with a functional
diagnosis, noticing the presence of a com-
plete or partial obstruction at a certain level,
and awaiting the surgeon’s exploration to
determine etiology.
In conclusion, it should be emphasized
that, although vomiting and gagging in the
first hours-of life may be physiologic, it also
may warn of pathology incompatible with
life. Careful evaluation of signs and symp-
toms, especially the mechanics of vomiting,
and the character of stools, with an x-ray of
the gas pattern, and finally, if indicated, a
catheter to determine the patency of the
esophagus, are the few simple procedures
which will invariably give the diagnosis in
those cases requiring immediate surgical in-
tervention. Again it should be emphasized
that the presence of obstructive lesions de-
manding immediate surgery can be prompt-
ly and certainly demonstrated by the fol-
lowing simple studies and procedures:
1. Evaluation of symptomatology.
a. Mechanics of vomiting.
b. Character of vomitus.
c. Character of stools.
2. X-ray study of gas pattern.
3. Passage of catheter into stomach.
DIAGNOSIS AND EARLY MANAGE-
MENT OF ACUTE POLIOMYELITIS
Marvin L. Davis, M.D.
Atlanta
Two hundred and ninety-two cases of
acute poliomyelitis were admitted to the
Contagious Unit of Grady Hospital during
the years 1948 and 1949. This group rep-
resented 64 per cent of the poliomyelitis
patients reported in Georgia during that
period. An analysis of the cases in this
series was done to emphasize the important
aspects of diagnosis of poliomyelitis and to
review the principles of therapy that were
followed at Grady Hospital in the early
management of this disease.
In neither of the two years did the number
of cases reach epidemic proportions. A re-
view of the annual incidence of poliomye-
litis in Georgia during the period of 1939-
1949 (Table 1) reveals only one epidemic
year, 1941.
TABLE 1
Annual Incidence of Poliomyelitis
Georgia, 1939-49
Year Cases/ 100.000
Population
1939 3.2
1940 1.0
1941 .25.1
1942 1.6
1943 0.9
1944 3.3
1945 4.1
1946 5.3
1947 : 2.8
1948 6.7
1949 7.2
Diagnosis
The diagnosis of poliomyelitis in this
group of patients was usually based on sev-
eral factors: epidemiology, history, findings
at physical examination and spinal fluid
changes. The diagnosis was confirmed by
autopsy in one case. The epidemiological
aspects considered were the seasonal occur-
rence of the disease, age, sex and race of
the patients. These factors were in keeping
From the Department of Pediatrics. Emory University
School of Medicine. Atlanta.
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
The Journal of the Medical Association of Georgia
POLIOMYELITIS AT GRADY H OS PI TA L, 1948-49
SEASONAL INCIDENCE (292 CASES)
with the findings reported in other large
series. However, it seems significant that
the disease occurred more often in white
persons than in Negroes.
Seasonal incidence. A seasonal incidence
curve (Fig. 1) shows that the peak was
reached during the months of July and
August with a slightly earlier rise than is
seen in cooler climates. While poliomye-
litis is known to occur more frequently in
summer months, the season in Georgia ex-
tends over a longer period.
Age: Nearly 50 per cent of this group
were between the ages of one and four years
(Fig. 2). The youngest patient was three
months and the oldest was 32 years. Sixteen
per cent of the cases were over 15 years of
age. Occurrence of poliomyelitis in infants
under one year of age was infrequent. While
a comparison of the results of this study with
earlier figures’ on poliomyelitis in Georgia
was not available, studies 1, 2 and 3, else-
where have demonstrated a relative shift of
age selection of poliomyelitis from the 0-4
year group to the 5-9 year group during the
past 25 years. The significance of this shift
is unknown hut is thought to represent a
failure to acquire natural immunity at an
early age.
Sex and race: No significant dispropor-
tion of distribution between sexes was noted
(Fig. 3). Other large surveys have likewise
revealed no predilection of poliomyelitis
for either sex. A review of the racial inci-
POLIOMYELITIS AT GRADY HOSPITAL, 1948-49
AGE INCIDENCE (292 CASES)
deuce (Fig. 3) showed that poliomyelitis
occurred six times more commonly in white
persons than in Negroes while the popula-
tion ratio of white persons to Negroes in
Georgia is only 2:1.
Presenting complaints: Fever was the
complaint most frequently presented at ad-
mission by these patients (Fig. 4). Com-
plaints of muscle weakness or paralysis,
malaise, headache, stiff neck and extremity
pains were encountered in that order. Symp-
toms more specifically suggestive of polio-
myelitis included voice changes, difficulty
in swallowing, urinary retention and res-
piratory difficulty. Actually, the complaints
early in the disease are nonspecific and it is
only later in the illness, when more specific
findings become manifest, that the correct
diagnosis suggests itself.
Physical findings: Stiff neck and weak-
ness of a lower extremity were by far the
most common findings on physical examina-
tion (Fig. 5). Next most frequently found
were stiff back, weakness of an upper ex-
tremity, and presence of a Kernig or Brud-
zinski reflex (or both). A much lower inci-
dence of such findings as muscular spasm,
palatal paralysis, bladder distention, facial
asymmetry and respiratory paralysis was
revealed.
Type of involvement: Sixty-two per cent
of these cases had spinal cord involvement
only, while 23 per cent had bulbar (or
bulbo-spinal) involvement and 15 per cent
August, 1950
329
POLIOMYELITIS AT GRADY HOSPITAL, 1948-49
SEX AND RACE INCIDENCE (292 CASES)
SEX RACE*
•ratio white negro in population of geor G IA = 2 1
Fig. 2. Sex and race inc d?nce.
POLIOMYELITIS AT GRADY HOSPITAL, 1948-49
INCIDENCE OF PRESENTING COMPLAINTS
(% OF 292 CASES)
Fig. 4. Incidence of presenting complaints.
were nonparalytic (Fig. 6). The differen-
tiation is important because the prognosis
and management often depend on the type
of anatomic involvement. Frequent muscle
examination should be done in the acute
stage because of the rapidity with which
progression may occur.
Spinal fluid changes : In 52 per cent of
the cases examination of the spinal fluid
revealed a cell count of 16 to 100; 42 per
cent showed 66 to 90 per cent lymphocytes
on differential count; and 48 per cent had a
positive Pandy test. These findings are con-
sistent with the spinal fluid changes usually
reported in other surveys, namely, moderate
pleocytosis, lymphocytic predominance on
differential count (except early in the dis-
ease) and elevation of the protein. The rela-
tive ease of performing a lumbar puncture
and the ready availability of facilities for
spinal fluid examination should increase the
number of cases in which the diagnosis could
POLIOMYELITIS AT GRADY HOSPITAL, 1948-49
INCIDENCE OF PHYSICAL FINDINGS
(\ OF 292 CASES)
POLIOMYELITIS AT GRADY H 0SPITALJ948-49
TYPE OF INVOLVEMENT (292 CASES)
Fig. (i. Type of involvement.
be established by the referring physician.
Differential Diagnosis
Many diseases are confused with polio-
myelitis and a large number of patients were
referred to Grady Hospital as poliomyelitis
suspects who were found to have other dis-
eases. Some diseases occurred with enough
frequency to be important in differentia]
diagnosis.
Guillain-Barre syndrome ,4 or acute infec-
tious polyneuritis, was encountered in sev-
eral cases admitted as poliomyelitis sus-
pects. The essential points in the diagnosis
of this disease are: symmetrical distribution
of paralysis, frequent occurrence of sensory
loss, minimum or absence of muscle tight-
ness and pain, and usually a normal spinal
fluid cell count with a definitely elevated
protein.
Tick paralysis ,5 which occurs during the
same season as poliomyelitis, was occasion-
ally a source of confusion. The important
330
The Journal of the Medical Association of Georgia
differentiating points are the absence ol
fever, a normal spinal fluid, absence of
muscle spasm, little or no stiffness of neck
or back, usually diffuse muscle weakness
and ascending symmetrical involvement,
and finding an engorged tick on the patient.
With trauma there may be localized tender-
ness, and neurologic examination and spinal
fluid are normal. Lymphocytic choriomen-
ingitis, mumps meningo-encephalitis, and
arthropod-borne encephalitis may be distin-
guished from poliomyelitis by serologic
tests." In tuberculous meningitis a high
spinal fluid protein and a decreased sugar
are of value in differentiating it from polio-
myelitis. Bacterial meningitis is usually ac-
companied by a high fever, convulsions and
in many cases the responsible organism can
be identified in the spinal fluid. The recently
discovered Coxsachie virus' which appears
to be responsible for an illness simulating
nonparalytic poliomyelitis, is impossible to
differentiate without laboratory procedures.
Early Management
Since there is no specific agent available
for the treatment of poliomyelitis8 n the es-
sential aims of management are general sup-
portive measures and the anticipation and
handling of any complications that may de-
velop. Supportive measures include the re-
lief of pain and the alleviation of phvsical
and mental discomfort, immobilization by
complete bed rest, maintenance of adequate
nutrition, and the use of chemotherapy and
antibiotics for the prevention and treatment
of secondary infections.
Management of nonparalytic patients con-
sisted of the application of hot moist packs
to painful or spastic muscle groups. No sig-
nificant complications developed.
Paralytic patients were treated with hot
packs, and by positioning of affected parts
of the body to prevent pain and the develop-
ment of deformities. However, in this group
many special problems arose which required
extreme care. Most important among these
was respiratory failure, which may lie pro-
duced by paralysis of muscles of respira-
tion, respiratory center involvement, inade-
quate oxygen and carbon dioxide exchange
due to pulmonary edema or angiospasm,
and obstruction to the respiratory passage-
way. The provision of artificial respiration
and maintenance of a patent airway are of
paramount importance in the management
of this complication. Frequent suctioning
must be performed to prevent accumulation
of secretions resulting from pharyngeal and
palatal paralysis. Elevation of the lower
extremities aids in postural drainage of se-
cretions from the pulmonary tree. Frequent
turning of the patient forestalls the collec-
tion of secretions in the dependent portions
of the lungs and the occurrence of pneu-
monia. Vomiting and aspiration are grave
complications and are frequently respon-
sible for atelectasis in a patient who already
has very little respiratory reserve. Bron-
choscopy is a useful procedure and at times
may be a life saving measure where atelecta-
sis has occurred following aspiration.
While the advisability of tracheotomy at
times may be debatable,10 it was resorted to
in those instances where a patent airway
could not be otherwise maintained. Pul-
monary edema has been shown to be a major
factor in poor oxygen and carbon dioxide
exchange. Masland et al.11 have described
very satisfactory results from the use of
positive pressure in the prevention and
treatment of pulmonary edema.
An artificial respirator was necessary in
those cases where patients could no longer
achieve adequate respiration by their own
power. In all cases where there existed any
suspicion of respiratory failure a respirator
was readied and placed at the bedside.
Where respiratory failure was primarily the
result of respiratory center involvement, the
respirator was not used except as a last des-
August, 1950
331
perate gesture. These patients usually do
not adjust well to the machine and in some
instances are probably harmed by breath-
ing against it and by increased aspiration
of mucous. Once the patient is placed in the
respirator, careful and constant nursing care
is necessary. Most patients showed consid-
erable improvement, and difficulty in adjust-
ment to the machine was encountered in only
a few instances. Duration of stay in the
respirator varied from 48 hours to over nine
months.
Where there was any evidence of respira-
tory failure, continuous oxygen was sup-
plied by nasal catheter. Oximeter readings12
of the oxygen saturation of the blood were
not available, and the unreliability of deter-
mining the degree of cerebral anoxia on the
basis of clinical cyanosis necessitated the
use of continuous oxygen therapy.
Tube feeding was carried out in many
respirator cases and in those patients with
swallowing difficulty. This procedure sup-
plemented the administration of parenteral
fluids and was discontinued when oral feed-
ings could be safely resumed. The feeding
used was a milk formula of high caloric,
high vitamin, and high protein content.
Expert nursing care is absolutely essential
for the survival of respiratory cases and it
emphasizes the need for an experienced
team of doctors and nurses. Frequent suc-
tioning of pharyngeal secretions is neces-
sary and constant observation and attend-
ance are mandatory. Aspiration of mucous
or vomitus into the lungs constitutes an ever-
present threat to the life of the patient, and
its occurrence may result in immediate
death. The attending nurse is charged with
provision of moral support of her patient.
Circulatory center involvement, which
occurred in a few patients, was manifested
by clinical circulatory collapse. This con-
dition can progress very rapidly and severe
involvement carries a grave prognosis.
Oxygen administration anti-shock therapy,
central nervous system stimulants and ex-
pert nursing care are essential in the man-
agement of these patients.
Encephalitic symptoms occurred in 22
cases. Since it has been postulated that much
of the encephalitic picture stems from
cerebral anoxia, nasal oxygen was usually
administered.
Crinary retention was a special problem
that was encountered frequently. Rarely
was incontinence noted. Subcutaneous ad-
ministration of 2-10 mg. of furmethide13 11
(a bladder specific parasympatheticomi-
metic) resulted in almost immediate empty-
ing of the bladder in most cases. Intermit-
tent and indwelling catheterization was used
on several occasions. Antibiotics and chem-
otherapy were valuable where catheteriza-
tion was complicated by urinary tract in-
fection.
Summary
1. Two hundred and ninety-two cases of
acute poliomyelitis admitted to Grady Hos-
pital during 1948 and 1949 were surveyed.
2. There were 11 deaths, making an over-
all mortality rate of 4 per cent.
3. The clinical and laboratory findings
were consistent with those of other large
series.
4. The disease occurred three times more
frequently in white persons than in Negroes.
5. The essential aims of management
were general supportive measures plus the
anticipation, recognition and handling of
complications that developed. Respiratory
failure was the most important complication
encountered. Maintaining a patent airway,
continuous oxygen therapy, use of an arti-
ficial respirator and expert nursing care
were vital factors in the successful manage-
ment of this complication.
BIBLIOGRAPHY
1. Howe, Howard A.: Epidemiology of Poliomyelitis, Am.
J. Med. 6:537 (May) 1949.
2. Gilliam, A. G.: Changes in Age Selection of Fatal
Poliomyelitis, Pub. Health Rep. 63:677-684, 1948.
332
The Journal of the Medical Association of Georgia
3. Dauer. C. C. : Trends in Age Distribution of Poliomye-
litis in the United States, Am. J. Hyg. 48:133-146, 1948.
4. Ford. Frank R. : Diseases of the Nervous System in
Infancy. Childhood and Adolescence, ed. 2. Springfield,
Charles C. Thomas, 1946.
5. Ransmeier, John C. : Tick Paralysis in the Eastern
United States. J. Pediat. 34:299 (March) 1949.
6. Horstmann. Dorothy M.: Clinical Aspects of Acute
Poliomyelitis, Am. J. Med. 6:592 (May) 1949.
7. Melnick, J. L. ; Lidinlso, N. ; Kaplan. A. S. , and Kraft,
L. M.: Virus Pathogenic for Infant Mice, J. Exper. Med.
91:185. 1950.
8. Studies on the Chemotherapy of Virus Infections.
11. Failure of Darvisul (Phenosulfazole) to Affect the Course
of Experimental and Clinical Poliomyelitis. J. Pediat.
35:444. 1949.
9. Bahlke, A. M., and Perkins, J. E. : Treatment of
Preparalytic Poliomyelitis with Gamma Globulin. J.A.M.A.
129:1146, 1945.
10. Hill. L. F. : Tracheotomy in Bulbar Poliomyelitis,
J. Pediat. 36:537 (April) 1950.
11. Masland. R. L. : Lawson, R. B., and Kelsey, W. M. :
The Use of Positive Pressure as an Aide in the Handling
of Respiratory Paralysis from Anterior Poliomyelitis, J.
Pediat. 36:31 (Jan.) 1950.
12. Millikan, G. A. : The Oximeter, an Instrument for
Measuring Continuously the Oxygen Saturation of Arterial
Blood in Man, Rev. Scient Instruments 13:434, 1942.
13. Boken, A. B. : Bulbar Poliomyelitis, Am. J. Med.
6:614 (May) 1949.
14. Lawson, R. B., and Gervey. F. K. : Paralysis of the
Bladder in Poliomyelitis, J.A.M.A. 135:93, 1947.
REHABILITATION OF THE CRIPPLED
CHILD
Harriet E. Gillette, M.D.
Atlanta
A crippled child may be defined as an
individual in whom there has been inter-
ference with the developmental processes,
either before, during, or after birth. Such
interference may be in the form of develop-
mental defect, trauma, infection, toxins, de-
generative process or other noxious mech-
anisms, many as yet unclassified. Damage
may be in the sensory, motor, or visceral
organs and may be so slight as to be merely
annoying or so great as to cause total inca-
pacity.
The scope of this paper includes only
those children for whom it is good econom-
ics to expend a great deal of time, labor,
and money in order to make them contrib-
uting members of society.
In setting up a program of rehabilitation
our ultimate objective is to enable the indi-
vidual to be self-sustaining and to lead a
full life with both vocation and avocation.
This should be kept in mind at the first and
Aidmore Cripplied Children's Convalescent Hospital.
Atlanta.
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 195U.
all subsequent examinations, no matter what
the age of the child. The immediate objec-
tive is to return the patient to a child’s life,
consistent with his handicap, as soon as
possible.
The needs of the crippled child may he
formulated in terms of the normal: (1) A
means of communication to make known
his immediate wants and to provide an
avenue for education. The deaf child will
require special sense training; the cerebral
palsied and bulbar polio must learn control
of muscles of speech and respiration; the
aphasic, by dint of countless repetitions,
must set up new engrams for each experi-
ence. (2) The ability to care for himself,
to feed, dress, perform bathroom activities,
apply braces, write, propel a wheel chair,
and operate household appliances necessary
for daily living. It is truly amazing how
much can be done with feet, or with a stick
held between the teeth, when arms and hands
cannot function. (3) Education, as the basic
step in reaching the ultimate objective of
self-sustainment. Special teaching technics
may have to be used and various therapies
integrated with the academic program, still
the crippled child derives as much benefit
and is as deserving as his normal sibling.
Psychometric examination aids not only the
teacher but everyone who comes in contact
with the child. Special facilities for those
children who cannot compete with a normal
group would not only be good treatment, but
sound economics as well. (4) Security, the
feeling of belongingness, of being included
in both the family circle and a community
group. Too often the crippled child is placed
on the fringe, and this is brought about by
overprotection just as frequently as it is by
neglect and misunderstanding. The young-
ster who is given a share in competition in
a group of his own level obtains the neces-
cary stimuli for growth and development
which can be obtained in no other way. The
August, 1950
333
process of socialization is many-faceted and
it cannot be accomplished except within a
group which accepts the individual on his
own merits. (5) Satisfaction of emotional
needs — of loving and being loved — of ac-
complishment however .small, of excelling
in one particular activity. A freckle-faced
hoy has known the highest joys of success
because he was the only one in the ward
who could learn to wiggle his ears. Being
given recognition and credit for this achieve-
ment has helped him to attempt somewhat
more useful activities which previously were
not deemed worth the effort. (6) Ambula-
tion. This is the point about which parents
are first concerned and the one at which
therapy is usually first directed; and yet it
is probably the last in importance. Should
a child he forced to endure surgery, a great
deal of therapy, or prolonged bed rest if
there is no place to walk, or if his discipline
is so had that he is harmful to himself and
to others, or if he cannot take care of himself
after he gets there? The ability to walk is
little appreciated by you and me; we would
miss it if it were suddenly taken away but
we could still carry on our daily activities in
a fairly satisfactory manner from a wheel
chair.
The luxurious act of walking implies a
basic pattern of reciprocal innervation,
equilibrium, and a specific alignment of
bodily segments and muscle balance. The
loss or failure of development of any one or
more of these can be supplemented by mus-
cle training, mechanical appliances, or sur-
gery. Drugs may sometimes aid the basic
therapies. It may be necessary to diminish
the strength of a muscle or muscle group as
well as to increase that of others in order to
obtain proper relationships of a part. Econ-
omy and grace of movement should never
be sacrificed at the expense of walking with-
out proper bracing or crutches. The ability
to change one’s location is commensurate
with the need and effort required.
It would he exceedingly difficult to choose
from the needs mentioned if oidy one of
them could he satisfied. In a program of re-
habilitation we attempt to meet all, and in
this specialty, more than in any other, team-
work is of vast importance.
Accurate diagnosis, the setting of objec-
tives, prescription of modalities, and follow-
up to the time of employment is the respon-
sibility of the physician. He will require
consultation from the various fields of medi-
cal specialties and from allied services from
time to time. Above all, he must maintain
a broad view of the crippled child as an in-
dividual and not just a mass of muscles,
nerves, visceral and sensory organs.
Physical therapy attempts by means of
muscle training and strengthening, heat,
massage, hydrotherapy, and electrotherapy,
to train the motor elements to act in a more
normal fashion. Alignment of bodily seg-
ments is worked for; first through accurate
muscle testing, release of contractures, and
strengthening of weakened groups. Training
in balance, relaxation, use of prostheses,
and a graceful gait are accomplished by
various technics. Activities of daily living
are an important part of the program and
it is a proud day for the young paraplegic
when the last block of his achievement chart
is filled in.
The occupational therapy program may
he divided into two phases; specific and non-
specific. The first deals with muscle train-
ing, accomplished by the use of interesting
activities which are suited to the develop-
ment of involved muscle groups. Here again,
mechanical appliances for the upper extrem-
ities may be necessary just as are braces
for walking. Self-help skills such as feed-
ing, dressing, putting on braces, grooming,
etc., are taught. The second, non-specific
phase of the program is use of handcrafts.
This is not a random activity but is care-
The Journal of the Medical Association of Georgia
334
fully planned and given on prescription.
Here it is possible to work out behavior
problems, conquer homesickness, and satis-
fy the creative urge. An aggressive young-
ster, inclined to bully his roommates, was
given copper to beat into trays. The noise
was deafening but ward troubles ceased.
Speech therapy begins with finding the
reason for poor speech or for its complete
absence. An audiometric examination is in-
dicated in a large majority of speech dis-
abilities, as the child who has never heard
sounds of certain frequencies cannot he ex-
pected to reproduce them without special
training. Lip reading and speech produc-
tion with articulation and inflections closely
approximating the normal, fit a deaf child
for a useful life. The child who has a cleft
palate and who has not had the benefit of
surgical repair or application of a prosthe-
sis and subsequent speech training, is crip-
pled just as surely as is the one who has lost
the use of an extremity; indeed, he will find
it much more difficult to find employment.
In the cerebral palsied, motivation is often
the first step. This is followed by long train-
ing in relaxation and coordination of mus-
cles of speech and respiration.
Music therapy has a wide application in
developing a sense of rhythm leading to
more graceful movement, in teaching re-
laxation, in motivation, and in socialization.
With music’s wide appeal, it may form the
basic approach to an otherwise unresponsive
child. Perfection in playing an instrument
is not sought; rather the good which can be
obtained from its use. A background of
music promotes a better atmosphere in the
ward and moods can be varied to fit the
need.
Recreational therapy is not merely a
filling in of leisure time; it accomplishes a
very definite aim and is often given on pre-
scription. Primarily, it is used to teach
socialization, the art of good winning and
losing, and the feel of group living. Par-
ticipation in a skit is part of everyone’s
growing up and this experience should be
made available to the abnormal as well as
to the so-called normal child. All therapies
may be supplemented in recreation when
basic muscle re-education has been achieved.
For instance, a shoulder which is being
strengthened in physical therapy receives
an added workout in a game of shuffleboard
or badminton and the cheers of the specta-
tors add just that much more to speech ther-
apy. A camping program in which treat-
ments are minimized and just plain joy of
living found, would be desirable for every
handicapped child.
Education, while not considered a ther-
apy, nevertheless must be an integral part
of a well rounded program of rehabilitation.
\
Special technics may be employed as in
sight saving rooms and materials for the
blind, hearing aids and visual clues for the
deaf, and means of concentrating the scat-
tered intellectual functions and increasing
the attention span of the cerebral palsied. A
crippled child must learn the three R’s in
some way and he should be encouraged and
given facilities to proceed to higher educa-
tion within the limits of his handicap.
Lastly, our program includes vocational
rehabilitation. Ideally, prevocational coun-
selling should be begun at the age of 12,
with aptitude tests and cognizance of obser-
vations of the various therapists who have
worked with the child. By beginning at this
age activities can be directed toward a more
definite end. Then by the age of 16 years,
if the child is ready, actual training can be-
gin and valuable time will not have been lost
in attaining the ultimate objective of a use-
ful life.
To see a severely involved child graduate
into a normal society, and incidentally into
the great army of taxpayers, is indeed a
gratifying experience. It is then realized
Aucust, 1950
335
that he is only as crippled as his environ-
ment makes him.
TREATMENT OF FLAT FEET IN
CHILDREN
J. H. Kite, M.D.
and
W. W. Lovell, M.D.
Atlanta
A foot is usually considered flat if the
longitudinal arch is flattened out. In addi-
tion to this the forefoot is abducted and the
heel is everted. In the mild cases the arch
may be only a little lower than normal, and
the foot may be referred to as being in a
“foot strain” position. In the severe flat
foot cases the arch is completely obliterated
and there is bulging in along the medial
border of the foot, and the heel is turned
out in an extreme valgus position.
A flat foot is a foot out of balance. In the
infant there may be an imbalance of the
muscles of the foot, so that the forefoot is
pulled out in abduction more often than it
is pulled inward in adduction. If the foot
is pulled equally both ways, the foot is bal-
anced and it will develop normally. If it
is nearly always pulled out strongly and
only occasionally pulled inward and ibis
feebly, the foot will develop a fixed flat foot
deformity.
Frequently the muscle imbalance is over-
looked until the child is old enough to pull
up and stand. In addition to the muscle
imbalance there may be a slight anatomic
variation in the shape and position of the
bones which may produce a structural im-
balance. The os calcis rolls out from under
the talus and fails to give the normal sup-
port. This may be due in part to a relaxation
of the muscles and ligaments. The object of
treatment is to place the bones in the correct
Read before the Medical Association of Georgia in annual
session. Macon. April 19, 1950.
anatomic position, and to strengthen the
muscles and ligaments.
There is a wide variation in the severity
of the deformities in flat feet. Some feet dif-
fer so slightly from normal, that they might
improve spontaneously, others show only a
mild flatfoot deformity which can be cor-
rected by special shoes and manipulations,
while still others present a very severe flat
foot deformity, which might be called a
“congenital flat foot” or “reverse clubfoot.”
This last group always requires casts and
wedgings to correct the deformity. These
cases also show a high percentage of re-
currence after correction. There is a rare
deformity in which the foot is fixed rigidly
in a flat foot position by a bony bar or bridge
between certain bones, as the calcaneonavi-
cular bar. There is a still more difficult foot
to treat, and that is one in which there is a
congenital absence of parts of the foot or
leg, as in congenital absence of the fibula.
T reatment
Shoes: The simplest form of treatment
and the one most used is to prescribe some
type of swung-in shoe. There are more than
a dozen brands on the market, all being
built along the same general lines. The
forefoot is swung-in more than in the normal
shoe, the heel is raised approximately one-
eighth of an inch along the medial border
and is usually carried forward a little on
the medial side. The choice between the
different brands of shoes is made on the
amount the forefoot is swung-in, the amount
of lift under the heel, whether this lift is
under the anterior end of the os calcis only,
or whether it goes all the way back to the
rear of the heel, and on the stiffness and
weight of the shoes. Broad and heavy shoes
may be selected for boys and narrower and
lighter shoes for girls. Some brands are so
broad and stiff they are ill-fitting, while
others are rather flimsy and give little sup-
port. Since feet differ in width and length
336
Thk Journal of the Medical Association of Georgia
Fig. 1 Fig. 2 Fig. 3
Fig. 1. (Figs. 1-3 show the method recommended for manipulating a flat foot to restore an arch). The forefoot is grasped
between the thumb and the flexed middle finger. This leaves the index finger free to make pressure on the tubercle of the
navicular.
Fig. 2. A firm grip is made on the heel by the other hand. The thenar eminence presses against the heel, and turns it
from eversion to inversion.
Fig. 3. The two grips are combined. The object is not to twist the foot inward on the leg, but to bend the foot in the
middle. The forefoot and heel are carried in toward the midline of the body, while pressure is made away from the midline of
the body on the arch. The forefoot is carried inward toward the other foot, and slightly downward, so as to restore an arch
to the foot.
and severity of deformity, it is not wise to
fit every foot with the same brand of shoe.
It is necessary to knoAV the brands available
as well as to understand the problem that a
given pair of feet present, to make the best
choice of shoes.
A word of caution is inserted to condemn
the indiscriminate use of the fluoroscope in
fitting children’s shoes in some retail stores.
No attempt is made to control the length
of the exposure as the mother goes from
store to store shopping for shoes, or when
she takes the child hack at intervals to have
the shoes checked. The accumulated dose of
radiation over a number of years may cause
skin damage or stunt the growth of the epi-
physis. Shoes have been fitted for years by
measurement and observation, and can still
be fitted by this safe method. The fluoro-
scope is used more for an advertisement than
it is for accurate scientific fitting.
In order to give good advice on subse-
quent visits, an accurate description of the
feet should he recorded. Photographs, foot
prints, and x-rays are occasionally needed.
For best results the doctor must develop an
interest in flat feet, and follow a large series
of cases. This report is based on the records
of 1,880 children, many of whom have been
followed through adolescence, and a few
into adult life.
Manipulations-. Shoes alone will correct
only the very mild cases. The average case
will respond more quickly if the parents
“stretch" the feet. The flat foot needs to be
placed in the opposite position. This the
child does not do as it walks and plays, and
this the shoe cannot do to any noticeable ex-
tent. Many cases will show no improvement
unless the feet are stretched regularly and
correctly. It is difficult to teach parents how
to hold the foot to carry the foot over into a
position which will help restore the balance.
Mothers volunteer the information that they
have been “working the feet,’' like some one
showed her. This usually consists of rub-
August. 1950
Fig. 4 Fig. 5 Fig. fi
Fig. 4. The severe type of fiat foot on the right may l>e referred to as a “congenital fiat foot” or a “reverse clubfoot.”
This foot was treated for three and one-half months by casts, followed by swung-in shoes and exercises.
Fig. 5. The feet of patient in Fig. 4, eleven years later. She has normal feet and wears normal shoes, and has no foot
trouble.
Fig. fi. “Outward rotation of legs and flat feet.” The legs are rotated outward from the hips, and the feet are nearly
always pulled out and up into calcaneovalgus position.
bing or wiggling the foot in an ineffectual
manner. Sometimes the mother is slow to
comprehend, and sometimes the doctor does
not have a definite plan worked out by
which the feet can be easily and effectively
“stretched." If the treatment is not given
correctly, the mother has wasted much time,
and the child has not been helped. She
should he taught maneuvers which have
proved to he of value after a long trial.
The method we have recommended for a
number of years is for the mother to grasp
the forefoot on the flexed middle finger,
leaving the index finger free to make pres-
sure on the middle of the arch. (Fig. 1).
This pressure is made on the tubercle of the
navicular. The mother’s other hand grasps
the heel firmly and inverts it, and pushes it
in toward the midline of the body. In a baby
the heel may be grasped by the index finger
and the palm at the base of the finger, but
for the older child the thenar eminence is
used. A firm grip is made on the heel as the
heel is inverted. (Fig. 2). The two holds
are combined and the forefoot and heel are
carried inward toward the midline of the
body, while pressure is made outward on
the medial side of the arch. (Fig. 3) . A fin-
ger from the hand on the heel is made to
press on the index finger which is pressing
on the navicular. In this way firm pressure
can be made comfortably on the middle of
the foot, and an arch molded in the foot.
This pressure is chiefly lateralward on the
arch. The forefoot is carried in toward the
midline of the body, and only slightly plan-
tar flexed. It is not a turning in of the foot
on the leg, but a bending of the foot in the
middle. The foot is held in this position
for about half a minute and released for a
few seconds to rest the patient, and repeated.
Five minutes are spent on the foot every
night and morning, and occasionally during
the day if there is an opportunity.
Exercises : When the child is old enough
to cooperate it can be taught exercises.
Briefly stated they are: (1) The patient is
shown how to stand pigeon-toed and how to
come up on the toes a given number of times,
gradually increasing the number. (2)
338
The Journal of the Medical Association ok Ceorcia
Standing pigeon-toed, liow to invert the foot
and stand on the lateral border of the foot.
(3) Sitting, the patient learns by following
a finger at first, how to turn the foot down
and *in and up, to strengthen the muscles
which invert the foot, and at the same time
to stretch the heel cord. (4) When the heel
cord is short a special exercise is taught.
The patient stands a short distance from a
wall in a pigeon-toed position, keeping the
heels on the floor. The body is kept straight
as the child leans forward until the chest
touches the wall. By changing the distance
from the wall, more or less pull is placed on
the heel cord. There are numerous other
exercises which cannot be discussed in detail
here.
On the first visit the mother is taught to
stretch the feet and the proper type of
swung-in shoe is selected. On subsequent
visits she is again checked on her stretching
and taught how to do it better. More than
half of the cases can be corrected by this
treatment. If there is improvement this
regimen is continued. If cooperation is poor
or there is no improvement, footplates are
used. The leather and rubber footplates
sold in the stores are not as effective as the
metal plates made by the brace maker. Some
clinics use plates with flanges on the side
of the plate to hold the foot on the plate.
The plate recommended is made to fit the
inner sole of the shoe, and the shoe holds the
foot on the plate. This plate gives better
support and can be worn with more comfort.
The shoe should be fitted correctly without
the footplate. Footplates are used when
there is an anatomic imbalance of the bones
of the foot, which have not been corrected
by manipulations or exercises. The swung-in
shoes and stretchings should be continued,
and the patient instructed how to walk with
the feet pointing straight forward. Foot-
plates may be thought of as being like
crutches, and are to be discontinued as soon
as the patient can get along without them.
Casts : For the feet which do not respond
to the above treatment, and for those which
are badly deformed, casts are needed to
hold the feet in a still better corrected posi-
tion. (Figs. 4 and 5). The cast will hold the
foot in the corrected position day and night,
for seven days in the week, and is many
times more efficient than manual stretchings.
If the foot is flexible and can be molded to
the desired position when the cast is applied,
the cast may be worn two or three weeks be-
fore it needs to be removed. If the foot is
rigid and cannot be placed in the desired
position the cast is “wedged" at weekly in-
tervals, to gain more correction. Cast treat-
ment is usually needed for two months or
longer, until the foot begins to grow in the
desired position. When the casts are re-
moved, the stretchings, swung-in shoes and
footplates are continued.
Outward rotation and flat feet: During
the past few years there has been an increase
in the frequency of another variety of flat-
foot deformity. (Fig. 6). Some babies show
from birth an external rotation of the legs
and with the feet pulled out and up in an
extreme calcaneovalgus position. The leg
rolls out from the hip. These legs cannot
be passively rotated inward much past the
midline. In addition to being born this way,
there are several factors which favor out-
ward rotation. The legs roll outward when
the baby sleeps on either its back or abdo-
men. When it sits flat in its crib or on the
floor the legs must rotate outward. In many
cases the outward rotation will disappear
spontaneously, but we do see older children
in whom the deformity persists and the feet
are abducted fifty to sixty degrees from
the midline.
The treatment for outward rotation is to
have the mother grasp the knees and roll the
legs inward as strongly as she can without
causing discomfort. She holds them this
August, 1950
339
Fig. 7. If the outward rotation does not respond to inward
rotation of the legs by the mother, the outward rotation
can be corrected by wearing a bar across the shoes at night
which rotates the legs inward. The bar can also be bent to
invert the heels, and correct the flat foot deformity.
way for half a minute, and releases them
and repeats it, spending five minutes on
this manipulation twice a day. The asso-
ciated flat feet are stretched as described
above. If stretching is done regularly, most
cases will show improvement in a month. If
there is no improvement a bar is placed
across the shoes, to be worn at night. (Fig.
7) . The shoes can be set on the bar to grad-
ually increase the amount the legs are rolled
in. The bar is also of value in helping to
correct the flat foot deformity. By bending
the bar toward the body the feet are invert-
ed. This bar is worn only at night, and usu-
ally corrects the outward rotation in a cou-
ple of months. (Fig. 8).
Operative treatment: There is seldom
a need for operation on flat feet in children.
The adolescent may need a heel cord length-
ening, but this can usually be stretched suf-
Fig. 8. Feet of previous patient after using the bar for two
months. Feet are still nicely corrected after two years.
ficiently by casts and wedgings. The con-
genital flat foot with the talus pointing
straight down toward the sole of the foot
and toward the medial side of the foot may
need a foot stabilization or some bone opera-
tion when the patient is older. Those with
calcaneonavicular bars or taleo-calcaneal
bars may need the bar removed and the foot
fused in a normal position. Flat foot asso-
ciated with the absence of the fibula requires
a brace, and maybe a fusion operation when
older. Flat feet following poliomyelitis and
spastic paralysis and similar conditions will
not be discussed in this paper.
Summary
Flat foot deformity in children varies
widely in severity. The mildest cases can
be corrected by swung-in shoes. The more
severe requires manipulations by the par-
ents, exercises and instructions in walking
and possibly footplates and plaster casts.
Much can be accomplished when the treat-
ment is begun early.
DISCUSSIONS
DR. A. M. JOHNSON (Valdosta) : In his usual
thorough manner Dr. Roberts has presented a scholarly
discussion of alimentary obstruction. Dr. Roberts’ plea
for early diagnosis in these cases is of paramount im-
portance. Delay in diagnosis is certain to raise the
mortality rate many times that which can be attained
under ideal management. Early and correct diagnosis
in these cases is best made through studious observa-
tion and detailed study by the attending physician,
himself, rather than the acceptance of findings of such
utmost importance from a not too well trained, and
:uo
The Journal of the Medical Association of Georgia
frequently over-worked nursing staff. The average floor
nurse i- frequently unfamiliar with the significance of
the exact type of vomiting a baby might show. Also
the type stool is usually recorded in a rather vague
manner as to indicate its approximate color and con-
sistency.
Such observations may not only be dangerous, but
actually misleading to the diagnostician. Whenever
called to see a baby who is reported to vomit for
more than 12 hours let us take time, even to pull
up a chair if necessary, to ob.-erve these infants being
fed; stand around for awhile if necessary and observe
the interval between eating and vomiting. Appraise
the appearance of the abdomen as well as the appear-
ance of the regurgitated fluid. The doctor’s personal
observation may speed surgical intervention, and in
this manner lower our mortality rate in such cases.
Observation, tedious and time consuming examination,
and liberal use of the x-ray and fluoroscope make for an
earlier and more accurate diagnosis of such grave
conditions as might demand immediate surgery.
The ideas expressed by Dr. Gillette in her paper
should be a challenge to us all — general practitioners,
surgeons, otologists, orthopedists and physical therapists
— to combine our efforts as a team to more completely
place these children in the position of belonging
and contributing to society.
Once these patients reach the goal of accomplish-
ment whereby they can feel within themselves that
they are contributing and belong to the great social
group, then new vistas of life are open to them. When
the little fellow with one hand learns to tie his shoes
with this single hand he has something to be proud
of, that is something the other fellows cannot do.
He is just a little smarter than the fellow with two
hands, and he is a little nearer the goal of belonging
and contribution.
He is psychologically and physically better prepared
to enter the big world of activity and compete with
other fellows without the fears and self-consciousness
that have kept him so long in his old world of
doubts, fears and all the other things that go with
the feeling of inferiority and just being different.
To attain the desired rehabilitation of these crippled
children we must have as a foundation the cooperation
of the family doctor, educational heads, the specialists
in their different fields, and most of all a coordinating
body whose burning interest in this work is their
constant challenge.
In Dr. Gillette, I am sure we all have the feeling
that, because of her zeal, there will be many more
children in this state who will graduate into a normal
society. Without her fine work their lives would be
spent and end as dependent introverts who would
never be able to face the world without this great
work.
Rehabilitation cannot end with a well fitted brace
or the cosmetically excellent repair of a harelip. The
brace must be as inconspicuous as possible. The child
must be taught and shown locomotion in the most
graceful manner attainable for him. The child with
the harelip or cleft palate must learn diction and to
speak in the most euphonious manner possible.
Each case must be studied as an individual and
objectives kept constantly in mind, lest the child
become physically rehabilitated, yet remain emotionally
and didactically crippled.
The first things we must know as doctors, whether
we be the family doctor, the baby’s doctor or the con-
sulting orthopedist, are the distinguishing character-
istics which differentiate the FLAT foot from the FAT
foot. I am frank to admit that I see a large number
of babies whose mothers say the foot is flat, but to
me it is a perfectly normal fat foot. We must know
which foot that freedom, development which comes
from walking, and time will correct, and which foot
will need I he aid of massage, special exercises and
special swung-in shoes. It is most important that we
not just send these patients to the shoe store with
instructions to buy a given shoe, rather than have
them fitted with the designated shoe and return to
the doctor for determination of proper or improper
fitting. If fitting is done in any other manner the shoe
clerk soon will become the fountain head of knowledge
to the mother who is concerned over her child who
she thinks may have flat feet. We know, of course,
that there are a great number of children wearing
swung-in shoes who have not the slightest need for
them, and would probably be much better off bare-
foot.
1 have heard many papers read on the subject, but I
feel that the paper we have just heard by Drs. Kite
and Lovell emphasizes the soundest principles of
therapy on the matter. They have given us analysis
of almost 2000 case findings, and the accumulated
knowledge of many years experience in this branch
of orthopedic care. 1 wish to thank Dr. Kite and
Dr. Lovell for bringing us this timely and informative
paper.
DR. ROBERT L. BENNETT (Warm Springs): 1
have been asked to discuss the last four papers.
As you know, they have rather a wide scope, ranging
from obstructions of the alimentary canal in the
newborn on to flat feet.
Dr. Roberts has very modestly said that his dis-
cussion is rather elementary, but he was prompted
by the frequency with which obstructive lesions of
the alimentary tract in the newborn are admitted to
children’s hospitals too late and frequently without
definite diagnosis.
Unfortunately, neither by training nor experience
am I qualified to discuss the problems outlined by Dr.
Roberts, but 1 know of no better proof that you here
must have gotten a great deal out of the discussion
than to realize my own interest as I read his paper
before this meeting and as I listened to him this
morning. I am on more familiar ground with the
subject when I discuss the last three papers.
Like Dr. Roberts in his discussion of early diagnosis
of alimentary tract lesions, we who take care of
crippled children are frequently disturbed when we
have problems brought to us too late — certainly too
late for maximum or optimum effective recovery.
At times the diagnosis is faulty, but I think much
more frequently the fault lies in an incomplete realiza-
tion that the physically handicapped child is not a
specimen of a disease process but an individual with
all the problems that are faced by normal children,
accentuated by a specific physical functional handicap.
At Warm Springs, and at other similar centers I am
sure, we have become increasingly aware that we are
failing in certain cases to restore happy and effective
living in a normal environment, not because we are
not giving highly skilled attention to muscles and
nerves and bones, but because we are forgetting that
the child is an individual, in our interest in his disease.
I think at last we are learning to evalute the child
in terms of the environment to which he must return.
As Dr. Gillette has so well brought out, we have
learned that we must make this evaluation not when
he has finished treatment at Warm Springs, but when
he begins treatment at Warm Springs, so that this
factor can be incorporated in our over-all program.
So that we will not run the risk of being criticized
in that we might be over-protecting the child, I
think Dr. Gillette brought out an extremely important
point; namely, that the physically handicapped indi-
vidual can be limited just as much by over-protection
as he can by neglect.
1 also was very much interested in Dr. Gillette’s
statement that unfortunately the patient and usually
his parents use as a yardstick of recovery the ability
August, 1950
311
to walk again. 1 think any of you who have taken
care of severely involved quadriplegics will realize
that the victory of restoring some measure of func-
tional capacity, even though the patient is confined
to a wheelchair, is just as great a victory as it is to
restore the ability to walk to a less involved patient.
1 think we are becoming increasingly interested in
restoring functional capacity to those individuals who
have involvement of upper extremities, whereas in the
past I think we spent much more emphasis on the
lower extremities and the ability to walk.
Dr. Davis has given us a very nicely outlined and
academic presentation of the incidence and diagnosis
and treatment of patients at Grady Memorial Hospital,
Atlanta. 1 think all of you are well aware that the
earlier the diagnosis is made in acute anterior polio-
myelitis, the less the mortality rate will be, because
certainK an accurate early diagnosis will alert each
one of us to the possibility of danger that is ever
present in acute poliomyelitis.
PARENTS GET TIPS ON
COPING WITH TELEVISION
''Don't ban television." parents of school-age children
are advised by a child development consultant to
Today's Health , published by the American Medical
Association.
Although school surveys have sounded a danger
signal about the effects of television on youngsters, it
is here to stay and children must learn to live with it,
says Elizabeth B. Hurlock, Ph.D., of Philadelphia.
‘'In recent months, surveys in several areas have
shown that school grades drop when children have
television sets in their homes — even when they regularly
visit neighborhood homes to view the programs,” Dr.
Hurlock points out in the June issue of the magazine.
■‘The reports showr that, on the average, children
are spending as much time per day on television as
on their lessons in school and at home,” she says.
“Since the television problem is nationwide, I am
offering some suggestions which, I hope, will help
parents to cope successfully with this newest of
problems in child training.
“1. Don't ban television. Instead of forbidding your
child to watch television, apportion the time he may
spend before the screen.
“2. Help your child to select programs that are
worth while and suitable for his age. Explain to him
why you do not want him to see certain programs
even if his friends watch them.
“3. Whenever possible, watch the programs with
your child. Later, discuss with him their merits and
faults. This will enable him to appreciate good pro-
grams more fully and to pass up the bad ones.
“4. Regard his television as a form of education
as well as amusement. Let it be the starting point of
discussions and reading related to the topics of the
programs. Interest in music, art, current events, history,
travel, sport and literature can be fostered.
“5. Encourage him to be interested in other forms
of play, especially those that require outdoor exercise
and demand teamwork with other children. Many
children become television devotees because their par-
ents unwittingly encourage it to keep them quiet and
out of mischief.
“6. Watching television may be used as a reward.
You may forbid your child to watch his accustomed
programs when his behavior falls below expected
standards or when his school grades take a plunge.
“7. Finally, remember that television is a new toy
and its novelty will wear off. At present, owning a
television set gives the child prestige in the eyes of
his playmates. As more families acquire sets, the
prestige value of ownership will wane. Likewise, as
the novelty of watching the programs wears off, the
child's preoccupation with it will lessen.”
A.M.A. COUNCILS GIVE RECOMMENDATIONS
FOR IMPROVING NUTRITION OF WORKERS
A three point program for improving nutrition of
industrial workers is recommended to industry by the
\merican Medical Association’s Council on Foods and
Nutrition and the Council on Industrial Health.
The program includes:
1. Use of plant facilities to make available foods
well selected and prepared in the light of modern
nutritional knowledge.
2. Support of nutrition research.
3. Campaigns to teach how to select a good diet.
These measures, the councils point out in an article
in Archives of Industrial Hygiene and Occupational
Medicine, published by the A.M.A., are superior to
indiscriminate, mass administration of vitamins, a
"practice which supports the commercial exploitation
rather than the scientific, rational use of these important
dietary factors.”
Such mass administration of vitamins is unwise
nutritionally because special vitamin preparations can-
not take the place of valuable natural foods in achiev-
ing the completely satisfactory nutritive state, the
councils say, adding:
“Concerns that are interested enough to consider
spending large sums of money just to buy vitamin
pills for their employees could render a valuable
service to their industry and section of the country
if they would use this money to support research on
this question (nutritional deficiency) in their plants.
“Numerous suggestions can be offered for construc-
tive action that business executives might take now in
relation to this question pending the completion of
the researches just mentioned.
“Industrial plants might assist more than they do
in the educational work that must be done. They
might be used for the display of posters and the dis-
tribution of literature that teach how to select a good
diet. Organizations of employees could well be enlisted
in a campaign to educate the individual workers in such
matters and through them their wives could be en-
couraged to attend the various nutrition classes estab-
lished in the communities throughout the land.
"The use in the plant of machines that dispense
bottles of milk could be studied to determine its value
for the plant in question. Through health department
officials the management of any plant may readily
secure advice and assistance in improving the general
nutrition of workers.”
AMERICAN BOARD OF OBSTETRICS
AND GYNECOLOGY
The annual meeting of the board was held in Atlantic
City, New Jersey, from May 21 to 27 inclusive, 1950,
at which time 259 candidates were certified.
New bulletins, incorporating changes made at the
recent meeting, are now ready for distribution. These
changes include adoption of a special form to be
designated as the “Appraisal of Incomplete Training
Form” which will be forwarded to prospective appli-
cants upon request. Numerous changes concerning
graduate training in obstetrics and/or gynecology have
also been adopted and will be of special interest to
hospitals conducting residency programs as well as
to prospective applicants to this board.
The next scheduled examination fPart I), written
examination and review of case histories, for all
candidates will be held in various cities of the United
States and Canada on Friday, February 2, 1951. Appli-
cation may be made until November 5, 1950. Applica-
tion forms and bulletins are sent upon request made
to: Paul Titus, M.D., Secretary, American Board of
Obstetrics & Gynecology, 1015 Highland Building,
Pittsburgh 6, Pa.
The Journal of the Medical Association of Georgia
342
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor *
478 Peachtree Street, N. E., Atlanta, Ga.
August, 1950
SAN FRANCISCO MEETING OF THE
AMERICAN MEDICAL ASSOCIATION
The San Francisco meeting was one of the
most successful in the history of the American
Medical Association. Held June 26-30, this
meeting brought more than 25,000 persons in
the first three days to San Francisco. By the
end of the second day more than 9,300 physi-
cians had registered; including guests, the total
registration in this time was approximately
20,000. with two days of the meeting remaining.
The largest previous registration of physicians
in the Association’s history was 15,667 in
Atlantic City in 1947, at which time the Cen-
tennial meeting of the Association was held.
The second largest registration was in Atlantic
City in 1949, at which time 13,221 registered.
In addition to members and Fellows of the
Association, thousands of guests, such as mem-
bers of the physicians’ families, students, mem-
bers of related professions, exhibitors and others
made up the attendance.
Three major activities drew capacity attend-
ances. The House of Delegates, which consists
of 198 members, was apparently the subject
of considerable new interest, as more and more
members of the profession personally visited
the House during its sessions to learn firsthand
the actions taken by this democratic body. At
every session the meeting room was filled with
an alert and interested audience, whose atten-
tiveness clearly indicated the interest of this
group in the questions, resolutions and discus-
sions offered by the members of the House.
Bishop Karl Morgan Block delivered the invo-
cation at the opening session of the ninety-ninth
meeting of the American Medical Association.
Included in some of the more important
actions of the House were; Adoption of a report
on displaced persons, authorization of a student
American Medical Association, the Board of
Trustees to initiate the organization of such a
body; adoption of reports on medical educa-
tion and medical practice in England, these to
be published in early issues of The Journal;
adoption of a modified report of the Committee
on Hospitals and the Practice of Medicine which
denounces systems whereby hospitals hire sal-
aried physicians for medical care and bills the
patients for this care; refusal to support the
Association of Interns and Medical Students as
presently constituted; support of the World
Medical Association; criticism of some hospitals
which make membership in specialty boards a
requisite for appointment or advancement, and
approval of continuation of the National Educa-
tion Campaign during 1951 with the firm of
Whittaker and Baxter as directors of the cam-
paign. At the same time the Board of Trustees
was authorized to proceed with expansion of
the A.M.A.’s Department of Public Relations
and authority was granted to expand some of
the special committees of the Council on Medi-
cal Service in antipication of eventual discon-
tinuance of the National Education Campaign.
The House also voted to include subscription
to The Journal in membership dues and set
dues for 1951 at $25, the rate for 1950. The
status of Fellowship was referred to an interim
committee for study and reporting back to the
House at the December 1950 meeting. It also
chose New York City for the annual convention
in 1953. Some idea of the activity of the House
can be gained from the fact that in one day
it transacted 74 pieces of business.
Among the officers elected by the House of
Delegates were John W. Cline of San Francisco,
Calif., President-Elect; R. B. Robins of Camden,
Ark., Vice President; George F. Lull. Chicago,
re-elected Secretary; J. J. Moore, Chicago,
Treasurer (re-elected); F. F. Borzell. Philadel-
phia, Speaker of the House of Delegates ( re-
elected) ; James R. Reuling, Bayside, N.
Vice Speaker (re-elected), and Leonard Larson
of Bismark, N. D., and Thomas P. Murphy of
Meriden, Conn., to the Board of Trustees.
The scientific meetings contained papers of
national and international significance. Not only
were the papers and exhibits of great interest
to the members of the medical profession—
they were of outstanding public interest, if one
can judge by the newspaper reporting. More
than 300 papers were presented and 157 scien-
tific exhibits offered to those interested in all
phases of medical practice. The 1,492 authors
and participants provided a total of 4,700 hours
of lectures and demonstrations, truly an inten-
sive postgraduate course for everyone. These
scientific activities attest the interest and will-
ingness of the participants to offer their knowl-
edge for others. Particular credit is due the
leadership of the Council on Scientific Assembly
under the able chairmanship of Henry Viets.
An indication of the extensiveness of the pro-
gram can be obtained from the Convention
number of The Journal (May 20).
The 304 technical exhibits were also well
attended. In fact, many of the exhibitors said
that to their knowledge their booths were visited
by a more searching crowd than ever before
in the history of the American Medical Associa-
tion meetings. The 304 technical exhibits and
150 scientific exhibits covered more than 100,000
square feet. — Editorial The Journal of the
American Medical Association, July 8, 1950.
August, 1950
343
PHYSICIANS FOR THE ARMED FORCES
By the time of the Pearl Harbor attack, in
December 1941, some 11,000 civilian physicians
had already left their homes and practices to
furnish medical support to the expanding armed
forces of this country. About one year later
the number had increased to 42,000, all on a
voluntary basis. At the same time several
thousands of premedical and medical students
were deferred from active military duty to
colleges and universities throughout the country
to complete their medical training with a view
to being called to the armed forces later to
serve as medical officers.
At this time there is evidence of probable
need once again for additional medical officers
to support our increasing defense establishment.
Budgetary allowances have been increased for
additional enlistments. The President of the
United States has authorized an increase in
these enlistments to augment the present troop
strength and has stated that this authorization
includes medical officers. There are many young
physicians in the country whose services were
deferred during the war in order that they
might complete their medical education in either
ASTP or V-12 programs, and many others have
received their intern training in the hospitals
of the armed forces.
The moral obligation that rests on them to
serve the nation in this time of need is clear
and unequivocal. While it is true that services
of many other persons were deferred and that
they received training in various specialties
during the war, there were few groups other
than physicians who could later utilize their
training to advantage in civilian life. — Editorial
The Journal of the American Medical Associa-
tion, July 22, 1950.
NEW ULCER DRUG SEEN AS
PREVENTIVE OF SURGERY
Most persons with serious disability from
peptic ulcer can avoid surgery by receiving
treatment with a new ulcer drug, banthine, early
tests with one series of patients indicate.
The synthetic compound, which is taken in
tablet form, blocks the impulses of the nervous
system which stimulate overactivity and over-
acidity of the stomach. It is available only on
prescription by a physician and must be taken
under medical supervision.
Clinical trial of banthine in 100 peptic ulcer
patients is described by Drs. Keith S. Grimson,
C. Keith Lyons, and Robert J. Reeves of Duke
University School of Medicine, Durham, N. C.,
in the Journal of the American Medical Asso-
ciation.
Of this group of patients, 62 were considered
to have “conventional indications for surgery”
before treatment with banthine was begun.
Surgery was performed on five because .of de-
velopment of scar tissue or other special indica-
tions.
“Most of the patients were limiting their ac-
tivity, restricting diet and using antacids be-
fore their trial of banthine,” the doctors say.
“During treatment they were advised to dis-
continue use of antacids. With few exceptions,
they were encouraged gradually to return to
work and resume a normal diet during the first
week or two oE treatment.
“With the exception of two patients, the group
has continued regular work or. if originally
incapacitated, has returned to regular work.
Pain of ulcer usually is relieved completely
before healing can occur.
“It is much better that peptic ulcer when
possible should be treated medically. It is our
present opinion that banthine is a medical treat-
ment better than that heretofore available and
that need fot surgery has and will decrease.
Perhaps scar tissue can be avoided by prophy-
lactic use of a simple treatment such as ban-
thine. However, obstruction already present to
a pronounced degree may lead to failure of ban-
thine therapy and need for surgical intervention.
“Results with banthine used in lieu of rest,
restriction of diet or antacids or other medica-
ments have been gratifying. Elimination of con-
ventional restrictions and medical treatments
necessary for study purposes, however, is not
necessarily recommended as a good general
practice. Occasionally because of delay of relief
of pain or recurrence of pain banthine treatment
has been supplemented.”
REPORT OF DELEGATES TO THE
AMERICAN MEDICAL ASSOCIATION
(April 18, 1950 l
Since the 1948 annual session of our Associa-
tion we have suffered our greatest loss, in many
years, in the field of medical legislation. Dr.
Olin .H. Weaver served this Association, the
people of Georgia, the American Medical Asso-
ciation and the people of the United States
wisely and well. He was faithful, punctual,
industrious, endowed with unusual judgment,
loyal, courageous and fearless. He was patient
and tireless in sifting the wheat from the chaff,
in innumerable long committee meetings and
exhausting meetings of the House of Delegates.
His conclusions were arrived at only when all
the facts had been presented, after which he
maintained his position regardless of all pres-
sure groups. In his passing we have lost an
able, true and great representative. In the deep-
est humility, we say:
“Well done thou good and faithful servant.”
(Will the audience please rise in a moment
of silent tribute?)
Dr. Minchew, Dr. Sharp and I attended all
the meetings, both formal and informal, of the
Ninety-Seventh Annual Session of the Ameri-
can Medical Association held in Chicago in
June, 1948 and of the Interim Session held in
3 11
The Journal of the Medical Association of Georgia
St. Louis in December, and also, in addition,
many committee meetings. All the official pro-
ceedings have been published in The Journal
oj the American Medical Association and many
abstracts of the most important matters dis-
cussed in our own Journal by Dr. Shanks, our
Editor. Of course, the long discussions, many
of them controversial and some of them before
the entire membership of the House of Dele-
gates, are too voluminous for publication in
detail. Some idea of the very great interest
taken in the proceedings by the constituent asso-
ciations is the fact that of a total of 175 dele-
gates 173 were in actual attendance.
The most important single fundamental action
taken at the Chicago Session was the final
adoption of the revised Constitution and By-
Laws. This was the first complete revision in
more than forty years. It was begun at the
1946 Session held in San Francisco. Nine
completely re-written and revised drafts were
submitted to the delegates for their study,
criticisms and suggestions. Your delegation was
represented at all committee hearings. Your
delegates presented many written suggestions
which we considered safeguards to the constitu-
ent associations and individual members. We
literally fought an unceasing battle from June
1946 to June 1948 for what we believed and
still believe to be right. We are happy to report
that Article 1 of the new Constitution still
carries as its second sentence the following: “It
is a federacy of its constituent associations”.
Thus, the individual state associations still main-
tain their absolute control over membership
and all other matters of state and local concern.
We also consider of paramount importance
our amendment to Article 5 the phrase — -“As
determined by their constiuent associations”.
This allows each constituent association to
enumerate its own members without any “check-
back”, “striking out” or additions by any other
authority. In other words, the official list of
the members of the Medical Association of
Georgia as sent in by the Secretary-Treasurer of
this Association is the official list of members
of the American Medical Association in Georgia.
One other amendment is of great concern
to our Association. It occurs in Chapter IX,
Section 1 ( C ) of the By-Laws: “Apportionment.
— The apportionment of delegates from each
constituent association shall be one delegate
for each thousand (1,000) active members or
fraction thereof, as recorded in the office of the
Secretary of the American Medical Association
on December 1st of each year. Such appor-
tionment shall take effect the ensuing January
1st and shall remain effective for one year there-
after. In December of each year the Secretary
of the American Medical Association shall
notify each constituent association of the num-
ber of delegates to which it is entitled during the
next succeeding year”.
The most widely discussed action of the
Interim Session held in St. Louis in December
1948 was the assessment of all members of the
American Medical Association of $25.00 each.
This was done only after full and free dis-
cussion, careful consideration, and mature den
liberation by all members of the House of
Delegates in informal meeting. In the formal
meeting it was passed unanimously.
For more than a hundred years the American
Medical Association has had in its Constitution
and By-Laws a provision for dues and assess-
ments. Since the reorganization of the Ameri-
can Medical Association in 1902 no dues or
assessments have been charged although this
provision has remained in the Constitution and
By-Laws. From time to time voluntary contri-
butions have been asked for and received to
carry out many of the various phases of the
association's activities. For the most part these
fund-raising campaigns have been carried out
by individual members and groups of members
acting both independently and with other
organizations. Thus, the burden heretofore
has fallen chiefly on the willing who have not
always been the most able. We are firmly
convinced that the most democratic way of
raising funds is to let each member pay his
individual allotment, particularly when the ob-
ject is for the benefit of all. We were faced
with the necessity of charging members so
much per year for dues or allowing them to
make a single payment in the form of an assess-
ment. We believe the great majority of our
members will prefer the single assessment and
furthermore we believe that they will pay it
willingly and gladly. Particularly will they do
so when they stop to consider the great amount
of self-sacrificing work done by many of their
fellow members to carry out the objects of the
association which are “to promote the science
and art of medicine and the betterment of public
health”.
In conclusion, we assure you of our sincere
appreciation of your trust and confidence in
us as your delegates to the American Medical
Association.
Respectfully submitted,
B. H. MINCHEW, M.D.
C. K. SHARP, M.D.
ALLEN H. BUNCE, M.D.. Chairman.
The Journal would like to record the scientific
work of Georgia physicians. It earnestly requests,
therefore, that each physician in the State who
publishes a contribution in some other medical
periodical submit an abstract of the article for
these columns.
The Medical Association of Georgia will
hold its next annual session at the Bon Air
Hotel Augusta, April 17-20, 1951.
August, 1950
345
ERNST & ERNST
Accountants and Auditors
System Service
Atlanta
Dr. W. G. Elliott
Chairman of The Council
The Medical Association of Georgia
Cuthbert, Georgia
We have examined the records and files maintained in the office of the Secretary and Treasurer of The
Medical Association of Georgia. The scope of our examination included a review of the cash transactions for the
year ended March 31, 1950, and accounting for the income of the Benevolent and Building Funds and the Abner
Wellborn Calhoun Lectureship Fund for the year then ended, and assets held in the funds at March 31, 1950.
The records of cash transactions for six monthly periods selected by us were tested by comparisons of the
totals of cash receipts recorded in the cash book with deposits shown by monthly bank statements and by inspec-
tion of paid checks, invoices and other data on file in support of the recorded disbursements.
Cash on deposit was reconciled with the amounts reported to us by the depository banks.
Securities comprising the Benevolent and Building Funds were being held in safekeeping by the Federal
Reserve Bank of Atlanta as confirmed directly to us.
Securities and cash representing the Abner Wellborn Calhoun Lectureship Fund were accounted for by
direct correspondence with The Citizens and Southern National Bank, Atlanta, Georgia, Trustee.
A statement of cash receipts and disbursements is included herein. Also included is a statement of assets
and liabilities of the several funds and schedules of accounts receivable and accounts payable at March 31, 1950.
The amounts stated for accounts receivable and accounts payable were determined from the records of The
Association and, at the request of the Secretary-Treasurer, we did not correspond with the recorded debtors
or creditors to confirm the book balances.
Insurance protection of The Association as determined from policies inspected by us is shown on another page
of this report.
Ernst & Ernst
Certified Public Accountants.
Atlanta, Ga.
May 15, 1950.
STATEMENT OF CASH RECEIPTS AND DISBURSEMENTS
THE MEDICAL ASSOCIATION OF GEORGIA
Year Ended March 31, 1950
GENERAL FUND
Cash balance — March 31, 1949_
General receipts and disbursements:
Receipts:
Membership dues collected:
For year 1950
F or year 1949
For year 1948
Received from American Medical Association for
services, postage, etc :
Interest on savings share account No. 6585 of Standard
Federal Savings and Loan Association
Disbursements:
Salaries and extra compensation:
Secretary and Treasurer . $3,000.00
Clerical 5,850.00 $ 8,850.00
Less portion allocated to Association Journal 3,937.50 $ 4,912.50
.$ 5,976.91
6,841.56 12,818.47
Office equipment purchased 887.83 18,618.80
$ 6,828.78*
Other receipts and disbursements:
Annual meeting:
Fees collected from exhibitors . $ 7,241.50
Less expenses of annual meeting 2,925.52 4,315.98
Association Journal:
Subscriptions received
Advertising receipts
$11,032.75
16,967.53 $28,000.28
Expenses — as shown by schedules:
Public relations office
Administrative and other
$ 7.308.75
3,536.00
20.00 $10,864.75
732.25
193.02 $11,790.02
346
The Journal of the Medical Association of Georgia
Less expenses:
Salaries allocated I 3,937.50
Publication expenses — as shown by schedule 16,504.92 20,442.42 7,557.86
American Medical Association:
Dues, etc. collected for remittance to A.M.A. $20,237.00
Less amount remitted ... . 18,137.00 2,100.00
Withholding (payroll) taxes:
Collected from employees for payment to Collector of
of Internal Revenue $ 1,080.90
Less payments remitted 751.80 329.10
Benevolent and Building Funds:
Interest received from U. S. Savings bonds $ 1,205.00
Less U. S. Savings bond purchased - 1.000.00 205.00
NET INCREASE IN CASH DURING YEAR 7,679.16
CASH BALANCE— MARCH 31, 1950 $39,041.28
ABNER WELLBORN CALHOUN LECTURESHIP FUND
Cash balance — March 31, 1949 $ 530.89
Receipts — dividends on stocks owned by fund $ 195.00
Disbursements — fees paid to Trustee 10.58 184.42
CASH BALANCE— MARCH 31, 1950 $ 715,31
*Indicates disbursements in excess of receipts.
DETAILS OF EXPENSES
THE MEDICAL ASSOCIATION OF GEORGIA
Y^ar ended March 31, 1950
PUBLIC RELATIONS OFFICE
Salaries:
Director — - $3,152.77
Clerical 1,233.35 $ 4,386.12
Traveling expenses 659.95
Office supplies and expenses 266.05
Exhibit space — Southeastern Fair 200.00
Telephone and telegraph 195.18
Exhibit — Georgia State Fair 101.11
Postage 60.00
Printing 36.00
Sundry 72.50
TOTAL $ 5,976.91
ADMINISTRATE E AND OTHER EXPENSES
Travel expenses $ 1,849.64
Medical defense — legal, etc 1,423.95
Pension 600.00
Public policy and legislation.—— 594.40
Contribution to Fulton County Medical Society library 500.00
Postage 492.00
Honorarium to president j, 300.00
Office supplies and expense 287.20
Stationery and printing 265.65
Dr. W. L. Benedict — lecture at annual meeting 150.00
Telephone and telegraph - 147.89
Insurance 71.45
Sundry 159.38
TOTAL $ 6,841.56
PUBLICATION OF ASSOCIATION JOURNAL
Printing $15,161.80
Cuts of illustrations i 678.61
Commission paid . 278.27
Postage 220.00
Clipping service !. 60.00
Addressograph supplies — service 56.25
Copyright fees 48.00
Telegrams 1.99
TOTAL
$16,504.92
Aucust, 1950
347
STATEMENT OF FUNDS — ASSETS AND LIABILITIES
THE MEDICAL ASSOCIATION OF GEORGIA
March 31, 1950
General
Fund
Benevolent
and
Building
Funds
Abner IF.
Calhoun
Lectureship
Fund
Combined
ASSETS
Cash
Securities owned (total market value $66,165,251
Accounts receivable
Office furniture and equipment
$39,041.28
.00
2,724.03
887.83
$ .00
63,320.00
.00
.00
$ 715.31
4,604.00
.00
.00
$ 39,756.59
67,924.00
2,724.03
887.83
TOT \L ASSETS .
$42,653.14
$63,320.00
$5,319.31
$111,292.45
LIABILITIES
Accounts payable:
American Medical Association
Taxes withheld from employees
Other
$ 2,100.00
329.10
2,033.71
$ .00
.00
.00
$ .00
.00
.00
$ 2,100.00
329.10
2,033.71
TOTAL LIABILITIES
$ 4.462.81
$ .00
$ .00
$ 4,462.81
EXCESS OF ASSETS OVER
LIABILITIES
$38,190.33
$63,320.00
$5,319.31
$106,829.64
Note A — Office furniture and equipment shown above does not include items purchased prior to April
1, 1949.
Note B — During the year ended March 31, 1950, $750.00 was paid from the General Fund which was
properly payable from specific funds as follows:
Abner W. Calhoun Lectureship Fund (Dr. W. L. Benedict — for lecture at annual meeting) $150.00
Benevolent Fund (pensions)— _ 600.00
$750.00
CASH ON DEPOSIT — GENERAL FUND
THE MEDICAL ASSOCIATION OF GEORGIA
March 31, 1950
The Citizens and Southern National Bank, Atlanta, Georgia $32,461.35
Standard Federal Savings and Loan Association, Atlanta, Georgia 6,579.93
TOTAL $39,041.28
BENEVOLENT AND BUILDING FUNDS — SECURITIES OWNED
THE MEDICAL ASSOCIATION OF GEORGIA
March 31, 1950
U. S. GOVERNMENT SAVINGS BONDS
SERIES F
Due June 1. 1956
Due June 1. 1961...
SERIES G
Due July 1. 1957
Due March 1, 1959
Due Jan. 1. 1960
Due Jan. 1. 1962. ..
TOTALS
Face
Redemption
Cost
Amount
Value
$ 7,400.00
$10,000.00
$ 8,090.00
5,920.00
8,000.00
5,920.00
15,000.00
15,000.00
14.205.00
15,000.00
15,000.00
14,265.00
15,000.00
15,000.00
14,430.00
5,000.00
5,000.00
4,940.00
$63,320.00
$68,000.00
$61,850.00
Note — The Association appropriated funds for benevolence and building as follows:
$25,000.00
35,000.00
Benevolence
Building
$60,000.00
TOTAL
348
The Journal of the Medical Association of Georgia
\BNER WELLBORN CALHOUN LECTURESHIP FUND
(THE CITIZENS AND SOUTHERN NATIONAL BANK. ATLANTA, GEORGIA — TRUSTEE)
THE MEDICAL ASSOCIATION
March 31, 1950
OF GEORGIA
CASH HELD BY TRUSTEE
Principal
Income
Cash
Cash
Combined
Balance — Mar. 31, 1949-
$369.15
$161.74
$530.89
Receipts:
Dividends received :
Georgia Power $6.00 preferred stock.—
.00
150.00
150.00
Atlanta Gas Light 4%% preferred stock
.00
45.00
45.00
Transferred to “Principal” front “Income”- — (see note below)
199.91
199.91*
.00
$569.06
$156.83
$725.89
Disbursements:
Fees paid to Trustee - —
.00
10.58
10.58
BALANCE— MAR. 31. 1950
$569.06
$146.25
$715.31
SECURITIES HELD BY TRUSTEE
Number ol
Market
Carrying
Shares
Value
Amount
Atlanta Gas Light 41/>% preferred stock
10
$1,030.00
$1,040.00
Georgia Power $6.00 preferred stock
25
2,856.25
2,849.00
Southwestern Railroad common stock
13
429.00
715.00
TOTALS
$4,315.25
$4,604.00
TOTAL CASH AND SECURITIES
$5,319.31
* Indicates red figures.
Note — Under the provisions of the trust indenture, “all unexpended income in the hands of trustee on July 1st
of each year shall be added to the principal of the trust fund”.
ACCOUNTS RECEIVABLE
THE MEDICAL ASSOCIATION OF GEORGIA
March 31, 1950
EXHIBITORS AT ANNUAL MEETING
Brayton Pharmaceutical Company
Estes Surgical Supply Company
Everhart Surgical Supply Company
General X-Ray Corporation
Lullaby Diaper Service..
Majors Company, J. A
Marks Surgical Supplies, Inc
Van Pelt and Brown, Inc.
FOR ADVERTISING
American Medical Association
Atlanta Graduate Medical Assembly :
Ballard Optical Company, Walter
City View Sanitarium rj,_
Coca-Cola Company, The
Eager and Simpson
Emory University Hospital ^
Georgia Baptist Hospital
Keeley Institute, The r: -,\ _
Landham and Klugh, Doctors ...
Long Hospital, The Crawford W.._
Marshall and Bell, Inc
Mathis, R. L
New York Polyclinic Medical School and Hospital
Orr Doctors Building, W. W. ;
Patrick, Robert E
Peachtree Sanitarium
Piedmont Hospital *
Pineworth, Inc.
Smullian, A. H
$150.00
250.00
150.00
250.00
150.00
200.00
225.00
225.00
$833.65
32.40
9.00
12.00
20.00
9.00
12.00
12.00
18.00
9.00
12:00
7.50
11.00
16.00
7.50
6.00
24.99
12.00
10.00
5.00
$1,600.00
August, 1950
349
Southern Life Insurance Company ol Georgia ..
St. Joseph's Infirman
Thompson Company, J. Walter .
TOTAL
EQUIPMENT PURCHASED
THE MEDICAL ASSOCIATION OF GEORGIA
Year ended March 31. 1950
For public relations office:
Typewriter
Mimeograoh
. $140.51
185.94
Desk, chair, and filing cabinet ...
For office of secretary-treasurer:
Electric fans
—
374.98
$ 41.00
$701.43
Projector
TOTAL
145.40
186.40
$887.83
ACCOUNTS PAYABLE
THE MEDICAL ASSOCIATION OF GEORGIA
March 31. 1950
18.00
12.00
14.99 1.124.03
S2.724.03
Name
For
Amount
American Medical Association .... Dues collected
Collector of Internal Revenue Withholding tax
Other accounts payable:
Addressograph-Multigraph Corporation Service
Artcraft Engraving Company Cuts
Atlanta Linen Service Service
Dunnaway, John A Legal services ....
$2, 100.00
329.10
12.50
4.53
3.10
75.00
Franklin Printing and Manufacturing Company... Printing 1.256.34
2.10
25.00
75.00
347.00
39.25
5.00
103.35
72.05
8.49
Foote and Davies, Inc. Stationery
Georgia Press Association _ Mailing Service ........
Huff. Mrs. E. Z. . ..Salary ..
Shanks, Edgar D Traveling, public policy & Legislation
Southern Bell Telephone and Telegraph Company ...Service
Southern Press Clipping Bureau .Service
St. Louis Button Company Badges
Thompson Printing Company Printing,
Western Union Telegraph Company ... Service .
etc.
2,033.71
TOTAL
1.462.81
INSURANCE PROTECTION
THE MEDICAL ASSOCIATION OF GEORGIA
March 31. 1950
LOSS OR DAMAGE TO PROJECTORS, LOUDSPEAKERS, SCREENS,
PUBLIC ADDRESS SYSTEM, ETC. $3,400.00
FIRE
Office furniture, fixtures, books and medical publications in office 2,000.00
FIDELITY BONDS
Secretary and Treasurer _ $1,000.00
Miss Viola Berry 1,000.00 2.000.00
BLUE CROSS MAKES PROGRESS
Nearly a hundred million dollars, representing more
than 88 per cent of income, was paid to hospitals by
the voluntary, non-profit Blue Cross Plans for care
of members during the first quarter of 1950, Richard
M. Jones, Chicago, director, Blue Cross Commission of
the American Hospital Association, said recently.
From a total income of $109,801,301, the 90 Blue
Cross Plans of the United States and Canada paid
$96,989,972 for member’s care and used only $9,184,-
564 (8.37 per cent) for operating expenses.
There are more than 38,000,000 persons enrolled in
the Blue Cross Plans in the United States and Canada,
representing more than 24 per cent of the United
States population and 21 per cent of the Canadian
people.
MEDICAL COLLEGE OF GEORGIA
Dr. -G. Lombard Kelly, President of the Medical
College of Georgia, Augusta, announces the seventh
offering of a post-graduate course in Office Endo-
crinology. This course will be given under the direc-
tion of Dr. Robert B. Greenblatt, September 4-9,
1950. Dr. Edward Henderson of Bloomfield, N. J. and
Dr. Carlos P. Lamar of Miami, Fla., will be visiting
lecturers. The tuition fee for the course (including
luncheons) is $50. Send applications to Registrar,
Medical College of Georgia, Augusta.
350
I he Journal of the Medical Association of Georgia
OMAN’S AUXILIARY TO THE MEDICAL ASSOCIATION OF GEORGIA
President
Mrs. Lehman W. W illiams
135 East 45th Street
Savannah
President-Elect
Chai rrnan Organization
Mrs. J. R. S. Mays
2587 Elizabeth Street
Macon
First Vice-President
Program Chairman
Mrs. Ralph Fowler
303 McDonald Street
Marietta
Second Vice-President
Chairman Today's Health
Mrs. John W. Turner
3985 Vermont Road. N. E.
Atlanta
Third Vice-President
Scrapbook Chairman
Mrs. Paul T. Russell
513 N. Cleveland Drive
Albany
Recording Secretary
Mrs. Leo Smith
St. Mary’s Drive
Waycross
Corresponding Secretary
Mrs. C. R. A. Redmond
113 Henry Avenue
Savannah
OFFICERS 1950-1951
T reasurer
Mrs. Robert C. Major
Magnolia Drive, Forrest Hills
Augusta
Historian
Mrs. Robert Crichton
Milledgeville State Hospital
Milledgeville
Pari iam en tarian
Mrs. W. Bruce Schaefer
110 East Franklin
Toccoa
Achievement Award
Mrs. William H. Benson
Burnt Hickory Road
Marietta
Archives
Mrs. C. W. Roberts
75 Ponce de Leon Ave., N. E.
Atlanta
Budget
Mrs. Ralph Chaney
Bransford Road
Augusta
Bulletin
Mrs. Milford B. Hatcher
274 Jackson Springs Road
Macon
Doctor's Day
Mrs. Virgil Williams
Griffin
Editorial
Mrs. Ben Hill Clifton
1893 Wycliff Road, N. W.
Atlanta
Mrs. J. Bonar White Exhibits,
and Scrapbook Awards
Mrs. R. E. Jones
1014 Love Avenue
Tifton
Legislation
Mrs. Harold Smith
4 Henry Avenue
Savannah
Public Relations
Mrs. J. Harry Rogers
699 E. Paces Ferry Rd., N.E..
Atlanta
Research in Romance
of Medicine
Mrs. T. J. Ferrell
1521 St. Mary’s Drive
Waycross
Revisions
Mrs. Lee Howard
625 East 44th Street
Savannah
Student Loan Fund
Mrs. Shelley C. Davis
1259 Peachtree Battle Ave..
N. W.
Atlanta
Mrs. James H. Brawtter Trophy
Mrs. J. Harry Rogers
699 E. Paces Ferry Rd., N.E.
Atlanta
Camellia Garden
Mrs. R. W. Bradford
Milledgeville State Hospital
Milledgeville
REPORT OF PRESIDENT ROGERS
(April 18, 1950)
Mr. President and Members of the
House of Delegates:
It is my privilege tonight to appear before you and
give you an account of the work which we have done
this year, work which we have accomplished as your
Auxiliary. We understand full well that we are an
Auxiliary and we do nothing without your approval.
On August 9, 1949, the Executive Board of the
Auxiliary met with the members of the advisory com-
mittee from the Medical Association and presented
our plans for the year’s work. We are grateful to the
members of this committee — Dr. Murdock Equen, chair-
man; Dr. Ralph H. Chaney. Dr. J. Harry Rogers, Dr.
C. F. Holton, Dr. W. G. Elliott. Dr. Eustace A. Allen.
Dr. Bruce Schaefer. Dr. Thomas Ross and Dr. Shelley
Davis for their assistance and their support during
the year.
At this meeting they felt, as we hoped they would,
that the most important thing we could do this year
would be to try to alert not only our members but also
our friends to the dangers America faces in the proposed
compulsory health insurance bills. So, with their
approval, we adopted “Fight With Knowledge” as
our theme for the year and placed most emphasis on
our first objective, that of forming study clubs to
learn everything possible about the bills introduced
in Washington, and also about the A.M.A.’s 12 Point
Program.
On August 10, the Auxiliary held its third annual
mid-summer conference at which county presidents and
presidents-elect met with the executive board for a
fuller discussion of suggested work. At luncheon
that day we were fortunate in having four of you with
us. Dr. Enoch Callaway, president of the Medical1
Association of Georgia; Dr. Murdock Equen, chair-
man of the Advisory Committee to the Woman’s-
Auxiliary; Dr. Eustace A. Allen, the Association's
chairman of Public Relations; and Dr. J. Harry Rogers,
who was there in his capacity as husband of the
Auxiliary president.
This year the Auxiliary has the largest membership
it has ever had, 1,081; there are 31 local auxiliaries
and nine of the districts are organized and active.
With local auxiliaries and members-at-large, we now
have members in 74 counties. Each member is a liaison
between you and the public and this year we were able
to carry our fight for what we believed into a larger
segment of the state’s population than ever before.
I feel very strongly that many members who were
indifferent before, and others who had not cared
enough to find out just what the Auxiliary is, have
become interested because we have had a specific job
— that of alerting ourselves and the public to the
dangers of Oscar Ewing’s brand of medicine.
Our primary interest has been in learning every-
thing possible about the compulsory health insurance
Aucust, 1950
351
{tills in Congress and t he 12-Point A.M.A. Program, and
1 am delighted to be able to report to you that every
Auxiliary and every member-at-large have studied and
they have learned. They have carried that knowledge
with them as they talked to their friends and their
neighbors, over the back fence, at the bridge table,
informally at other women’s meetings and under varied
circumstances. We have about 25 women who are
trained well enough to talk before any group — some
local societies have permitted them to do so, and
others have preferred that they do their talking in a
more informal way.
The Auxiliary has received exceptional cooperation
in this fight from your Public Relations Committee, of
which Dr. Eustace A. Allen is chairman. Mr. Ed
Bridges, director of Public Relations, has been in-
valuable to us, both as a speaker to many of our
auxiliaries as we strove for knowledge and also as
a speaker to lay groups at meetings arranged by us.
We were able to get many influential organizations
to hear Mr. Bridges, among them the Junior League
of Macon, the West Point Woman's Club, the Pilot
Club of Macon, the Council of Social Agencies of
Bibb County, and P.T.A.’s in Avondale Estates, Jeffer-
son and Commerce. Mr. Bridges also wrote an excel-
lent skit, “Voluntarily Yours” for one Auxiliary to
present before the wives of Georgia legislators and
which other auxiliaries have since presented.
While we have devoted our chief efforts to alerting
the public on compulsory health insurance, we have
not neglected the other phases of our program as
approved by your Advisory Committee. We have
worked very hard in cooperation with other groups,
members serving as health chairmen in women’s clubs,
P.T.A.’s, with University Women, with league of
women voters and with many other similar groups.
We have worked closely with the American Red Cross,
the American Cancer Society, the National Foundation
for Infantile Paralysis, the American Heart Association,
the Cerebral Palsy Society of Georgia and with many
projects on the local level, especially suited to some
particular locality.
One of our members has served as co-chairman of
the Governor’s Committee for Georgia’s participation
in the Mid-Century White House Conference for
Children and Youth, and three other of our members
have served on this most important committee. One
member has served as chairman of public relations
for the Georgia Citizen’s Council and has assisted in
arranging the better health conferences. Two members
had charge of these conferences in their region and
one member is chairman of the Executive Committee
of the Better Health Conference of Georgia, which
is the health division of the Georgia Citizens' Council.
We have members in every Auxiliary who are taking
an outstanding part in the health and welfare of their
respective communities as officers in other organiza-
tions. I wish I could enumerate them all, but should
I do so we would be here all night. But I must mention
two important community contributions members have
made. One is president of the largest city federation
of Women’s Clubs in the state and presented an
outstanding program on compulsory health insurance.
Another, who is president of the Chatham County
Children’s Conference, was responsible for a visit to
Savannah of Dr. Grace Overton, who culminated her
week there with a talk, “Your Citizens’ Status in a
Successful Guidance Program in Your Community
Schools.”
One of our smaller auxiliaries has five of its mem-
bers assisting with a speech school and a number
of members have taken the lead in starting cerebral
palsy chapters in various cities. Another smaller
auxiliary presented films on human growth to their
city schools, both w'hite and colored. One of the
larger auxiliaries sponsored a course in parental
guidance, arranged by the Auxiliary and given in
cooperation with the YWCA, the six lectures ' being
opened to the lay public. The program featured the
development of the child from pre-school age through
maturity, stressing emotional development. A brilliant
panel of medical men and lay experts in human
living presented the six lectures.
Our First Vice-President arranged for a booth at
the Georgia State Fair to disseminate health informa-
tion to a large and varied group of people, who we,
as an auxiliary, do not have the opportunity of reaching
by our usual open meetings, forums, etc. This booth
was manned by members of one of the larger auxiliaries
from 12 noon until 10 p.m. daily, Monday through
Friday. They distributed thousands of pieces of health
literature and hundreds of the pamphlet. The Volun-
tary Way Is the American if ay. But the greatest
thing they did was to show six health films to a total
of 11,563 people during that time. This same auxiliary
has been active in its study of compulsory health
insurance, one of the members setting up a plan of
study that the state legislation chairman highly com-
plimented. They also wrote letters to the president
of each organization of women in their city asking
if the Auxiliary could speak to them on compulsory
health insurance or either send them a speaker. This
work resulted in a change in the newspapers’ attitude
in that city, the papers that had formerly been in
favor of compulsory health insurance now straddling
the fence. I am very proud of what each auxiliary
is doing and from their fine reports I could cite many
other outstanding achievements by each group. But
again I must remember that time is limited.
Our next objective was “Every doctor’s wife a mem-
ber of the Auxiliary and an active participant in
Auxiliary activities.” That is still a dream but I hope
very sincerely that all you members of the Medical
Association of Georgia will make yourselves familiar
with what the Auxiliary is striving to do, and then,
if you approve of us and our efforts, go home and
urge your wife to become one of us.
Our fourth objective has been to assist in forming
health councils and we have been actively carrying
out that work in many communities, both in cooperation
with other organizations and under Auxiliary sponsor-
ship. The fifth objective, stressing subscriptions to
Hygeia, the national health magazine published by
the A.M.A., and The Bulletin, official publication of
the Woman’s Auxiliary to the A.M.A., shows a result
of 327 Hygeia subscriptions and 99 Bulletin subscrip-
tions.
Our final objective, and one which is always of
utmost importance to us, is that of sociability. We
stand ready always to entertain county, district and
state medical societies as asked, this promoting fel-
lowship among doctors and their families. That is one
thing that always remains with us, for it is the corner-
stone upon which our Auxiliary has been built. One
of the larger auxiliaries serves dinner twice a month
for their medical society and there are usually about
200 members present. All the auxiliaries have social
hours in connection with their meetings and in this
way are learning to know- each other better. The
friendships formed are lasting and this year we in
the Auxiliary have drawn even closed together as
we have recognized our common danger. This year
every Auxiliary celebrated Doctors’ Day, some with
an elaborate social affair, others with simpler enter-
tainment, but all celebrated March 30 as the day to
honor their doctors.
We have continued our work in research in Romance
of Medicine, 16 papers having been contributed to
the library this year. One Auxiliary is writing a
history of every doctor who has ever practiced in
that county. The Board of Trustees of Fulton County
Medical Society graciously allotted us space at the
Academy of Medicine in Atlanta to keep our perma-
352
The Journal of the Medical Association of Georgia
nent records, which are there in file cases. Members
have continued their contributions to the Student
Loan Fund and we now have on hand a balance, as
of March 27, of $5,105.47, which is available for
loans to eligible medical students. V newer venture
of ours, one that was started last year, is the Camellia
Garden at the State Hospital in Milledgeville. There
are now 101 camellia plants in the garden and about
750 small azalea plants. Auxiliary members have
supervised the work, buying fertilizer, sprays, etc., and
the work is being done by the patients. It is thought
that the garden will increase as an important occupa-
tional therapy project at the hospital as time goes on.
I visited the garden twice during the year and it is
something of which we can all be proud, for it will
grow in beauty yearly.
I have had a very busy year, but one for which I
shall always be grateful. 1 have driven from Rabun
Gap to Tybee Light and I have found Auxiliary
members interested, alert, hardworking and leaders in
their communities. I have driven 8,558 miles over
Georgia this year and I have spoken in every district
in the State. I was privileged to assist in the re-
organization of the Fourth District Auxiliary and also
assisted in the reorganization of Troup County and
the organization of Upson County, and South Georgia
(Valdosta!. Only Saturday I received a long distance
telephone message that a temporary chairman for
organization of Coweta County had been appointed,
following the Fourth District reorganization which a
number of Newnan women attended; and that she
expected to have 20 members enrolled within the
next few days.
I have attended 12 district meetings and 28 County
Auxiliary meetings. 1 also participated fin four legis-
lation and public relations study clubs. I was honored
by being asked to speak to the Fulton County Medical
Society at their public relations meeting and to speak
briefly to the societies of the Second, Fourth, Sixth
and Eighth districts at their semi-annual district
meetings. I have written a total of 952 personal
letters and have addressed 1150 copies of our year-
book, a good part of the work of compilation of which
I did, as well as all the proofreading.
I attended the Conference of State Presidents and
Presidents-Elect with the national officers and chair-
men in Chicago in November, 1949. Two of our
members are national chairmen, Mrs. Bruce Schaefer
as legislation chairman and Mrs. Eustace A. Allen
as revision chairman. Mrs. Schaefer, with Mrs. David
B. Allman, national president, and Mrs. Robert Haynes,
southern president, are among the featured speakers
at our convention.
I have represented the Auxiliary many times during
the year. I have served on the health committee of
The Better Health Conference of Georgia and attended
several meetings of this committee, as well as the
3-day conference of the Georgia Citizens Council. I
was appointed to the Family Life Conference and at-
tended a meeting at which plans for the state-wide
conference to be held in February, 1951, were formu-
lated. I also was appointed to the Governor’s Safety
Conference and attended two all-day sessions of that
conference in Atlanta in March, serving on the com-
mittee on Public Information.
On November 17, 1949, I had a conference with
Governor Herman Talmadge at which I discussed some
of our problems in Georgia in connection with com-
pulsory health insurance and at which I received his
promise of his wholehearted cooperation. I have worked
actively with Mrs. Z. V. Peterson, chairman of legisla-
tion for the Georgia Federation of Women's Clubs, and
have received untold assistance from her. I represented
the Auxiliary at a meeting held in Warm Springs to
which the National Foundation for Infantile Paralysis
had invited state presidents of representative Georgia
women’s groups. I later met with a group of Atlanta
women to formulate plans for a breakfast that was
given later for the benefit of the polio fund.
By Governor Talmadge’s appointment I served on
his committee for Georgia's participation in The Mid-
Century White House conference on children and
youth, held in Atlanta February 28, 1950. 1 served on
the health committee and was appointed by Dr. Guy
Rice, chairman of this group, as one of five persons
to serve on a sub-committee to write the health ques-
tionnaire to be sent to each Georgia county. The
recommendations of this sub-committee will be formally
presented to the full Governor's committee in June.
It has been one of the most satisfying experiences
of my life to serve you and the Auxiliary as president
during 1949-1950. I have met with wonderful coopera-
tion everywhere, and the little I have done has been
made possible by the unswerving loyalty of each of
my officers and chairmen. Nor can 1 forget the wonder-
ful cooperation from the county presidents, who are
after all the heart of our Auxiliary. We who are
officers and chairmen can plan, but the plans must
be carried out on the county level. So to each of
my official family, a swell as to each member of the
Auxiliary, I express my deepest gratitude. And to you
of the Medical Association of Georgia, to Dr. Enoch
Callaway, president; Dr. A. M. Phillips, president-
elect; and Dr. Murdock Equen, chairman of the
Advisory Committee, and to all the others who have
been back of us in all we have attempted this year
( not to forget that husband of mine who patiently
waited for me as I covered those 8,558 miles over
Georgia!, I say, on behalf of the Woman’s Auxiliary
to the Medical Association of Georgia, thank you from
the bottom of our hearts, and God bless you everyone.
MRS. J. HARRY ROGERS,' President,
Woman's Auxiliary to the
Medical Association of Georgia.
MEDICAL COLLEGE OF GEORGIA. AUGUSTA.
SEMINAR IN EXFOLIATIVE CYTOLOGY
AND CANCER DIAGNOSIS
SEPTEMBER 18-23, INCLUSIVE, 1950
A seminar in exfoliative cytology and cancer diag-
nosis is announced by Dr. G. Lombard Kelly, Presi-
dent of the Medical College of Georgia.
A concentrated program of teaching on the funda-
mentals of exfoliative cytology and diagnositic pro-
cedures is provided. Adequate facilities are offered for
miscroscopical and laboratory practice. A second week
is offered for those who wish to devote their time
entirely to the study of the ample material available.
The seminar is presented under the direction of Dr.
H. E. Nieburgs and staff. Guest lecturers will be: Dr.
S. Zuckerman. Professor of Anatomy, University of
Birmingham, England; Dr. H. J. Wespi, Chief of
Obstetrics and Gynecology, Canton Hospital of Aarau,
Switzerland; Mrs. Ruth M. Graham, Vincent Memorial
Hospital, Boston, Mass.; Dr. Ingrid Stergus, Pathologist
Battey State Hospital, Rome, Ga., and Lt. Col. Joe
M. Blumberg, Walter Reed Hospital, Washington, D. C.
MONDAY, SEPTEMBER 18
9:00-10:00 — Registration- — Miss Mary B. Cumbus,
Registrar.
10:00-11:00 — The Value and Limitations of Exfoliative
Cytology in Cancer Diagnosis. — Dr. Nieburgs.
11:00-12:00 — The Effect of Hormones and Endocrine
Disorders on Vaginal and Endocervical Smears —
Dr. Nieburgs.
12:00-1:00 — Histiogenesis of Tissues Responsive to
Estrogens.— Dr. Zuckerman.
1:30-2:30 — Lunch and Round Table Discussion.
3:00-4:00 — Histiogenesis of Tissues Responsive to
Estrogens (Cont.) — Dr. Zuckerman.
4:00-5:00 — Vaginal Smears in Childhood, Adolescence ;
Puberty, Childbearing Age, Pregnancy and
Menopause. — S. Bamford.
Aucust, 1950
353
TUESDAY. SEPTEMBER 19
9:00-10:00 — Vaginal Smears in Childhood, Adoles-
cence; Puberty, Childbearing Age, Pregnancy
and Menopause. — (Continuation) — Dr. Nieburgs.
11:00-12:00 — Diagnosis of Endocrine Disorders in
Childhood, Pregnancy and Menopause by V a-
ginal Smears — Dr. Nieburgs.
12:00-1:00 — Carcinogenic Factors of Cervical Cancer.
—Dr. Nieburgs.
1:30-2:30 — Lunch and Round Table Discussion.
3:30-5:30 — Laboratory and Microscopy.
8:00-9:00 — Motion Picture : Uterine Cancer : Path-
ogenesis, Detection and Diagnosis.
WEDNESDAY, SEPTEMBER 20
9:00-10:00 — Morphogenesis of Cervical Cancer. — Dr.
Pund.
10:00-11:00 — The Genesis and Diagnosis of Preinvasive
Cancer. — Dr. Wespi.
11:00-12:00 — Cell Morphology in Endocervical Smears
from Invasive Cervical Cancer. — S. Bamford.
12:00-1:00 — Specific Cell- Morphology in Endocervical
Smears from Preinvasive Cervical Cancer. Dr.
Nieburgs.
1:30-2:00 — Lunch and Round Table Discussion.
3:00-5:30 — Laboratory and Microscopy.
8:00-9:00 — Photomicrography and Motion Picture
Photomicrography in the Study of Cancer Cells;
Professional and Office Procedures. — Mr. Wood
and Dr. Nieburgs.
THURSDAY, SEPTEMBER 21
9:00-10:00 — Cell Morphology in Adenocarcinoma of
the Cervix and Fundus. — Dr. Nieburgs.
10:00-11:00 — Sources of Error. — Dr. Nieburgs.
11:00-12:00 — The Value of Endocervical Smears during
and following Radiation Therapy. — Ruth M.
Graham.
12:00-1:00 — The Role of Colposcopy, Schiller Test,
and Exfoliative Cytology in the Early Diag-
nosis of Cervical Cancer. — Dr. Wespi
1:30-2:30 — Lunch and Round Table Discussion.
3:00-5:30 — Laboratory and Microscopy.
8:00-9:00 — Motion Picture: The Problem of Early
Diagnosis. (Breast Cancer .)
FRIDAY, SEPTEMBER 22
9:00-10:00 — Pathogenesis of Pulmonary Cancer. — Dr.
Pund.
10:00-11:00 — Cytologic Examination of Sputum and
Pleural Fluids in Tumors of the Chest. — Dr.
Stergus.
11:00-12:00 — Diagnosis of Gastric Cancer by Exfoliative
Cytology. — Ruth M. Graham.
12:00-1:00 — Normal and Abnormal Cells in the Urine
and Prostatic Secretion. — Ruth M. Graham.
1:30-2:30 — Lunch and Round Table Discussion.
3:00-5:30 — Laboratory and Miscroscopy.
8:00-9:00 — The Role of the Pathologist in Cancer
Detection. — Col. Blumberg.
SATURDAY, SEPTEMBER 23
9:00-10:00 — Recent Advances in Radioactive Tech-
niques for Cancer Diagnosis and Treatment.
■ — Dr. Schmidt.
10:00-11:00 — Procedures and Evaluation of Recent
Chemical Tests for the Diagnosis of Cancer
(Demonstration Lecture) — Dr. Singal.
11:00-12:30 — Clinical Demonstration of Procedures for
V aginal and Endocervical Smears, Cervical
Biopsies Endocervical Scarpings and Endomet-
rial Biopsy. — Dr. Nieburgs.
12:30-1:30 — Lunch and Round Table Discussion.
2 :00-4 :00 — Microscopy.
SEPTEMBER 25-30— INCLUSIVE
Microscopic examination of slides and laboratory pro-
cedures.
FACULTY
DR. H. J. WESPI, Chief of Obstetrics and Gynecology,
Canton Hospital of Aarau, Switzerland.
DR. S. ZUCKERMAN, Professor of Anatomy, l niver-
sity of Birmingham, England.
MRS. RUTH M. GRAHAM, Vincent Memorial Hos-
pital, Boston, Massachusetts.
DR. INGRID STERGUS, Pathologist, Battey State
Hospital, Rome, Ga.
LT. COL. J. M. BLUMBERG, Pathologist, Walter
Reed General Hospital, Army Medical Center,
Washington, D. C.
DR. E. R. PUND, Professor of Pathology, Medical
College of Georgia, Augusta, Ga.
DR. H. L. SCHMIDT, Consultant in Medicine, Oak
Ridge Institute of Nuclear Studies.
DR. S. A. SINGAL, Associate Professor of Biochemis-
try, Medical College of Georgia, Augusta, Ga.
MRS. S. BAMFORD. M.S., Department of Clinical
Cytology, Medical College of Georgia, Augusta,
Ga.
MR. H. E. WOOD, B.P.A., Department of Art as
Applied to Medicine, Medical College of Georgia,
Augusta, Ga.
DR. H. E. NIEBURGS, Director, Department of Clini-
cal Cytology, Medical College of Georgia, Augus-
ta, Ga.
The fee is $75.00 for the first week and $100.00 for
both weeks. Applications should be sent to the Regis-
trar, Medical College of Georgia, Augusta, Ga. Deposits
should be made to the Registrar, Medical College of
Georgia, Augusta, Ga. Enrollment limited. Hotel
reservations may be obtained from the Sheraton Bon
\ir Hotel, Partridge Inn or the Richmond Hotel,
Augusta, Ga.
NEWS ITEMS
The Appling County Medical Society held its
regular monthly meeting at the public health office,
Baxley, June 13. Dr. Richard Torpin, Augusta, Profes-
sor of Obstetrics and Gynecology at the Medical College
of Georgia was the guest speaker. His subject was:
‘'Complications of Pregnancy and Labor and Their
Treatment in General Practice.” He stressed the im-
portance of a high protein and low salt diet in the
prevention of toxemia pregnancy and the treatment
of the secondary anemia that goes along with preg-
nancy, especially anemia that goes along with hook-
worm infestation. It is believed that 50 per cent of the
population of Appling County is infected with hook-
worm. Guests were Dr. Iverson Bryans, Jr., Augusta,
formerly of Baxley; Dr. John W. Mauldin, Alma;
Dr. C. R. Y oumans, and Dr. S. W. Martin, Hazlehurst.
* * *
Dr. John T. Arnold, Parrott, recently received a
fifty-year go-id service pin and a Certificate of Dis-
tinction from the Medical Association of Georgia “in
recognition of his unselfish devotion to his patients
and his loyalty to the medical profession”. Earlier
this year he was honored by the Randolph-Terrell Medi-
cal Society.
* * *
Dr. William H. Bateman, Dr. Gregory W. Bateman,
and Dr. Joseph D. Woddail, Atlanta, announce the
removal of their offices to 517-520 Grand Theatre
Building, Atlanta.
* * *
The first Better Health Conference in Northeast
Georgia was held on June 9 at the University of
Georgia in Athens. Dr. A. M. Phillips, Macon, Presi-
dent of the Medical Association of Georgia, was the
principal speaker. His subject was: “Community
Action for Better Health.” Approximately 200 persons
from 29 Northeast Georgia counties were present. Others
participating on the program were Drs. T. F. Sellers,
Paul Schroeder, Atlanta, and Dr. T. G. Peacock,
Milledgeville. Mrs. Bruce Schaefer, Toccoa. is chair-
351
The Journal of the Medical Association of Georgia
man of tlie Northeast Regional Committee and planned
the conferenee.
* * *
Dr. Charles G. Boland, Atlanta, was recently appoint-
ed medical director of the Plantation Pipe Line Com-
pany. In addition to advising company officials on
a medical and health program, he will review and
advise the company on all medical reports received
from approximately 50 other examining physicians.
* * *
Dr. Holloway Bush, Macon, announces the removal
of his offices from 613 Bibb Building to his new
office building at 959 Daisy Park. Macon.
* * *
Dr. J. M. Byne. Jr., Waynesboro: Dr. J. Dewey Gray,
Augusta; Dr. C. L. Ridley. Macon; Dr. Charles N.
Wasden, Macon, and Dr. H. G. Weaver, Macon, were
recently elected to the Alpha Omega Alpha honorary
medical fraternity, which is a national honorary medical
fraternity.
* * *
• Dr. Amey Chappell, Atlanta, was recently installed
as President of the American Medical Women's Asso-
ciation at its annual meeting held in Carmel. California.
* * *
The regular monthly meeting of the Sectional Staff
of Crawford W. Long Memorial Hospital was held
at the hospital. Atlanta, July 11. Program: Pediatric
Section. “Mortality Statistics for April” by Dr. W. L.
Bridges; Medical Section. "The Lymphomas”, Dr.
Charles M. Huguley, Jr.; Surgical Section, "Tracheo-
esophageal Fistula” by Dr. Richard King; General
Practitioners, “Problems for General Practitioners” by
Dr. Frank Eskridge, Sr.
* * *
Dr. Lester C. Crismon. formerly of Atlanta, is now
stationed at Bungalow' No. 175, Lago Colony, Aruba,
Netherlands West Indies. He is associated with the
Lago Oil & Transport Company, Ltd.
* * *
Dr. Theodore Everett, a native of Chipley, Fla., and
for the past two years a resident in urology at
L^niversity Hospital, Augusta, announces the opening
of his office at 1345 Greene Street, Augusta. Practice
limited to urology. Dr. Everett graduated from Tulane
University of Louisiana School of Medicine. New
Orleans, La. He served his internship at Jackson
Memorial Hospital, Miami, Fla., and served in the
Medical Corps of the U. S. Navy in the Pacific area
in 1945-1946. Prior to coming to University Hospital
he was a resident in urology at Hillcrest Memorial
Hospital, Tulsa, Okla.
* * *
Dr. David B. Fillingim, Savannah, was recently
presented a silver tray by the board of trustees of
the Warren A. Candler Hospital in behalf of his
services during the past year. The presentation was
made at the monthly meeting of the board at the
hospital.
* * *
The Fourth District Medical Society held its meet-
ing in Thomaston on June 12. The Upson County
Medical Society was host at a dinner at the Veterans
Clubhouse. Dr. J. M. Kellum, Thomaston, arrangements
committee.
* * *
Dr. Thomas R. Freeman, formerly at Lawson VA
Hospital, Chamblee, announces the opening of his
offices at 513 Whitaker Street, Savannah. Practice
limited to surgery.
* * *
Dr. William F. Friedewald, Atlanta, professor of
bacteriology at Emory University School of Medicine,
has been awarded a $13,176 grant by the National
Cancer Institute, U. S. Public Health Service for the
study of “viruses and tumors.” Dr. Friedewald and
other members of the Bacteriology Department will try
to determine what role viruses play in producing cancer
— if any. The grant to Emory was one of 50 such
awards made by the Public Health Service to support
cancer research in hospitals, universities and other
non Federal institutions in 30 states.
* * *
The Fulton County Medical Society held its semi-
monthly meeting at the Academy of Medicine, Atlanta,
on July 20. The moderator was Dr. Joseph H. Rankin.
Program: “Anesthesia in Pediatric Surgery”, Dr.
William H. Galvin; “Surgical Treatment of Gastric
Ldcer” by Dr. Duncan Shepard. Members of the
Clayton-Fayette and Henry County Medical Societies
were special guests.
* « *
Dr. Robert B. Greenblatt, Dr. Calvin H. Chen, and
Robert B. Dienst, Ph.D., all of Augusta, recently
announced that gonorrhea can be cured in one day—
simply by taking three doses of aureomycin at intervals
of a few hours. The report wras published in the
Journal of the American Medical Association. Research
on the matter has been going on for about two years.
The doctors said they had 98 per cent success in
treating 50 cases in this manner.
* * *
Dr. Thomas M. Hall. II, formerly of the Milledgeville
State Hospital, Milledgeville, recently accepted a post
on the medical staff of the Fairfield State Hospital,
Newtown, Connecticut.
* * *
Dr. Charles Howard, Atlanta, announces the asso-
ciation of Dr. Byron Harper in the practice of medicine,
561 Lee Street, S. W., Atlanta.
* * *
Dr. A. E. James, Albany, was recently named to
the American Board of Surgery. He has been working
toward this appointment since 1940. and is one of
5.000 United States physicians wrho have been en-
dorsed by the American Board since 1937.
* * *
Dr. George Lane, formerly associated with Dr.
George H. Alexander in the Alexander Clinic, Forsyth,
recently accepted a residency in surgery in the General
Hospital, Greenville, S. C. Dr. Thomas L. Hodges,
Jr., a native of Decatur, succeeded Dr. Lane at the
Alexander Clinic.
* * *
Public Relations Office, Medical Association of Geor-
gia: This office has been restaffed and the committee
of the Association responsible for the public relations
program is presently engaged in revamping the work
to be done by this department. Meet, if you please,
Mr. Richard J. Eales, Executive Secretary of this depart-
ment, and his secretary, Miss Aldyne Johnson. Com-
munications to the public relations department should
be addressed to 875 West Peachtree St., N. E., Atlanta.
* * *
Dr. Thomas F. Little, formerly of Tifton, recently
received his promotion from major to lieutenant colonel
in Tokyo, Japan, where he is a surgeon in the U. S.
First Calvary Division. Dr. Little has been in the
Far East Command since last September. During the
last war he served in the European theatre.
* * *
Dr. R. Bruce Logue, Atlanta, was elected a director
of the Scientific Council of the American Heart
Association at the recent annual meeting in San
Francisco, Calif. Dr. Logue, past president of the
Georgia Heart Association and a member of the Execu-
tive Committee, also was selected as a delegate from
the Council to the Assembly, the policy-making body
of the national organization. Other Georgia delegates
attending the San Francisco meeting were Dr. Gordon
Barrow, Atlanta, and Dr. Goodloe Y. Erwin, Athens.
August, 1950
355
MEETING OF THE EXECUTIVE COMMITTEE OF
THE PUBLIC RELATIONS COMMITTEE,
MEDICAL ASSOCIATION OF GEORGIA,
ACADEMY OF MEDICINE,
Atlanta, June 11, 1950
Present were: Dr. A. M. Phillips, president; Dr.
W. G. Elliott, chairman of council; Dr. Edgar Shanks,
secretary-treasurer; and Dr. Stephen T. Brown, chair-
man of the Public Relations Committee. Dr. C. C.
Aven, chairman of the Committee on Public Policy
and Legislation, was absent because of duties at
another meeting.
Present also were: Drs. H. D. Allen, Jr., J. C.
Norris, M. C. Pruitt, J. W. Chambers, W. S. Dorough,
H. L. Cheves, Mrs. Camille Holt and Mrs. Rita Edwards,
the two last-named being private secretaries to Dr.
Stephen T. Brown.
1. Dr. Edgar Shanks was requested by Dr. Stephen
T. Brown and others present to read from the official
records of the Association, particularly for 1949 and
1950, comment dealing with public relations, which
he did.
2. After further discussion of the problem, and the
duties of the Executive Committee, it was voted that
Dr. Stephen T. Brown act as chairman for the Executive
Committee of the Public Relations Committee for the
ensuing Association year, and that Dr. Edgar Shanks
act as secretary for the committee for a like period.
3. It was voted that the office of the Public Relations
Department be reopened; that Dr=. Stephen T. Brown,
C. C. Aven and Edgar Shanks function as the Office
Committee for the Executive Committee of the Public
Relations Committee, with Dr. Brown acting as chair-
man and responsible to the Office Committee and the
Executive Committee of the Public Relations Commit-
tee for the actual supervision of the personnel and
activities of the Public Relations Department; that
the Office Committee be authorized to employ some
suitable woman secretary on a monthly basis to work
in the Public Relations Department, and that the afore-
mentioned Office Committee be the Board of Censors
for all public relations material, including press re-
leases, used in the public relations program of the
Medical Association of Georgia.
4. It was voted that an Executive Secretary in
Charge of Public Relations be emploved as soon as
consistent with good business and professional practice
to work in the Public Relations Department, that the
applications for this position be sent Dr. Stephen T.
Brown, Medical Arts Building, Atlanta; and that if
and when a sufficient number of applications have been
received by Dr. Brown, the Executive Committee of
the Public Relations Committee meet with the purpose
of selecting a suitable person to fill this position.
5. It was voted that $300 be donated to the Fulton
County Medical Society in appreciation of the society’s
cooperation with the public relations program of the
Medical Association of Georgia.
6. Finallv, it was voted that the following budget
be applicable, insofar as po=sible, to the Public Rela-
tions Department for the ensuing Association year:
Salary — Executive Secretary $5,000
Salary — Secretary 2.400
Traveling Expenses 1,500
Conferences 500
Radio Programs 1,500
Press, advice, space, etc 1,000
Printing, Literature and Bulletins 500
Telephone and telegraph 500
Office rent - , 600
Stationery and office supplies 600
Postage 500
Office Equipment 500
Miscellaneous, including social security tax 300
Total Public Relations Department $15,400
7. Adjournment.
EDGAR D. SHANKS, M.D.
Secretary -Treasurer.
Dr. Max Mass, Macon, was the principal speaker
at the June 16 meeting of the Cooperative Club, Macon.
Dr. Mass explained the value of the x-ray in diagnosing
various diseases.
* * *
Dr. Harold P. McDonald, Atlanta, read a paper at
the first annual meeting of The Puerto Rico Urological
Association in Santurce, Puerto Rico, entitled ‘'Recent
Advances in the Treatment of Urinary Infections.” The
meeting was held on July 15 and 16.
* * *
Two doctors at the Medical College of Georgia at
Augusta were recently included in grants by the
Federal Security Administration for cancer control
research. From a total of $352,800, Dr. H. E. Nieburgs
was allotted $6,256 and Dr. D. C. Williams, Jr., and
Dr. Nieburgs, $3,873.
* * *
Dr. J. L. Morris, Alpharetta, recently announced
his retirement from active practice after 38 years
in the practice of medicine. He sold his stock of
drugs and clinical equipment to his son-in-law and
daughter, Dr. J. A. Roberts, and Dr. Jessie Morris
Roberts. The latter two took over the clinic in June
and will operate it under the name of the Roberts
Clinic, Alpharetta.
* * *
The Muscogee County Medical Society recently an-
nounced that Dr. William G. Love, Jr. has been named
to serve as a public relations director for the society.
Dr. Jack Hughston, secretary-treasurer, declared that
an informed public is a more cooperative public, and
said the society moved to take the action as one of
its duties to spread public information. Dr. Love
will work with newspapers and radio stations in report-
ing medical talks given to the society by prominent
medical men from throughout the country. Recent
guest speakers at the meeting of the society were
Drs. Stephen W. Brown and E. C. Burns, Augusta,
both of the radiology department. Medical College
of Georgia. They discussed “Diagnostic Points in
X-Ray.”
* * *
Dr. L. H. Muse, Atlanta, announces the association
of Dr. Julian Q. Watters, in the practice of pediatrics,
804 Medical Arts Building, Atlanta.
* * *
Dr. Thomas E. Oden, Blackshear, was recently pre-
sented with a 50-year pin and certificate of distinction
by the Medical Association of Georgia honoring him
for his service in the practice of medicine for half a
century. Dr. Oden has practiced in Pierce County
for many years and has treated patients in almost
every house in the county. Ten years ago he estimated
that he had delivered at least 2,000 babies.
* * *
Dr. Harry Parks, Atlanta, attended the graduate
school of medicine, Harvard Medical School and Peter
Bent Brigham Hospital in Boston, Mass., last month.
* * *
Dr. Samuel W. Perry and Dr. H. Bagley Benson,
Atlanta, announce the association of Dr. Richard E.
Boger in the practice of pediatrics, 490 Peachtree
Street, N. E., Atlanta.
* * *
Dr. Frank B. Pickett, Ty Ty physician, was recently
honored for his 50-odd years of “Christian ministry of
healing” by hundreds of his friends and grateful
patients in South Georgia. He has served Ty Ty and
vicinity since 1897, during which time he has delivered
more than 5,000 babies with only two maternal mor-
talities. Dr. C. S. Pittman, Sr., of Tifton, presented
356
The Journal of the Medical Association of Georgia
l)r. Pickett a gift on behalf of the medical profession.
Other gifts were presented by the community as a
whole and by individuals.
* * *
l)r. Jack H. Powell. Jr., has returned to Newnan
to enter the practice of medicine, and will be associated
with Drs. Jos. B. Peniston. Jas. H. Vrnold, and Jos.
W . Parks, Jr., with offices in the Doctors Building,
35 Jefferson Street. Newnan. He graduated from
l Diversity of .Maryland School of Medicine and College
of Physicians and Surgeons, Baltimore. Md. He served
one year of his internship at University Hospital, Balti-
more. and has just completed two years of internship
at Emory University Hospital, Atlanta.
* * *
Dr. Ralph D. Roberts, formerly of Gray, recently
began the practice of medicine with Dr. Francis Ward,
Fitzgerald. Dr. Roberts has completed three years
of surgical training at the Macon Hospital, Macon.
* * *
Dr. Leonard J. Rabhan. Savannah, announces that
his practice is now limited to diseases of the rectum
and colon (proctology).
* * *
Dr. Henry T. Sherman. Valdosta, announces the
opening of offices for the practice of internal medicine.
1310% North Patterson Street, Valdosta.
* * *
Dr. Addison W. Simpson. Sr., Washington, was re-
cently chosen as the recipient of the Gold Alumni
award of Presbyterian College. The award is given an-
nually to the alumnus who has made outstanding prog-
ress and achievement in his chosen profession. Dr. Mar-
shall W. Brown, president of the college, at Clinton. S.
C., made the award. In announcing the 1950 winner Dr.
Brown cited Dr. Simpson "for his uncelfish devotion in
the field of medicine.” Each year the award recipient
is decided upon by the board of directors of the
alumni association.
* * *
The forty-fourth annual meeting of the Southern
Medical Association will be held in St. Louis. November
13-16. 1950. For hotel reservations address the Housing
Bureau. Southern Medical Association. 911 Locust
Street. Room 406. St. Louis 1, Missouri. No hotel will
be designated as general hotel headquarters or head-
quarters for any section or official group. General
Headquarters will be the Kiel Municipal Auditorium
where all meetings and scientific and technical ex-
hibits will be held.
* * *
Dr. S. D. Stoddard, Savannah physician, was honored
recently at a gathering of the Salvation Army for his
voluntary services to the Salvation Army’s nursing
home at Hunter Field. Dr. Stoddard was presented a
plaque by Brig. Ernest Pickering, tri-state divisional
chief, at a luncheon at the Hotel DeSoto.
* * *
Dr. H. Ltiten Teate, Jr. announces the opening of
his office for the practice of pediatrics at 104 Ponce
de Leon Avenue, N. E.. Atlanta.
* * *
The Third District Medical Society recently held
its meeting in the Woman’s Club Hou-e. Montezuma,
with doctors of Macon and Pulaski counties as hosts.
Dr. C. P. Savage. Montezuma, president of the society,
presided. Invocation by Rev. Clias. H. Kopp: Address
of Welcome, Dr. Langdon C. Clieves, Jr., both of
Montezuma; Response by Dr. Frank Schley, Columbus.
Problems concerning the medical profe sion were dis-
cussed by physicians and surgeons including Dr. J.
Z. McDaniel and Dr. Mack Sutton, of Albany; Dr.
Jack C. Hughston and Dr. John S. Stewart, of Colum-
bus; Dr. J. C. Metts and Dr. Julian K. Quattlebaum.
Savannah. The Woman’s Auxiliary of the Third Dis-
trict Medical Society held its meeting at the same
time in the local Methodist Church.
Dr. Bothwell Traylor, formerly of Augusta, an
nounces the opening of his office at 455 North Milledge
Avenue, Athens. Practice limited to obstetrics and
gynecology. Dr. Traylor graduated from the Univer-
sity of Georgia School of Medicine, Augusta, in 1943,
and interned at the U. S. Marine Hospital. Seattle,
Wash., then served two years with the U. S. Army
Medical Corps during World War II. For the past
three years he has been resident obstetrician and
gynecologist on the staff of the University Hospital,
Augusta. He is the son of the late Dr. George A.
Traylor, former president of the Medical Association
of Georgia.
* * *
Dr. Hilton F. Wall announces the opening of his
office for the practice of general surgery at 21 Eighth
Street, N. E., Atlanta.
* * *
The Ware County Medical Society recently held
its monthly meeting at the Hotel Ware, Waycross,
with Dr. William A. Hendry, Blackshear, president,
presiding. Two scientific papers were presented:
"Splenectomy During Pregnancy” by Dr. T. J. Ferrell,
Waycross, and “Ainhum — A Tropical Disease” by
Dr. W. C. Calhoun. Waycross. Drs. Ferrell and Calhoun
were hosts to the supper held just before the meeting,
Physicians present were Drs. Braswell E. Collins,
J. R. Gay, Harold W'. Muecke, H. T. Adkins, L. W.
Pierce, H. A. Seaman, A. W. DeLoach, W. B. Bates,
Ed Roe Stamps, Floyd Davis, W . VI. Flanagin. V ilda
Shuman. Clayton M. Vlassey. D. M. Bradley, Leo Smith,
B. H. Minchew, all of Waycross; William A. Hendry,
Katherine Hendry, Thomas E. Oden, of Blackshear;
R. R. McCollum, Kingsland. and D. B. Terry, Homer-
ville.
* * #
Dr. J. B. Warned. Cairo, recently celebrated the
fiftieth anniversary of his graduation from Emory
University School of Medicine by attending the reunion
of his class in Atlanta. Dr. Warned stated that his
class numbered seventy-two at the time of graduation
in 1900.
* * *
Dr. James A. Wood, Macon, gave an account
of his recent tour of South America as he spoke to
the Rotary Club of Brunswick at its regular meeting
at the Oglethorpe Hotel, Brunswick, recently. Dr.
Wood told of traveling up and down the Latin American
continent and described the principal cities that he
visited. Much of his address was devoted to relating
his experiences and observations in Argentina. After
concluding the talk, he exhibited a series of color
photos that he took during his tour earlier this year.
* * *
Dr. J. J. Wright. Greenville, recent graduate of
the Medical College of Georgia, Augusta, has been
appointed director of the State Training School for
Mental Defectives at Gracewood. near Augusta. He
succeeds Dr. Wallace Winter, Augusta, who resigned
after holding the job since last fall. Gracewood pro-
vides care for over 700 boys and girls of subnormal
mentality.
* * *
Dr. Herbert VI. Olnick, formerly of Dahlonega, an-
nounces the opening of his office for the practice
of diagnosis, radiology and therapy in the Doctors
Building, 700 Spring Street. Vlacon.
* * *
The Baldwin County VIedical Society held its monthly
meeting at the Milledgeville State Hospital. Milledge-
ville, Vlay 1. Dr. J. Benham Stewart, Macon, was
guest speaker. His subject was "Diagnosis and Treat-
ment of Gallbladder Diseases.” Dr. Robert D. W'aller,
secretary.
* * *
Georgia physicians who attended the Ninety-Ninth
Annual Session of the American VIedical Association
August, 1950
357
held in San Francisco June 26-30 were: W. S. Cook,
Albany; Carl C. Aven, J. Gordon Barrow', Marion Trolti
Benson, Jr., Edgar Boling, Allen H. Bunce, Amey
Chappell, Olin S. Gofer, Dan C. Elkin, Robert P.
Grant, Charles M. Huguley, Jr., R. F. Reider and
B. L. Shackleford, all of Atlanta; Joe M. Blumberg,
Marion M. Estes, and Peter B. Wright, all of Augusta;
Mercer Blanchard. Columbus; Tyrus R. Cobb, Jr.,
Dublin; R. N. Spencer, Fort Benning; Harold E.
Shuey, Fort McPherson; O. F. Keen, A. M. Phillips,
C. H. Richardson, Sr, and Henry H. Tift, all of
Macon; Ralph W. Fowder, Marietta; Carol Graham
Pryor, Milledgeville ; Frank A. Blalock, Rome; Leonard
J. Rahban, Savannah, and Clifford P. Michael, Warner
Robins. The following Delegates representing the
Medical Association of Georgia were seated in the
opening session of the House of Delegates of the
American Medical Association: Dr. Allen H. Bunce,
Atlanta; Dr. Charles H. Richardson, Sr., Macon;
and Dr. A. M. Phillips, Macon, in place of Dr. Benja-
min H. Minchew, Waycross, who was unable to be
present.
* * *
CORRECTION
Endometriosis: The Urgency for Early Diagnosis and
Treatment. — In the article by Edgar H. Greene, M .D.,
in The Journal July, 1950. page 284, third paragraph
and third line the reference number “3"’ should have
been ‘'2." On the same page, lower right hand column
under numeral 3. the word “International” should have
been ‘Tntermenstrual.”
COMMUNICATION
BUREAU OF MEDICAL ECONOMIC RESEARCH
OF THE
AMERICAN MEDICAL ASSOCIATION
June 13, 1950.
To: Elected and Executive Secretaries of State
Medical Societies,
Subject: Life Insurance Examination Fees.
You will recall that the House of Delegates instruct-
ed George F. Lull, M.D., as secretary, to keep the state
societies informed of change in the schedule of fees
of life insurance companies paid to physicians for
examinations and for attending physicians reports.
On the eve of the convention in San Francisco I
thought that you and the Delegates from your society
might like to know that 43 companies have now raised
their fee schedules. The lict of companies is given
below1. In addition, I think there are three more com-
panies not on this list which are domiciled in the
south. I am not informed regarding the amount of
the increase in the fees of each company but I do
know that, in general, the increase is 50 per cent
across the board.
FRANK G. DICKINSON.
Aetna, American General, Bankers Life, Columbian
National, Connecticut General, Connecticut Mutual,
Continental Assurance, Control Life. Equitable Assur-
ance, N. Y., Equitable of Iowa, Fidelity Mutual, Frank-
lin Life, Great Southern, Guardian, Home Life, Jeffer-
son Standard, Life Insurance of Vermont, Lincoln
National, Manhattan, Maccabees.
Metropolitan, Mutual Life, New York; Mutual Trust,
National Life & Accident, National Life, Vermont;
New England Mutual, New York Life, Occidental,
Ohio National, Pacific Mutual, Pan American, Phoenix,
Pilot Life, Provident Mutual, Prudential, Security
Mutual, Southland Life, Southwestern, Standard, Ore-
gon; State Mutual, Sun Life, Travelers, United Life
& Accident.
OBITUARY
Dr. Henry W. Brooks, Sr., aged 56, Buena Vista
physician, died in the St. Francis Hospital, Columbus,
June 28, 1950. He had been stricken at his Buena
Vista home with a heart attack. Dr. Brooks was the
son of the late Dr. S. W. and Rosa Wells Brooks of
Geneva, and graduated from Emory University School
of Medicine, Atlanta, in 1916. During World War I,
Dr. Brooks served in the Medical Corps as a lieutenant,
and after the war was connected with the Veterans
Administration for eight years. Before moving to
Buena Vista he had practiced medicine in Columbus,
Butler and Box Springs. Dr. Brooks was a member
of the Muscogee County Medical Society, the Medical
Association of Georgia, and a fellow of the American
Medical Association. Also a member of the Buena
Vista Baptist Church, American Legion, past president
of the Lions Club, and was a former member of the
.Marion County Board of Education. Survivors include
his wife, Mrs. Allene Herring Brooks; two sons,
Edward C. Brooks, Buena Vista, and Henry W.
Brooks, Jr., Macon; a daughter, Mrs. Nat S. Welch,
Whitmire, S. C.; two sisters and four grandchildren.
Funeral services were held at the Buena Vista Baptist
Church with Dr. George C. Gibson, Tifton, officiating,
assisted by the Rev. J. W. Clark and the Rev. T. O.
Lambert. Burial was in Buena Vista.
% % %
Dr. John Gercline, aged 75, prominent Jersey physi-
cian died at his home, June 13, 1950. He had been
in ill health for some months. He was the son of the
late Dr. and Mrs. John Gerdine, his father being one
of the state’s outstanding medical figures. He was
born in West Point, Miss., and was brought to Athens
as a baby, where he grew up and attended school. He
graduated from the University College of Medicine,
Richmond, Va., in 1909, and for sometime practiced
medicine in Athens, moving to Jersey in Walton County,
some 30 years ago. He had endeared himself to his
numerous patients by his kindly understandable nature
and his great ability as a physician. He was a member
of the Walton County Medical Society, the Medical
Association of Georgia, and a fellow of the American
Medical Association. Dr. Gerdine is survived by his
wife, Mrs. Ola Mobley Gerdine; a daughter, Miss
Josephine Gerdine, Jersey; a son. Master Sergeant
John Gerdine, Jr., U. S. Army, Austin, Texas; a
brother. Dr. Linton Gerdine, Athens; sisters, Mrs.
E. W. Lamkin and Miss Mary Gerdine, both of Athens.
Funeral services were held at the Methodist Church,
Jersey, with Dr. Eugene L. Hill, pastor emeritus of
First Presbyterian Church, Athens, officiating, followed
by graveside services at the family lot in Oconee Hill
Cemetery, Athens.
* ❖ *
Dr. Joseph E. L. Johnson, aged 82, prominent
Roberta and Middle Georgia physician, died in a
Macon hospital, June 29, 1950. He graduated from
the Georgia College of Eclectic Medicine and Surgery,
Atlanta, in 1888. He went to Roberta in 1896 and
began the practice of medicine in the horse and
buggy days, and had practiced medicine for more
than 50 years. He had served several terms as mayor
of Roberta. He was an honorary member of the Bibb
County Medical Society, the Medical Association of
Georgia, the American Medical Association and a
member of the Southern Railway Surgical Associa-
tion. Dr. Johnson was head of the health department
for a number of years, assisting in establishing the
health center in Crawford County. He was also a
Knights Templar, a Shriner and a member of the
Woodmen of the World. Survivors are his wife, the
former Miss Mattie McFarland; two daughters, Mrs.
Roy Young, Atlanta, and Mrs. O. O. Abernathy, Hick-
ory, N. C.; three sons, Lawson Johnson, Roberta;
J. W. Johnson, Mobile, Ala., and Topping Lussi,
Thomaston. and several grandchildren. Funeral services
were held at the Roberta Methodist Church with the
Rev. E. B. Awtry, Smyrna, officiating. Burial was in
the City Cemetery, Roberta.
358
The Journal of the Medical Association of Georgia
Dr. II illiam Lowndes McDougall, aged 57, prominent
Atlanta eye, ear. nose and throat specialist, died follow-
ing a heart attack at his home, July 18, 1950. Dr.
McDougall was born in Atlanta and graduated from
Emory University School of Medicine, Atlanta, in 1919.
He completed his medical training at the Newr \ork
Eye and Ear Infirmary, New York City, where he
began the practice of medicine, and returned to Atlanta
in 1923. where he has practiced for approximately 30
years. He was associate attending surgeon at the
Emory University School of Medicine, where he was
head of the eye, ear. nose and throat teaching staff.
He was also associate surgeon at Grady Memorial
Hospital, and was on the staff of St. Joseph's Infirmary,
Crawford W. Long Memorial and Georgia Baptist
hospitals. He was a member of the Fulton County
Medical Society and had received an award from the
group for 25 years service; a member of the Medical
Association of Georgia, the American Medical Associa-
tion. the Southeastern Surgical Congress, the Georgia
Eye. Ear. Nose and Throat Society, the Fifth District
Medical Society, the Chattahoochee Valley Medical
and Laryngological Society and the Southern Medical
Association. He was a fellow7 of the American College
of Surgeons and was certified by the American Board
of Otolaryngology. A past national officer of Sigma
Chi social fraternity, he also belonged to the Phi Rho
Sigma VIedical Fraternity and was a past president
of the Tiological professional society. Dr. McDougall
was a member of the Peachtree Road Methodist
Church. Also of the Piedmont Driving Club and the
Capital City Club. Survivors include his wife, the
former Miss Mary Alice Thomas, Griffin; two daugh-
ters, Mrs. Franklin Smith and Mrs. Grattan Woodson,
both of Atlanta; a son, William L. McDougall, Jr.,
Atlanta; two brothers. Dr. Calhoun McDougall and
Robert McDougall, both of Atlanta, and several nieces
and nephews. Funeral services were held at Spring
Hill with Dr. E. G. Mackay officiating. Burial was in
West View Cemetery, Atlanta.
* * *
Dr. Seaborn F. Scales, aged 65, prominent Carrollton
and Carroll County physician and surgeon died at his
home in the Hickory Level Community, June 24, 1950.
Dr. Scales was born in Haralson County, the son of
the late Seaborn Washington Scales and Ella Pritchard
Scales. He graduated from the Atlanta School of
Medicine, now Emory LIniversity School of Medicine,
Atlanta, in 1910. He did postgraduate work at Cook
County Hospital. Chicago. III. He was a member and
past president of the Carroll-Douglas-Haralson Medical
Society, and a member of the Medical Association
of Georgia, the American Medical Association, and
was also a past president of the Emory Alumni
Association. Dr. Scales owned and operated a hospital
at Hickory Level for several years. He later joined
Dr. D. S. Reese in operation of the Carrollton Clinic.
He was a generous contributor and on the staff of
Tanner Memorial Hospital, Carrollton. He was past-
master of the Buck Creek Masonic Lodge, a Royal
Arch Mason, and a member of the Hebron Comman-
dery. He was a past member of the Board of Stewards
of the Concord Methodist Church and was a trustee
at the time of his death. Dr. Scales was recognized
as a talented and gifted surgeon and was well loved
by the people of Carroll County. His death is a
great loss not only to the profession, but the people
of Carroll County. Surviving are his wife, the former
Miss Mae Spence; one daughter, Mrs. Earnest Eady,
and granddaughter. Miss Barbara Eady, both of Car-
rollton; a sister, Mrs. G. R. Huddleston. Bowdon; three
brothers, V ilson Scales and Bill Scales, Carrollton,
and Tom Scales, Waco. Funeral services were held
at the Concord Methodist Church, Hickory Level, with
the Rev. E. B. Paris officiating. The Carroll-Douglas-
Haralson Medical Society served as an honorary escort
Burial was in the Concord churchyard, Hickory Level.
Dr. James Oscar Strickland, aged 72, well known
Pembroke and Bryan County physician died in a
Savannah hospital. July 11, 1950. A native of Bulloch
County, Dr. Strickland had been a resident of Pembroke
since 190,1. He graduated from the Atlanta College of
Physicians and Surgeons, Atlanta, in 1901, and began
the practice of medicine at Pembroke as an old-time
general practitioner. Dr. Strickland was always active
in projects of civic, fraternal and religious nature and
served as mayor of Pembroke several times. He served
as a member of the Bryan County commission and had
been chairman of that body several terms. He wTas a
former state senator from the first district. Dr. Strick-
land served in World War I as a first lieutenant. He
had been active in local business affairs and was a
former vice president of the Pembroke State Bank.
Survivors include his wife, Mrs. Rosa Averitt Strick-
land; a son, J. O. Strickland, Jr.. Pembroke; a daugh-
ter, Mrs. Henry J. Stokes, Knoxville. Tenn., and seven
grandchildren. Funeral services were held at the Pem-
broke Baptist Church with the Rev. John Joyner, pastor,
officiating, assisted by the Rev. V. P. Bowers and the
Rev. Tom Watson. Burial was in the Northside Ceme-
tery, Pembroke.
NEW BOOKS
Medical Diagnosis — Applied Physical Diagnosis: Edit-
ed by Roscoe L. Pullen. M. I)., F.A.C.P., Professor
of Graduate Medicine, Director of the Division of
Graduate Medicine, and Vice Dean of the School of
Medicine, Tulane University of Louisiana; Senior Visit-
ing Physician, Charity Hospital of Louisiana at New
Orleans; Consultant in Medicine. Veterans Administra-
tion Hospital, New Orleans, Louisiana; Consultant to
the Surgeon General. Department of the Army, Wash-
ington, D. C. Second edition. 1119 pages with 601
figures, 48 in color. Philadelphia and London: W. B.
Saunders Company. 1950. Price 112.50.
This is truly an applied physical diagnosis. This,
the second edition, is full of good material and its
editor is to be congratulated for getting together such
valuable information.
* * *
A Textbook of Gynecology, by Arthur Hale Curtis,
M.D.. Emeritus Professor and Chairman of the Depart-
ment of Obstetrics and Gynecology, Northwestern Uni-
versity Medical School: and John William Huffman,
M.D., Associate Professor of Obstetrics and Gynecology,
Northwestern University Medical School; Attending
Gynecologist, Passavant Memorial Hospital, Chicago.
Sixth edition. 799 pages with 466 illustrations, chiefly
by Tom Jones, including 37 in color. Philadelphia and
London: W. B. Saunders Company, 1950. Price $10.00.
In its sixth and present edition, with its various
facts augmented by excellent illustrations, this book
should be an addition to any physician’s library.
* * *
The Practice of Medicine, by Jonathan Campbell
Meakins, C.B.E., M.D., LL.D., D.Sc., Fifth Edition,
C. V. Mosby Company, St. Louis, 1950, pp. 1558. price
$13.50.
The fifth edition of Dr. Meakins’ Practice of Medi-
cine continues to maintain the standards that have
made it one of the more outstanding textbooks of
medicine.
Several noteworthy changes have been made in
this edition. The previously sparse section on psychia-
try has been replaced by one on psychosomatic medi-
cine by Dr. Frederick R. Hanson. In order to reduce
reduplication, a chapter has been devoted to chemo-
therapy and antibiotics. The chapter on the ductless
glands has been largely rewritten. The text in its
present form is well written and ably illustrated.
EDGAR SHANKS, JR., M.D.
THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia, September, 1950 No. 9
THE GASTROSCOPE AS A DIAGNOSTIC
AID IN GASTRIC DISORDERS
John S. Atwater, M.D.
Atlanta
There are some who say that the romance
of medicine is of the past but the memory
of my first glance through the gastroscope
and later, my first manipulation of the
instrument, under the guidance of Dr.
Rudolph Schindler, still is with me and
even now a genuine thrill is found in the
excitement of an unusual gastroscopic pic-
ture. The enthusiasm of visualizing the
lesion in the living subject is, of course,
associated with serious practical considera-
tions.
By and large, the flexible gastroscopes
that are available on the market constitute
safe instruments but one must exercise care
in the choice of patients for examination.
The most important contraindication to the
use of the gastroscope is the presence of an
aortic aneurysm. A et, recently two patients
with extensive fusiform aneurysmal dila-
tations of the entire thoracic aorta have been
instrumented without incident. There was
no displacement of the esophagus demon-
strable by fluoroscopy prior to the exami-
nations. Esophageal varices rank high in
importance also and probably are more
commonly encountered since gastrointes-
tinal symptoms are more likely to be pres-
ent with the underlying disease producing
the varices than with the aortic lesion.
From the offices of Drs. Davison, Arp, Atwater and Hurst.
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
Other esophageal lesions such as cardio-
spasm and obstructions of the esophagus
are important reasons to avoid gastroscopy.
The gastroscopist s attitude has changed
somewhat, however, toward cardiospasm.
If cicatricial changes have not taken place
to any degree, then gastroscopy still can be
performed under pentothol-curare-oxygen
anesthesia and sometimes, without anesthe-
sia. We have demonstrated this and are
now publishing a series of cases using this
method. We have been able to gastroscope
safely several patients with cardiospasm of
marked degree.
Severe grades of heart disease, marked
kyphoscoliosis, hiatus hernia, dyspnea and
psychosis are relative contraindications. A
corrosive gastritis is an absolute contraindi-
cation.
The use of the gastroscope has become
just as routine to the gastroenterologist as
has the cystoscope to the urologist and the
bronchoscope to the chest physician and
surgeon. The indications for gastroscopv
include the following:
1. Gastric ulcer.
2. Gastric carcinoma.
3. Duodenal ulcer. ,
4. Syphilis.
5. Gastrointestinal psychoneuroses.
6. Unexplained gastrointestinal hemorrhage.
7. Unexplained weight loss.
8. Unexplained anorexia.
9. Anemia, particularly pernicious anemia; sub-
acute combined cord degeneration; sprue.
19. Certain gastrointestinal allergic conditions.
11. Obstructive lesions of the stomach and duodenum.
It is felt by many observers that the gas-
troscopic observation is second only to the
microscopic examination in differentiating
certain lesions of the stomach as to whether
they constitute benign or malignant ulcers.
While it is true that grossly the surgeon and
360
The Journal of the Medical Association of Georcia
the pathologist cannot always tell the true
character of the gastric ulcer at the operat-
ing table or in the pathologic room, yet the
gastroscopic picture when examined before
changes in the circulation have taken place
may he of great value. The advantage
afforded the gastroscopist is largely due to
the presence of the circulating blood which
allows for sharp differences and contrasts
in the color and pattern. Sometimes these
contrasts are quite striking. This can be
appreciated only when one has had the op-
portunity of actually looking through the
gastroscope at such lesions.
There are several published series of
comparative studies, using gastroscopic,
radiologic, surgical and pathologic-surgical
methods of approach to the problem of
differentiation of benign and malignant
gastric ulcers. From these studies it can
be stated that in the hands of experienced
gastroscopists a high degree of accuracy of
diagnosis is available.
Separately, radiology and gastroscopy
offer a great deal in helping to differentiate
such lesions. Both methods, however, can
be in error. When they are used as comple-
mentary procedures, the titer of diagnostic
accuracy is greatly heightened.
Gastroscopy may be of invaluable aid in
watching the healing of a gastric ulcer that
has been managed medically. I cannot con-
cur with the opinion stated within the past
year that most gastric ulcers should be
considered surgical problems. The opera-
tive mortality of gastric resection in the
hands of the most skilled of surgeons is
sufficiently high not to be overlooked, nor
is the frequency of postoperative complica-
tions beyond reflection. When one has lost
a patient who has been resected for a gastric
lesion which proved to be benign, and when
one has had to treat some of the postoper-
ative gastric invalids, then one’s opinion of
the approach to the problem is altered. It
is my opinion that a gastric ulcer should lie
considered as a combined medical-surgical
problem and not as a separate surgical nor
a separate medical problem. Some patients
will, of course, require immediate surgical
treatment. Other patients will be followed
medically for a time only to learn that surgi-
cal treatment is the treatment of choice.
Still another group, and probably a large
one, can be saved the need of surgical inter-
vention and its attendant risks if close
radiologic and gastroscopic methods of
diagnosis are utilized.
Until very recent years there had been
no gastroscope with a biopsy attachment
available that was worth using. Many at-
tempts have been made in the past to per-
fect such an instrument. However, Dr.
Benedict of Boston demonstrated at the
American Gastroscopic Society last year an
instrument with which biopsy appears to
be feasible. At the present time there are
very few of these instruments in the coun-
try. Four months ago we acquired one of
these operating biopsy gastroscopes and
have used it successfully. If a satisfactory
biopsy can be obtained with the flexible
biopsy gastroscope, then much has been
accomplished in solving the question as to
whether a patient should be treated medi-
cally or surgically when he has a gastric
ulcer.
Another manner in which gastroscopy
serves is in the diagnosis of early cancerous
lesions of the stomach. There are many
instances of small circumscribed carcinoma
on record where x-ray diagnosis, using
relief technics, had failed to visualize the
lesion, but where the gastroscopist was able
to do so.
The operability of malignant lesions of
the stomach constitutes another indication
for gastroscopy. Exploratory laparotomy
may be avoided entirely at times, wdien one
bears in mind the gastroscopic picture and
September, 1950
361
correlates it with the morphologic classifi-
cation of the various types of gastric tumors.
The size of a gastric cancer is actually of
lesser importance than its location, and
from the standpoint of resectability it is im-
portant to know just how near to the cardia
of the stomach the lesion exists. Generally
speaking, 3 cm. of stomach below the cardia
should be free of demonstrable cancerous
infiltration if surgery is to be undertaken
with any degree of successful expectation.
The simultaneous occurrence of gastric
and duodenal ulcers is an indication for
gastroscopy. Statistics favor the gastric
ulcer under those circumstances as being
benign in character.
The nature of an obstructing lesion at the
pylorus can be offered some diagnostic help
through gastroscopic methods. Gastroscopy
under these circumstances might show
whether the lesion was due to an intrinsic
gastric carcinoma, a benign gastric ulcer, a
duodenal ulcer, hypertrophic pyloric ste-
nosis, prolapsing gastric mucosa, peduncu-
lated polyps or other such pathologic enti-
ties.
The presence or absence of gastric syph-
ilis can often be ascertained by gastroscopy.
X-ray methods do not always show the
cause for gastrointestinal hemorrhage, yet
an underlying gastritis, a severe hemorrha-
gic erosion or even benign tumors, may be
the source of the bleeding. Frequently they
can be demonstrated by gastroscopy.
Certain of the anemias, particularly per-
nicious anemia, combined cord degenera-
tion and the sprue syndromes can be diag-
nosed gastroscopically. The effects of treat-
ment of these conditions can also be fol-
lowed by the use of the gastroscope far
more effectively than by x-ray technic.
Obscure gastrointestinal complaints are
not always due to psychoneuroses of the
gastrointestinal tract. Some represent early
carcinoma. Many represent true gastritis.
In recent years there has been more wide-
spread use of gastric surgery due to the
many excellent advances in that field. This
in turn, however, has been accompanied by
an increase in the complications following
gastroenterostomy, gastric resection and
total gastrectomy. The principal complica-
tions following gastric surgery of interest
gastroscopically include the presence of
marginal or gastrojejunal ulcers, gastro-
jejunocolic fistula, the formation of new or
recurrent gastric ulcers and a severe type
of postoperative gastritis. In this last com-
plication some of the most bizarre and wide-
spread changes in the stomach that are ob-
served through the gastroscope may be seen.
Yet despite the magnitude of the lesion
many times the radiologic opinion does not
suggest any abnormality.
Lest anyone should be misled it should
be pointed out that the gastroscope is not
infallible, but it does offer an additional
means of approaching the problem of gas-
tric disease, both as to diagnosis and the
evaluation of our methods of treatment.
When gastroscopy is used as a complement
to other methods of diagnosis it performs
an invaluable service.
CHRONIC PANCREATIC DISEASE
Charles W. Hock, M.D.
Augusta
Chronic pancreatitis is a term used syn-
onymously with acquired fibrosis of the
pancreas. The lesion is diagnosed at the
operating table, the autopsy table, or by
being “pancreas conscious”. The incidence
of this condition is far higher than is gen-
erally considered and by more detailed
study of the clinical manifestations and the
information obtained from the laboratory,
more cases can be diagnosed clinically.
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
362
The Journal ok the Medical Association of Georgia
Chronic pancreatitis is not infrequently
associated with diseases of the liver, bile
passages and the intestine. Bacteria, virus
or other toxic agents may reach the organ
by the pancreatic duct, by the blood stream
and by the lymphatic system. Obstruction
due to any cause may be followed by chron-
ic inflammatory changes. Operative trau-
ma, due to operations upon the stomach,
duodenum or the biliary system, may occa-
sionally result in chronic interstitial fibro-
sis. Arteriosclerosis or other conditions al-
tering the vessel walls may cause disturb-
ances in the pancreas with resulting fibrosis.
Primary diseases of the pancreas, such as
acute pancreatitis, may be followed by
chronic interstitial fibrosis.
Two definite types of fibrosis may be rec-
ognized; namely, the interlobular and the
interacinar forms. In the former there is
increased connective tissue between the ir-
regular lobules and compression of the
glandular portion. In the latter, there is
marked proliferation of fibrous tissue in the
glandular acini and only minimal changes
in the interlobular tissue.
Chronic interlobular pancreatitis results
from occulsion of the pancreatic duct or
from infection due to streptococci, the colon
bacillus and occasionally the typhoid bacil-
lus. As the process progresses, such as in
obstruction of the duct, the glandular tissue
is replaced to a large part by fibrous tissue.
Small masses of relatively normal glands
are embedded in fibrous stroma which con-
tains almost no epithelial elements. Where
active degeneration of the gland is in
progress, numerous lymphoid cells are pres-
ent. The islands of Langerhans are un-
changed until very late in the process when
the acini are almost completely destroyed
and replaced by dense scar-like tissue, and
there is less tendency for the islands of
Langerhans to be affected as the fibrosis is
not as diffuse as in duct obstruction with a
stone.
In the interacinar type the newly-formed
fibrous tissue tends to have a more irregular
distribution and the interlobular boundaries
are obscured by masses and strands of new
tissue within the lobules. The islands of
Langerhans are affected early and with
progress of the lesion they are finally de-
stroyed and replaced by fibrous tissue. In
a number of instances there is an associated
sclerosis of the arteries. Chronic interacinar
pancreatitis is usually the result of a blood
borne infection often associated with cirrho-
sis of the liver, alcoholism and arterioscle-
rosis but the etiology is obscured in some
instances.
The symptoms of chronic pancreatitis are
rarely definite but the syndrome should be
suspected in a patient with chronic dyspep-
sia with or without a history of biliary colic,
if in addition there is severe or slight epi-
gastric pain located often to the left of the
midline and frequently referred to the left
scapula. The patient may also have nausea,
vomiting, weakness, emaciation and slight
jaundice. In some cases there is intermit-
tent glycosuria and hyperglycemia. They
may also have bulky, soft, fetid stools
varying in number, usually from four to
eight in 24 hours. These stools, however,
are more prone to occur in the early morn-
ing and morning hours. Microscopic exam-
ination and chemical tests will reveal undi-
gested fat and protein in considerable quan-
tities. The symptom complex, even wTien all
symptoms are present and in many cases
many of the symptoms are absent, is not
pathognomonic. Therefore, great stress
must be placed on the history (with gastro-
intestinal disturbances, jaundice, loss of
weight and the type of stools) and the phy-
sician must have an awareness of pancreatic
disease. At times considerable help may
lie obtained from aspiration of the duodenal
contents and study of this for pancreatic
ferments. The difficulty with this test is the
September, 1950
363
discomfort caused the patient and the fact
that most laboratories do not do sufficient
studies to be certain of the results. Blood
amylase and lipase studies may be of con-
siderable help in individual cases, but this
is not routinely true. Most workers in the
field have advised the early removal of
gallstones as prophylactic treatment. Like-
wise inflammation in the biliary system
should be treated by appropriate means.
The diet of the patient with chronic pan-
creatitis should be low in fats, relatively low
in protein (particular of the meats) and
high in carbohydrates. Only the lean part
of the meat should be eaten. The patient is
permitted to have milk, green vegetables,
raw fruits, and cereals. However, if the
stools are loose in character, fruits and
vegetables should be cooked always and at
times omitted from the diet. Alcohol, tobac-
co and coffee are to be avoided. The use of
sedatives and antispasmodics is quite help-
ful in controlling pain and helpful with
loose stools. Pancreatic extract (of the
triple strength variety) is of considerable
help in controlling loose stools and allows
the ingestion of a more liberal diet. If dia-
betes is present, naturally treatment of this
is indicated. Some authors have suggested
nonsurgical biliary drainage according to
Lyon’s method for infection in the biliary
tract, pancreatic duct or duodenum to pre-
vent this serious complication of chronic
pancreatitis.
The following case histories are given to
illustrate some of the types of histories ob-
tainable on patients with chronic pancrea-
titis.
L. S., aged 42, complained of intermittent severe
epigastric pain for four years, associated with alternat-
ing diarrhea and constipation. He had been a patient
in numerous government hospitals and all studies
were said to have been negative. In 1947 he had an
exploratory laparotomy. The pancreas was found to
be quite hard and the pathologic diagnosis was chronic
interstitial pancreatitis. He has been treated with a
low residue non-laxative diet and moderate doses of
sedatives and antispasmodics with good results. He
showed a transient glycosuria in 1949.
M. B., aged 68, complained of diarrhea for six
months. At the onset he had mild fever (100° F.).
He had glycosuria and hyperglycemia at this time.
Careful dieting helped to control loose stools and
glycosuia for about six months and then the diarrhea
appeared again. All studies of the gastrointestinal
tract (including x-rays, cultures, sigmoidoscopic exami-
nation, etc.) were negative. The patient was given
pancreatic extract, 20 grains after each meal, with an
immediate cessation of all diarrhea. Furthermore
the glycosuria disappeared in spite of an increase in
diet.
M. S., aged 53, when first seen in July 1948, had
typical symptoms of duodenal ulcer, which diagnosis
was confirmed by x-ray. In January 1949 the symp-
toms changed and the epigastric pain became severe
with radiation to the chest and back. The pain would
appear around 2-4 a.m., and was entirely different from
the previous pain. There was progressive loss of
weight. X-ray studies of the duodenum showed a
healed ulcer. Serum amylase was elevated to 300
units. The patient responded moderately well to diet,
sedation and antispasmodics.
N. J., aged 41, complained of severe griping abdom-
inal pain around the umbilicus associated with diarrhea
intermittently since 1939, when she had a cholecystec-
tomy for stones. All studies of the gastrointestinal tract
were negative. The patient was first tried on a low
residue non-laxative diet and antispasmodics with rela-
tively poor results. Pancreatic extract 10 to 15 grains
after meals produced constipation which was regulated
by diet.
Summary
The incidence of chronic pancreatitis is
far greater than has been generally recog-
nized. The rather vague symptomatology
has been a limiting factor in making the
diagnosis. In any patient with chronic dys-
pepsia, history of biliary colic, epigastric
pain radiating to the left shoulder blade,
nausea, vomiting, weakness, emaciation or
changes in the stools, particularly bulky,
soft, fetid stools containing oil or undigest-
ed protein should be suspected of having
chrQnic pancreatitis. Treatment consists,
where possible, of removal of the stones in
the biliary or pancreatic ducts, clearing up
infection and the giving of a diet low in
fats, relatively low in protein and generous
in carbohydrates. Pancreatic extract is of
value in controlling diarrhea in some cases.
REFERENCES
1. Opie: Diseases of the Pancreas, 1910.
2. Friedenwald. J. : Acute and Chronic Pancreatitis, South.
M. J. 30:1067-1074, 1937.
HEALTHGRAM
More help is needed from tuberculosis specialists
and from nutritionists in arriving at scientifically sound
and practical minimum standards for relief allowances
for the average tuberculosis patient and his family.
Ruth Taylor, Nat. Tuberc. A. Bull., Oct., 1949.
364
Tiik Journal of the Medical Association of Georgia
ADENOCARCINOMA OF THE COLON
AND RECTUM
D. F. Mullins, Jr., M.D.
Athens
Incidence: Next to the stomach, adeno-
carcinoma of the colon and rectum is the
most common carcinoma of the alimentary
tract. About 85 per cent of these cases are
seen after the age of 40 years, but the 5
per cent seen below the age of 30 years are
also important. Carcinoma of the colon
occurs in 3 females to 2 males, and carci-
noma of the rectum in 3 males to 2 females.
In our series of 37 cases the youngest was
42 years of age and the oldest 83 years,
giving an average of 61 years. The sex
incidence of carcinoma of the colon was 10
females to 9 males; in carcinoma of the
rectum, 10 males to 8 females. Pemberton’s1
ratio of carcinoma of the colon averages:
cecum, 5.95 per cent; ascending and trans-
verse colon, 16.99; sigmoid colon, 13.55;
rectosigmoid, 17.70; rectum, 46.78. When
first seen, about 40 per cent are beyond
cure; however, in about 88 per cent the
original lesion is resectable for cure or
palliation.
Causal Factors: The real cause of ade-
nocarcinoma is unknown. There are two
precancerous lesions of the colon and rec-
tum: one, polyps; and the other, chronic
ulcerative colitis. Polyps show cancerous
transformation in about 10 per cent, and
chronic ulcerative colitis in about 4 per
cent. About 45 per cent of patients with
familial polyposis develop carcinoma. A
few patients with multiple neurofibromato-
sis of the skin have carcinoma of the ali-
mentary tract. The possible role of chronic
irritation in polyp formation is of impor-
tance. Atwater1 relates that all types of
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
irritants have been accused of producing
polyp growth. Irritants working through
the medium of constipation have an oppor-
tunity to exert their most irritative action
at the fixed portions of the colon, such as
the cecum, flexures, rectal valves, and in
these regions polyps and cancer occur most
frequently. The pathogenesis of polyp for-
mation is in dispute. While Dukes'' postu-
lates that the only operative factor is a more
lively multiplication of epithelial cells with-
in a definite area, Cromar4 believes that
small adenomatous changes occur in focal
areas and, in time, due to the tug of the
fecal stream, are pulled down to form
polyps. In addition to polyps and chronic
ulcerative colitis, parasites may also play a
role in the production of colon cancer. Fibi-
ger' was able to produce gastric polyps in
12 of 62 rats by feeding cockroaches in-
fested with spiroptera. Two of these polyps
became malignant and metastasized to the
lungs. Broders confirmed this observation.
Diagnosis: When carcinoma of the colon
is suspected, an adequate examination
should include, in addition to a complete
history and physical examination and lab-
oratory examination, digital rectal exami-
nation in the Sims’ position, sigmoidorecto-
scopic, barium enema and air studies.
About 77.5 per cent of rectal carcinomas
are actually within reach of the examining
finger. Coller1' further states that clinical
features vary greatly, depending upon the
location of the cancer. A palpable mass
and severe anemia are peculiar to cancer of
the right side of the colon, while obstructive
phenomena and a change in bowel habits
are noted in carcinoma of the left half of
the colon.
Blood in the stool may be a presenting
sign, and is usually associated with late
cancer, produced by ulceration of the sur-
face of the tumor. Pain and tenderness are
usually due to irritation of the peritoneum.
September, 1950
365
Loss of weight is also a late sign and sec-
ondary to malnutrition, bleeding and the
general effect of the malignancy.
In order to confirm the suspicion of car-
cinoma of the colon and rectum, the biopsy
specimen with pathologic examination
should be used where possible, because the
surgeon can carry out definitive treatment
more confidently if he knows that he is con-
fronted with cancer. Brown and Colvert
state that the correct diagnosis is made on
the first x-ray examination in about 70 per
cent of cases, and in about 20 per cent re-
peat examinations are necessary before the
lesion is diagnosed. Thus the margin of
error in diagnosis by x-ray is about 10 per
cent in the experience of good roentgenolo-
gists. A filling defect or irregularity of the
colon is the most common x-ray finding.
Another possible method of diagnosis is
now being used in some of the larger medi-
cal centers, by application of the Papanico-
laou cancer detection test on centrifuged
washings from the rectum and colon. This
method may be of some value in diagnosing
lesions above the range of the proctoscope.
However, we need objective data regarding
its use before employing the method rou-
tinely.
The lesions of the colon that may mimic
cancer and should be excluded in the differ-
ential diagnosis are: diverticulas, polyps,
stercolith, chronic ulcerative colitis, inter-
nal herniation, intussusception, and rarely
amebiasis.
Pathologic Anatomy : About 90 per cent
of all carcinomas of the colon and rectum
are adenocarcinomas\ Two main types of
adenocarcinoma of the colon may be dis-
tinguished: a. medullary adenocarcinoma,
composed of large cauliflower-like masses
projecting into the lumen, is usually locat-
ed in the right colon. Clinically these pa-
tients show anemia and gross or occult blood
in the stool resulting from early ulceration
of the tumor. They may be palpable in a
slender person, b. scirrhous adenocarcino-
ma, composed of small atypical glands that
infiltrate the wall of the colon, resulting in
an annular constriction, usually located in
the left side of the colon. Clinically these
patients experience change in bowel habit,
are constipated and tend to become obstruct-
ed. Ulceration occurs late, and anemia re-
sulting from bleeding is uncommon. These
tend to metastasize earlier than the first
type. A third type, mucoid adenocarcinoma,
constitute a small percentage, tends to in-
filtrate widely, and the prognosis is less
favorable.
In adenocarcinoma of the rectum, path-
ologically and clinically we can separate
two forms: a. annular constricting ulcerated
carcinoma, which forms the majority of
rectal carcinomas, and b. papillary adeno-
carcinoma. The first type is flat, infiltrates
the mucosa and wall progressively in the
transverse plane, ulcerates in the center and
has indurated borders. In about one year
the tumor invades the perirectal skin and
external sphincter; second, may spread lat-
erally to the levator ani muscle, prostate,
bladder, pelvic peritoneum and female or-
gans; third, may spread upward along the
superior hemorrhoidal vessels and lymph
nodes to the paracolic nodes. The second
type, papillary adenocarcinoma of the rec-
tum, many times arising in papillomas,
forms a bulky tumor inside the lumen and
soon invades the circumference of the rec-
tum. Obstruction occurs fairly early. In
about 95 per cent of the cases both types of
rectal carcinoma may be palpated by digital
examination. This tumor invades the lymph
nodes later than the first type.
Metastasis : Gilchrist and David’ report
that lymphatic spread of carcinoma of the
colon is primarily embolic, but spread
from one node to another is not common.
These authors report lymph node metastasis
366
The Journal of the Medical Association of Georgia
in 125 of 200 cases, and emphasize the need
for the widest possible resection of lymph
nodes draining the area of carcinoma. Of
the 125 patients with lymph node metasta-
sis, 56 (44.8 per cent) lived 5 years. Retro-
grade metastases to nodes below the tumor
occurred in 4.6 per cent. The liver was the
site of metastasis in 15.9 per cent. Two of
the three patients in whom carcinoma of
the rectum developed during pregnancy
lived more than five years, suggesting that
the gloomy prognosis given pregnant women
with neoplasm may not be justified in carci-
noma of the rectum.
Summary : Thirty-seven cases of adeno-
carcinoma of the colon and rectum are
briefly presented.
REFERENCES
1. Bacon. H. E. : Diseases of the Rectum and Colon.
Philadelphia.. J. B. Lippincott Company, 1949.
2. Atwater. John S.: J. M. A. Georgia 37:252-64 (July)
1948.
3. Dukes. Cuthbert: Brit. J. Surg. 13:720, 1926.
4. Bargen, J. A.; Cromar, C. D. L., and-. Dixon. C. F. :
Arch. Surg. 43:186. 1941.
5. Broders, A. C. : South. Med. and Surg. 102:225. 1940.
6. Coller, F. A., and Berry, R. D. : J. A. M. A. 135:1061-
67. 1947.
7. Brown, C. H., and Colvert, J. R. : Ann. Int. Med.
27:936. 1947.
8. Moore. R. A. : A Textbook of Pathology, Philadelphia,
W. B. Saunders Company, 1944, p. 850.
9. Gilchrist. R. K.. and David, V. C.: Ann. Surg. 126:421-
28, 1947.
THE CHOICE OF OPERATION IN GAS-
TRIC AND DUODENAL ULCER
C. H. Richardson, Jr., M.D.
Macon
The surgical therapy of peptic ulcer has
recently been under considerable discussion
as the result of the introduction of vagus
nerve resection or vagotomy in 1943 by
Dragstedt and his co-workers at Chicago.1
Because of this it has been necessary to
try to determine the worth of this new pro-
cedure and re-evaluate old operative tech-
nics.
The present opinions are based on a re-
view of recent literature and a study of 27
of my cases. It is felt that every case of
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
peptic ulcer is an individual problem and
should be evaluated and treated on its own
merits. However, certain general principles
can be gained from such a study.
The indications for surgery are well es-
tablished and have not changed". These are
hemorrhage, perforation, obstruction, and
intractability. The consensus of opinion is
to treat acute perforation by simple closure,
and to treat massive hemorrhage conserva-
tively at first' \ If this fails, the operation
of choice is subtotal gastric resection to con-
trol the bleeding vessel and prevent further
1 1 3 4 29
hemorrhage
This discussion of the treatment of peptic
ulcer will be limited to gastroenterostomy,
subtotal resection, vagotomy, and combina-
tions of these. Other procedures have been
shown to have very limited application.
Gastric Ulcer
First let us consider gastric ulcer. Only
one fourth as frequent as duodenal ulcer,
unless the ulcer heals promptly it should be
treated surgically because of its close rela-
tion to gastric carcinoma. By careful x-ray
studies and gastric analysis it is usually
possible to differentiate between the two.
Absence of free acid points toward malig-
nancy and indicates early operation. ^ hen
this is done a biopsy and frozen section may
be helpful in deciding between a total gas-
trectomy and a less radical procedure.
There have been reports of gastric ulcers
healing after vagotomy; however, this is
not consistently true' 1 . Subtotal resection
for this type of ulcer is technically easy with
low hazard and, as the gastric acidity is
rarely much increased, the operation carries
a high degree of success'' " ' 8 J.
TABLE 1
Gastric Ulcer
Cases — 7
Treatment — Resection
Results — Satisfactory
1 Dumping syndrome
0 Recurrence.
In the present series, all of whom were
operated on, seven of the 27 cases were
September, 1950
367
benign gastric ulcers and subtotal resection
was chosen in all with satisfactory results,
two cases having vagotomy in addition to
resection.
REPORT OF CASE
Case 1 . N. S., a white male, aged 45. History of
episodes of severe indigestion, heartburn, and pain
for ten years, not responding well to diet or alkalies.
X-ray examination showed a lesion high on the posterior
wall of stomach near esophagus. Gastric analysis:
Free HC1 10; total 15 after alcohol. At operation a
large chronic gastric ulcer penetrating the pancreas
was found. Frozen section was made and showed no
malignancy, tipper half of stomach and spleen along
with both vagus nerves were resected, and esophagogas-
trostomy was done. A postoperative left subphrenic
abscess developed and was drained. Patient made good
recovery : had mild diarrhea at first and mild dumping
syndrome, but was back at work in eight weeks and is
apparently cured. He is now eating a full diet and
having no G. I. complaints one year after resection.
Duodenal Ulcer
Duodenal ulcer has been called a psycho-
somatic disorder '. Certainly it is a difficult
disease to treat. It has been shown that
hypersecretion of gastric juice occurs, par-
ticularly at night, and perpetuates the di-
sease1". At least two mechanisms exist that
may contribute to this11. One a humoral
mechanism, the usual food stimulation; and
the other a nervous one1". Over-stimulation
by this latter mechanism has been shown to
be the main secretory fault of the peptic
ulcer patient1 13.
TABLE 2
Gastric Secretion
1. Humoral = Food-Antrum-Fundus
HC1 & Pepsin
2. Cephalic = Vagus — Fundus
Hcl & Pepsin
Gastroenterostomy by effecting a short
circuit and bringing alkaline intestinal
juices in contact with the stomach will often
cause the ulcer to heal. However, a recur-
rence rate of 20 to 30 per cent has caused
it tc be discarded except for the elderly
patient with obstruction and a low acid
where it is still the operation of choice. This
procedure carries the lowest mortality of
stomach operations, being around one per
cent2 8 14.
Subtotal gastric resection has a lower re-
currence rate, but it carries a mortality of
two to five per cent even in good hands14. To
TABLE 3
Results of Surgery
Gastroenterostomy Resection
HELER 4% , Mortality
N. Y 74% 83% Good
1944
GRAY 1% 5% Mortality
Mayo Clinic 77% 90% Good
1949
be successful, the pylorus and two thirds
of the stomach should be removed. The re-
sults are better if the ulcer can also be re-
moved. Quite a few patients suffer consid-
erable subsequent weakness and disability
so that satisfactory results are reduced to
approximately 85 per cent. It is quite effec-
tive in reducing the humoral food type
stimulation to gastric juice1’. Recurrent
ulcer occurs in approximately five per cent
of cases1"
TABLE 4
Two to Five-Year Follow-Up After Vagotomy
Satisfactory
Cases Results
GRIMSON 104 85%
DRAGSTEDT 144 80-86%
MOORE 116 88%
RUFFIN 2500 85-90%
Vagotomy, or vagus nerve resection, lias
been performed in over 8.000 cases and
careful studies up to five years are on rec-
ord'*. The healing of duodenal ulcers after
adequate vagotomy is quite consistent and
the protection against recurrence and hem-
orrhage high. If a nervous mechanism is
primarily at fault as has been maintained,
then vagotomy is the logical procedure of
choice. The operation is not without its side
effects also, the major ones being loss of
tone and delayed gastric emptying. Even-
tually this tone is regained but because of
this side effect the majority of surgeons
doing vagotomies now add a gastroenteros-
tomy to prevent this retention and help the
stomach empty. Theoretically vagotomy
may be contraindicated in hypertensive vas-
, i • 15 18 19 20 21 22 23 28 29 30 34
cuiar disease
TABLE 5
Results of Surgery
Resection Vagotomy
GRISWOLD ’49 90% 90%
WALTERS ’49 85-95% 79-86%
CRILE ’48- 87% 89-98%
FINNEY ’49 88% 97%
The Journal of the Medical Association of Georgia
368
Several series have been reported com-
paring resection and vagotomy which show
the successful results are approximately
equal. The advantages of vagotomy are its
lower mortality and the preservation of the
individual’s stomach’ 4 Jl'.
TABLE 6
Results of Surgery
Resection and
Resection Vagotomy
Lahey Clinic — 12°/i 58%
Colp, Mt. Sinai 85% 85%
Finney. Hopkins 88% 96%
Some workers have combined vagotomy
and resection. However, to date this has
not proven to be of much added value and
it adds considerably to the magnitude of the
operation1’ 26 '.
TABLE 7
Duodenal Ulcer
Cases — 17
Resection . 5
Result Good 4
Recurred 1
Vagotomy . 12
Result Good j 10
Improved 1
Failed 1
In the 17 cases of duodenal ulcer, resec-
tion was performed five times and vagotomy
with gastroenterostomy twelve times. Mar-
ginal ulcer followed one subtotal resection
and there was persistence of ulcer follow-
ing one vagotomy, later shown to be incom-
plete. From these few cases the impression
has been gained that the “typical ulcer pa-
tient” responds quicker to vagotomy and is
on his feet sooner with less disability than
with resection. The average hospital stay is
cut down by one-third and early weight gain
is the rule. The side effects of vagotomy
have not been as severe as those of resection.
Several patients have complained of mild
cardiospasm, and about half have had a
transitory diarrhea.
REPORTS OF CASES
Case 2. C. J. Heavy set white male, aged 42. Chronic
duodenal ulcer twelve years with severe pain. Insulin
test showed free acid 70 and total 150. X-rays showed
duodenal deformity and persistent spasm. At operation
duodenum was scarred, deformed and the ulcer appar-
ently was attached to head of pancreas. A vagotomy
was done and posterior gastroenterostomy under
endotracheal ether anesthesia. Patient made an un-
eventful recovery and stated that his ulcer pain was
completely gone as soon as he awoke. X-rays have
shown healing and complete stenosis of pylorus. P. 0.
insulin test showed free acid 10. total 50. He has
worked steadily since recovery and has had no recur-
rence of symptoms in over a year.
Case 3. M. R., colored female, aged 25. Admitted
because of G. I. hemorrhage. X-ray showed duodenal
ulcer penetrating posteriorly. Acid values high. Vagus
nerve resection and gastroenterostomy were done but pain
persisted. Insulin test twice showed a positive reaction
and x-rays showed non-function of gastroenterostomy.
At reoperation three additional vagus fibers were found
and divided and gastroenterostomy was made larger.
This time P. O. insulin test negative, and ulcer then
healed according to x-ray. Patient complained of some
pain but has gone on to recovery.
Marginal Ulcer
The surgical result in recurrent or margi-
nal ulcer of gastric resection is not as good
as for primary ulcer1 \ Howrever, nearly
all reports indicate a high success for vag-
otomy and recommend its use2S ir' '. Three
marginal ulcers were treated in this series:
one by resection who also had a gastric
ulcer, one by vagotomy, and one by vag-
otomy and second gastroenterostomy. All
have been satisfactory to date.
REPORT OF CASE
Case 4. L. C., white female, aged 55. In 1947 had
a chronic duodenal ulcer intractable to medical treat-
ment, duration 12 years. Free acid 55 and total 85.
Operated on and subtotal resection was done. Patient
developed severe retention one week postoperatively,
which was relieved after another week by conservative
measures. Postoperative gastric analysis with alcohol
showed free acid 10 and total 15. About three months
P. O. patient began to develop a marginal ulcer. This
was treated conservatively for two years but failed to
remain healed. An insulin test showed gastric acidity
of 30 free and 70 total, so in February 1949 trans-
abdominal vagus nerve resection was done. Postopera-
tively the anastamosis became obstructed and an entero-
enterostomy was done. Patient has had no further
recurrence of pain and x-rays show ulcer healed. She
is able to carry on a normal activity and eats a fairly
normal diet.
Comment
To summarize, each patient w ith a peptic
ulcer is an individual case and should have
a thorough evaluation and trial at medical
management. If this fails and surgery is
resorted to, a careful correlation between
the clinical picture, x-ray findings, and gas-
tric analysis is needed to choose the pro-
cedure best for that particular case. Sub-
total gastric resection is the usual choice
for benign gastric ulcer. Occasionally vag-
otomy may be indicated in the high ulcer
where the risk of gastric resection is great,
although upper resection is probably a
September, 1950
369
better procedure. Duodenal ulcers with ob-
struction and low acid respond well to sim-
ple gastroenterostomy. Those with high
acid response to insulin produced hypogly-
cemia should have vagotomy combined with
gastroenterostomy. Those with low acid re-
sponse to insulin but high response to alco-
hol or histamine, probably should have a
resection. Vagotomy may be contraindicat-
ed in hypertensive vascular disease. Rarely
resection and vagotomy combined are indi-
cated, but cases which have had massive
bleeding should have vagotomy whether re-
section is done or not.
Conclusions
The choice of operation in gastric ulcer
is subtotal resection whenever possible.
Duodenal ulcer presents more of a problem
and time is needed to evaluate all factors.
However, the present indications favor vag-
otomy and gastroenterostomy as the opera-
tion of choice. There is probably little ad-
vantage in combining resection and vag-
otomy as a primary procedure. Marginal
ulcer, occurring after gastroenterostomy or
resection, is best treated by vagotomy.
BIBLIOGRAPHY
1. Dragstedt, L. R. : Vagotomy for Gastroduodenal Ulcer,
Ann. Surg. 122:973. 1945.
2. Heuer, G. J. : The Treatment of Peptic Ulcer, Phila-
delphia. J. B. Lippincott Company, 1944.
3. Welch, C. E. : Treatment of Acute, Massive Gastro-
duodenal Hemorrhage, J.A.M.A. 141:1113 (Dec.) 1949.
4. Lewison, E. F. : Bleeding Peptic Ulcer, Surg. Gynec.
& Obst. 90:1-30.
5. Maimon, S. N-, and Palmer, W. L. : Gastric Cancer:
Diagnosis, Course, and Prognosis, Postgrad. Med. 6:201-211,
1949.
6. Solis-Cohen, Leon: Diseases of The Upper G. I. Tract,
Correlation of Clinical and Radiologic Findings, Postgrad.
Med. 7:106-113, 1950.
7. Weiss, S. : Peptic Ulcer, Theory and Practice, Rev.
Gastronenterol. 16:336, 1949.
8. Crile, G., Jr.: The Surgical Treatment of Peptic Ulcer,
S. Clin. North America p. 1123-1137 (Oct.) 1948.
9. Crohn, B. : Peptic Ulcer as a Psychosomatic Disease,
S. Clin. North America p. 309 (April) 1947.
10. Levin, E. : Nocturnal Gastric Secretion, Arch. Surg.
56:345-356, 1948.
11. Best, and Taylor: Physiological Basis of Medical
Practice, New York, William Wood & Company.
12. Griswold, R. A.: Physiologic Changes Following
Vagotomy for Peptic Ulcer, South. Surgeon 15:1-8 (Jan.)
1949.
13. Dragstedt, L. R. : Transabdominal Gastric Vagotomy,
Surg., Gynec. & Obst. 85:461, 1947.
14. Gray. H. K. : Results of Classical Operation for
Duodenal Ulcer, J.A.M.A. 141:509, 1949.
15. Moore, F. : Current Practices in Surgical Treatment
of Ulcer, S. Clin. North America, Oct., 1947.
16. Griswold, R. A. : A. Rationale for the Surgical
Treatment of Duodenal Ulcer, Surg., Gynec. & Obst. 88:585,
1949.
17. Marshal, S. A. : Gastrojejunal Ulcer, S. Clin. North
America (June) 1946.
18. Colp, R. : A Comparative Study of Subtotal Gastrec-
tomy with and Without Vagotomy, Ann. Surg. 128:470, 1948.
nesecuon ot Vagi
picrvcs
Ulcer, J.A.M.A. 133:741, 1947.
20. Grimson, K. S.: Vagotomy, Observations During Four
Years, Surgery 27:49, 1950.
21. Moore, F. : Follow Up of Vagotomy in Duodenal
Ulcer, Gastroenterology 11:442, 1948.
22 Dragstedt, L. R. : Follow Up on Vagotomy Alone in
Treatment of Peptic Ulcer, Gastroenterology 11:460, 1948.
23. Nordland, M.: A Clinical Evaluation of Vagotomy
m the Treatment of Peptic Ulcer, South Surgeon vol 16
(Jan.) 1950.
24. Ruffin, J. M. : The Ultimate Results of Vagotomv
Gastroenterology 11:466, 1948.
25. Walters, W. : Vagotomy in The Treatment of Peptic
Ulcer, Collect. Papers Mayo Clin. & Mayo Found. 40:19,
26. Finney. G. G. : Surgical Aspects Duodenal Ulcer Post-
grad. Med. vol. 6 (Sept.) 1949.
27. Wilkinson, S. A.: Vagotomy Combined with Subtotal
Gastrectomy, Gastroenterology 11:457, 1948.
28. Ruffin, J. M. : Vagotomy fn the Treatment of Peptic
Ulcer, Vet. Admin. Technical Bull. (Nov. 25) 1947.
29. Fritz, J. M, and Dragstedt, L. R. : Vagotomy: Indica-
tions and Results, Mod. Med. (Oct. 15) 1949.
30. Collins. E. N. ; Crile, G., Jr., and Davis, J. B.: Follow
Up of Vagotomy Plus Gastroenterostomy or Pyloroplasty for
Ulcer, Gastroenterology 11:453, 1948.
31. Hollander, F. : Laboratory Procedure in the Study of
Vagotomy, Gastroenterology 11:419, 1948,
32. Hollander, F. : Insulin Test, Gastroenterology 7:607
1946.
33. Ransom, H. K. : Experiences with Total Gastrectomy
South. Surgeon 16:801-819 (Dec.) 1948.
34. Orr, I. M., and Johnson, H. D.: Vagal Resection in
the Treatment of Duodenal Ulcer, Lancet 253:84 (July)
1947.
35. Thorex, P. : Vagotomy, J.A.M.A. 135:1146, 1947.
36. Machella, T. E.: The Mechanism of the Post-Gastrec-
tomy Dumping Syndrome, Ann. Surg. 130:145, 1949.
13 3 7741M°1947 F ° ' Resection of Va8us Nerves, J.A.M.A.
700 Spring St.
AN ANALYSIS OF FIFTEEN CASES OF
INTUSSUSCEPTION
John W. Turner, M.D.
and
August B. Turner, M.D.
Atlanta
An analysis is made here of 15 cases of
intussusception occurring at Grady Memo-
rial Hospital from 1943 to March 1950
inclusive. Four cases encountered in pri-
vate practice will also be presented briefly.
Adult cases in this series will be dealt with
briefly, emphasis being given to those cases
occurring in infancy and childhood. Dur-
ing the period from January 1943 to April
1, 1950 there have been in the neighborhood
of 134,346 admissions to Grady Memorial
Hospital, of which approximately 38.8 per
cent were white and 61.2 per cent colored.
From these admissions 15 cases, both adult
Read before the Medical Association of Georgia in annual
session. Macon, April 19, 1950.
370
The Journal of the Medical Association of Georgia
and infant, are presented for evaluation.
On the basis of 134,346 admissions with
15 cases of intussusception being reported
there was an incidence of 0.012 per cent,
or one case in ten thousand admissions. In
a series of 95 cases reported by H. A. Ober-
helman from 141,580 admissions to Cook
County Children’s Hospital in Chicago the
incidence was, according to these figures,
0.067 per cent or six cases from every ten
thousand admissions. This difference in in-
cidence is not as large as one would antici-
pate between a general and children’s hos-
pital.
The three adult cases to be presented
briefly here had an average age of 51 years
and, according to the classifications of Rob-
ert H. Gibson, two of them were of the
chronic type and the third was of the sub-
acute type. Dr. Gibson states that a sub-
acute intussusception is one in which symp-
toms have been present for at least one
week; the chronic type is one in which symp-
toms have been present for more than two
weeks. Two of the above adult cases gave
a history of abdominal discomfort, cramps
and short-lived episodes of nausea and vom-
iting for more than three months prior to
admission. Both cases also gave a history of
grossly bloody stools during their illness.
The third case, which falls into the subacute
classification, gave a history of intermittent
cramping abdominal pain, nausea, vom-
iting, and diarrhea of eight days duration.
There was no history of grossly bloody
stools in this case. In each of these three
cases the diagnosis was made preoperatively
by barium enema and the patients were pre-
pared in the usual manner for surgery. A
number of investigators have reported that
in the adult type of intussusception the cau-
sative factor is usually very easily demon-
strated. This is borne out in the three cases
presented here. Two of these cases had
carcinomas of the colon which formed the
head of the intussusceptum. These two cases
were treated by terminal ileectomy, partial
colectomy and primary ileo-transverse col-
ostomy. The third case, which was of the
subacute type, presented a fibroma of the
terminal ileum as the factor responsible for
the intussusception. The treatment in this
case was the same as for the above two.
These three patients spent an average of 28
days in the hospital, received an average
of 15 days preparation and were discharged
on an average of the 12th postoperative day,
to lie followed in outpatient clinics.
The symptoms which usher in this disease
are usually of sufficient severity and are of
such sudden onset, in most instances in a
previously healthy child, that the mother
is prompted to bring tbe child to the physi-
cian early in the disease. The burden, there-
fore, of prompt and proper treatment, and
often times of delayed and improper treat-
ment, usually rests upon the physician who
first has occasion to examine the patient. A
history obtained from the mother of the
patient is usually sufficient to suggest the
diagnosis; a more detailed history and ex-
amination of the patient will usually either
confirm the diagnosis of intussusception or
suggest a disease in which the urgency for
immediate treatment is not so great. There
are three essential points which are promi-
nent in this disease:
1. It is usually of rather sudden onset
in a well-nourished, previously well child
or infant.
2. It is characterized by severe cramplike
abdominal pain of an intermittent type.
3. Nausea and vomiting are present early
in the disease.
The passage of a bloody or currant jelly
stool is a finding which varies considerably
in the different series of cases reported.
Oberhelman reports an incidence of 70
per cent, Snyder 55 per cent, Gross and
Ware 85 per cent, and in the series being
September, 1950
presented here an incidence of 100 per cent.
We think that in too many cases the patient
is not presented for treatment until the moth-
er is frightened by the finding of a diaper
full of blood and in too many instances the
patient’s symptoms are passed over too
lightly by the physician because there has
been no blood in the stool, and the diagnosis
is deferred until a later visit. In all cases
of intussusception, we dare say, there will
eventually be blood in the stool unless there
is early reduction, either spontaneous or
manipulative. Let us not depend upon the
passage of a bloody stool before making the
diagnosis in those cases which we are fortu-
nate enough to see in their incipiencv. If
there is a doubt in your mind as to the valid-
ity of your diagnosis, this doubt may easily
be dispelled by the relatively simple pro-
cedure of a fluoroscopic study of the pa-
tient’s abdomen during the time he is receiv-
ing a barium enema.
A thorough physical examination is of
utmost importance here as in any other case.
In 81 per cent of Oberhelman’s series, 69
per cent of Snyder’s series, and in 66%
per cent of this series there was a mass pal-
pable in the abdomen. This mass in most
instances is fairly mobile, has been de-
scribed as being sausage-shaped and, due to
the dehydration usually present, is very
readily palpable. In 25 per cent of the
series being reported the head of the intus-
susceptum could be palpated directly by
rectal examination; it was described in each
instance as having the contour of a cervix
but being much less firm. In one of these
cases the head of the intussusceptum pro-
truded from the rectum and was reduced
into the rectum by the child’s mother. All
patients included in this series were cril-
dren of indigents but, in spite of this,
all were well developed, well-nourished,
healthy children prior to the onset of the
present illness. Dehydration, abdominal
371
tenderness and, in some instances, slight
distention are the other physical findings
which were fairly consistently present.
Oberhelman reports signs of obstruction
present in 42 per cent of the cases in his
series. Rectal examination in addition to
being of great value in palpating and locat-
ing an elusive mass may also reveal blood
in the lower bowel.
The average age of patients in this series
was 17 months; however, this does not give
us a true picture of the situation since there
were three cases included here which were
2 years, 3 years, and 7 years of age respec-
tively. Of the 12 cases in young patients
presented, 75 per cent were 10 months of
age or younger and, with the exception of
the above three cases, all were between the
ages of five and ten months. These figures
compare favorably with larger series which
have been reported, as follows:
Ladd and Gross
Mayo and Phillips
Oberhelman
Present series
70% between 4-11 mos.
80% between 4-11 mos.
68% below 1 year.
75% between 5-11 mos.
For some unexplained reason this disease
has a slightly greater incidence in males
than in females. In Oberhelman’s series
there were 68 per cent males; in this series
there were 58.4 per cent males.
By definition intussusception is the invag-
ination or indigitation of a portion of the
intestine into an adjacent portion. An in-
tussusception is composed of three essential
parts: the intussusceptum, the intussusci-
piens, and the head of the intussusceptum.
The intussuscipiens is the portion of bow'el
into which the intussusceptum invaginates.
The head of the intussusceptum is the most
distal point of advancement of the intus-
susceptum and may be readily identified by
palpation in most cases. The type of intus-
susception takes its name from the parts of
the bowel involved. The incidence of the
different types of intussusception as report-
372
The Journal of the Medical Association of Georcia
ed by different authors and as compared individuals there is one essential which
with their series is tabulated below: should be constantly borne in mind and that
Gross and Ware
McLaughlin
Present series
Enteric 5%
Colic 2.1%
Enterocolic 90%
Other 2.92%
j ileocolic 76%
} ileoileocolic 14%
10-15%
5-10%
75-80%
0%
25%
75%
ileocolic 58%
ileoileocolic 16%
Multiple theories have been advanced in
regard to the etiology of this disease which,
as McLaughlin says, ranks second only to
appendicitis as the cause of acute conditions
iu the abdomen requiring surgical treatment
in infancy and childhood. Among the num-
erous conditions which have been referred
to from time to time as possible causes of
this disease are: enlarged Peyer’s patches,
enlarged mesenteric nodes, redundancy of
the cecum, ileocecal neuromuscular dys-
function, enteric infection, excessive cath-
arsis and transition from breast -or bottle to
a more solid diet. Many of these conditions
have been found to be present in cases of
intussusception but it has not been possible
to determine whether they developed prior
to, during or as a result of the intussuscep-
tion. There are, however, three mechanical
factors which are very definitely responsible
for the production of a certain percentage
of intussusceptions. These are: (1) Meck-
el’s diverticulum, (2) intestinal polyps or
tumors and (3) reduplication of the bowel.
Only in rare instances can we demonstrate
an etiologic factor responsible for the pro-
duction of an intussusception in infancy or
childhood. Ladd and Gross state that in 95
per cent of their cases no etiologic factor
could be demonstrated. Oberhelman found
no etiologic factor in 82.1 per cent of his
cases and no etiologic factor was demon-
strated in 100 per cent of the present series.
In those cases in which a mechanical etio-
logic factor can be demonstrated it is found
to be a Meckel’s diverticulum in an over-
whelming majority.
In the consideration of treatment for these
is promptness. Robert E. Gross states, “The
interval between the onset of symptoms and
the institution of treatment is of paramount
importance and mortality rates will more
nearly approach zero the more frequently
treatment is instituted within 24 hours of
onset”. It has been shown that there is a
very abrupt rise in the mortality when treat-
ment is delayed more than 24 hours after
the onset of symptoms. Reduction of an
intussusception by means of barium enemas
and hydrostatic pressure under fluoroscopic
control has been advocated by some as an
adjunct to surgery, but only in those cases in
which the diagnosis has been made very
early in the disease. It is our opinion that
reduction of an intussusception is an ex-
tremely hazardous task, even under direct
vision in many instances, and we do not
think that reduction should be attempted by
means of rectal instillations. In addition to
the possibility of damaging the bowel it is
also quite possible that complete reduction
cannot always be obtained and the patient
will have to be subjected to the additional
hazard of laparotomy. X-ray should be
used only as an adjunct to diagnosis. After
the diagnosis of intussusception has been
made, preparation for surgery should be
begun immediately. While the operating
room is being readied the patient should re-
ceive all necessary supportive therapy such
as fluids and blood if these are necessary.
Under general anaesthesia, usually open
drop ether, the abdomen is opened in the
right lower quadrant either by a vertical or
transverse incision. The head of the intus-
susception is located and reduced as much
September, 1950
373
as possible, usually to the region of the
ileocecal valve and ascending colon, and
then the mass is retracted from the abdomen
and by taxis the reduction is completed
under direct vision. In case gangrenous
bowel is encountered, or in case reduction
is impossible, it will be necessary to resect
the involved bowel. Many technics of re-
section have been described, all of which
are equally satisfactory. The operator
should carry out the procedure with which
he is most familiar.
In the series of cases reported here the
average time from onset of symptoms until
admission to the hospital was 21 hours and
20 minutes; the average time between ad-
mission and laparotomy was roughly two
hours. Our patients spent a total of 115
days in the hospital or an average of 9.5
days each. There was one death in this
series, giving a mortality of 8.5 per cent.
Th is death occurred on the 8th postopera-
tive day and was attributed to a peritonitis
of unknown origin. The patient was con-
valescing satisfactorily until the day of
death.
Among four cases encountered in private
practice there was no mortality; two of these
cases were of particular interest and will be
presented briefly here. One of these was an
infant 3^/? months of age in whom the diag-
nosis of intussusception was made and lapa-
rotomy performed within 6 hours of the
onset of symptoms. The intussusception was
readily reduced and was found to be due
to a fibroma measuring 1 cm. in diameter
attached to the tip of a Meckel’s diverticu-
lum and forming the head of the intussus-
ceptum by inverting the diverticulum. The
diverticulum, along with the fibroma, was
resected and the patient made an uneventful
recovery. The other case was that of a boy
9 years of age in whom symptoms had ex-
isted for 36 hours prior to admission to the
hospital. The diagnosis having been made,
the patient was prepared for surgery imme-
diately. Upon opening the abdomen the in-
tussusception was readily reduced, reveal-
ing about 12 inches of gangrenous bowel
with a large Meckel’s diverticulum attached.
The gangrenous bowel was resected and the
ends of the bowel were closed and a side-to-
side anastamosis was done. Convalescence
in this instance was more stormy, but the
patient was not considered seriously ill at
any time. In each of the four cases encoun-
tered in private practice a tumor mass was
palpable in the abdomen.
Summary-
In summary, it is emphasized that this
disease is one which occurs predominately
in infants between the ages of four and
eleven months. It is relatively easily diag-
nosed and, though its incidence is relatively
low, it does stand as the second most com-
mon acute surgical disease in this age
group. Again it is emphasized that prompt-
ness in diagnosis and treatment is of ex-
treme importance. The mortality rate in
those cases requiring resection is in the
neighborhood of 45 per cent.
REFERENCES
1. Ravitch. Mark M., and McCane. Robert M., Jr.:
Reduction of Intussusception by Barium Enema; a Clinical
and Experimental Study, Ann. Surg. 128:904-917 (Nov.)
1943.
2. Snyder. William H. ; Kraus, Alfred R., and Chaffin,
Lawrence: Intussusception in Infants and Children. A
Report of 143 Consecutive Cases, Ann. Surg. 130:200-210
(Aug.) 1948.
3. Kahle, Richard H. : An Analysis of 151 Cases of
Intussusception from Charity Hospital, New Orleans, La.
Ann Surg. 52:215-224 (May) 1948.
4. McLaughlin, Charles W. : Surgical Management of
Irreducable Intussusception, Arch. Surg. 56:48-55 (Jan.)
1948.
5. Lindbey, Gustaf, and Moraler, Olello: Treatment of
Acute Intussusception by an Enema of Roentgenologic Con-
tract Medium. Am. J. Dis. Child. 77:303-308 (March) 1949.
6. Oberhelman, Harry A., and Condon. John B.: Intus-
susception in Infants and Children. An Analysis of Ninety-
five Cases in the Cook County Children's Hospital, S.
Clin. North America pp. 3-22 (Feb.) 1947.
7. Gadbois, Raymond W. ; Dean, Michael H., and John-
son, William E.: Treatment of Intussusception Caused by
Invaginated Meckel's Diverticulum. Report of a Case
with Review of Experience in a Community Hosiptal, New
England J. Med. 241:595-600 (Oct. 20) 1949.
8. Cross, Robt. E., and Ware, Paul F. : Intussusception
in Childhood. Experiences from 610 Cases, New England
J. Med. 238:645-652 (Oct. 28) 1948.
9. Dennis, Clarence: Resection and Primary Anastomosis
in the Treatment of Gangrenous or Non-Reducible Intussus-
ception in Children. A Safe, Simple, One-layer Silk Anasto-
mosis, Ann. Surg. 126:788-796 (Nov.) 1947.
10. Gibson, Robert H. ; Dockerty. Malcolm B., and Dixon,
Claude F. : Intussusception in Infants and Children, S. Clin.
North America pp. 1141-1151 ((Aug.) 1949.
11. Thorek, Philip, and Lorimer, W. S., Jr.: Retorgrade
Intussusception, J.A.M.A. 133:21-23 (Jan. 4) 1947.
12. Talor, William H. : Multiple Intussusception, Direct
and Retrograde, of Traumatic Origin, Ann. Surg. 127:730-
737 (April) 1948.
371
The Journal of the Medical Association of Georgia
13. Baener. J. Peyton: Surgical Treatment of Irreducible
Intussusception in Infants. Surg.. Gynec. & Obst. 85:747-750
(Dec.) 1947.
14. Fallis, Lawrence S.. and Warren. Kenneth W. :
Irreducible Intussusception in Infants. Report of Two
Successful Primary Resections. Surg.. Gynec. & Obst.
81:384-386 (Oct.) 1945.
15. Abram, Hymone S. : Intussusception. Particular
Reference to Roentgen Diagnosis Without Opaque Media,
Radiology 36:490-492 (April) 1941.
Note: The foregoing papers are a part of a sym-
posium. Discussion of them will follow completion
of the publication of the symposium, in the October,
1950, number of THE JOURNAL. — Ed.
DIAPHRAGMATIC HIATUS HERNIA
Sandy B. Carter, M.D.
Atlanta
Diaphragmatic hiatus hernia is a condi-
tion that occurs fairly often but is seldom
suspected. Frequently the diagnosis is not
considered and not made until upper gas-
trointestinal roentgen studies are made in a
routine check-up or for some other sus-
pected gastrointestinal pathology.
A single case is presented briefly to illus-
trate some of the features that will be dis-
cussed. Twenty-seven additional unselected
cases from Grady Hospital have been
studied for data that may he of interest,
CASE REPORT
The patient was a 62 year old housewife, first seen
Jan. 13, 1949. About 25 years ago she began to suffer
from epigastric pain radiating into her back in the
interscapula region, accompanied by nausea and rarely
by vomiting. The attacks were usually associated with
exertion of some kind, i.e. coughing, lifting, bending,
housework. The attacks had increased in severity and
frequency. Frequent gastrointestinal and gallbladder
x-rays had been done and were always reported nega-
tive.
Physical examination revealed an obese female in
no distress. The entire physical examination was
negative except for slight epigastric tenderness.
Gastrointestinal series revealed a fairly large hernia
of the gastric fundus protruding through the esopha-
geal hiatus into the mid thorax. There was a gastric
ulcer measuring 9 by 7 mm. on the lesser curvature
margin of the stomach. Multiple diverticula were seen
in the duodenum and jejunum. Gallbladder visualiza-
tion was normal.
The patient was placed on a strict ulcer regimen.
After four weeks the gastrointestinal tract was x-rayed
again. The hiatus hernia and diverticula were visual-
ized again but the gastric ulcer was not demonstrated,
suggesting that the ulcer had healed. Although the
symptoms had improved there was still considerable
epigastric discomfort. Therefore, a left phrenic crush
was performed. In addition, a weight reduction, semi-
bland diet was instituted. The patient gradually lost
from 206 dow'n to 150 pounds. When last seen in Novem-
ber. 1949 she reported that she was feeling well.
Discussion
The chief obstacle in the diagnosis of
diaphragmatic hiatus hernia is failure to
suspect it or to look for it. It must he con-
sidered in all obscure cases of abdominal
and thoracic disturbances. Some of the im-
portant characteristics of hiatus hernia to
remember are that it simulates many other
diseases, it varies in symptomatology, the
symptoms are not constant and undergo fre-
quent changes, and specific x-ray methods
are necessary to demonstrate it. Many pa-
tients have been x-rayed before without diag-
nosis simply because of the matter of tech-
nic.
Harrington1 terms this condition the
“masquerader” of the upper abdomen and
considers this the most important clinical
consideration of diaphragmatic hernias
through the esophageal hiatus. In 343 oper-
ated cases, he found an average of three
previous erroneous clinical diagnoses be-
fore the correct diagnosis.
Incidence : The exact incidence of dia-
phragmatic hiatus hernias is unknown as
evidenced by the literature on the subject.
Kirklin and Hodgson' state that diaphrag-
matic hernias of all types occur in 1 or 2
per cent of all gastrointestinal examinations.
During 10 months in which hiatus hernias
were routinely looked for, Stapleton1 found
24 cases in 522 examinations, an incidence
of 4.6 per cent. In two years, Brick4 found
308 hiatus hernias in 3,448 gastrointestinal
x-ray studies, an incidence of 8.93 per
cent.
Age, sex, race : The typical case has been
described as an obese woman past middle
age, and this seems to fit in with most of the
reports. Brick4 found almost 77 per cent
of his 308 cases occurring between the ages
of 50 and 80, w ith the largest number in the
decade from 50 to 60. Kirklin and Hodg-
son' also found the largest number between
50 and 59, with 92 per cent occurring after
September, 1950
375
40. The sex ratio has been reported any-
where from 2:1 to 10:1 in favor of women.
Brick4 found 165 women and 143 men in
his series of 308 cases. The small series pre-
sented here shows a ratio of 1.5:1 in favor
of women. The number in each 10 year
period. Table 1, showed little variation
between 30 and 80 years of age.
TABLE 1
Age, Sex, Race in 28 Cases Hiatus Hernia
Age Women Men White Colored Total
20-29 1 — — 1 1
30-39 ___1 — 4 1 3 4
40-49 5 14 2 6
50-59 4 1 5 — 5
60-69 4 2 5 1 6
70-79 2 2 4 —4
80-84 112—2
Total 17 11 21 7 28
No previous reports were found concern-
ing the race distribution of hiatus hernias.
In this series there were 21 white and seven
colored patients, giving a ratio of three
whites to one colored. This is of increased
interest when it is known that of the total
admissions to Grady Hospital there are 1.5
times as many colored as white. However,
of the seven Negro patients, two were ad-
mitted because of massive hematemesis and
one because of incarceration of the hernia.
It is conceivable that Negroes are less sus-
ceptible to the ordinary symptoms of dia-
phragmatic hernia and present themselves
only when some unusual feature appears.
Manifestations : The symptomatology of
diaphragmatic hiatus hernia can be found
in textbooks and will not be repeated here.
As previously stated, the symptoms are va-
ried and simulate other diseases. Some of
TABLE 2
Symptomatology of Diaphragmatic Hiatus Hernia
and Conditions They Simulate
Gastrointestinal :
Epigastric pain
Distress during or after meals
Bloating
Belching
Heart burn
Nausea
Vomiting and regurgitation
Night pain
Pain in recumbent position
Dysphagia
Hiccough
Hemorrhage
Pulmonary:
Cough
Dyspnea
Cyanosis
Cardiac:
Anginal pain
Tachycardia
Palpitation
Cyanosis
Anemic:
Weakness
Dyspnea
Pallor
interference with the function of the herni-
ated abdominal viscerae, the degree of im-
pairment of normal function of the dia-
phragm, and the amount of increased pres-
sure within the thorax.
The symptoms in the present 28 cases
are shown in Table 3. The most frequent
complaints were epigastric pain and nausea
and/or vomiting. Both of these symptoms
occurred in an equal number of cases. Mas-
sive hematemesis occurred in five cases, two
of which were in colored patients. Massive
hematemesis has not been reported to occur
in as large a per cent as this. However,
TABLE 3
Manifestations in 28 Cases Hiatus Hernia
Massive Hematemesis 5
Melena 4
Epigastric pain 14
Epigastric fullness and eructation 6
Nausea and/or vomiting 14
Abdominal cramps 1
Dyspnea 2
Substernal pain : 2
Dysphagia 2
Anorexia 1
secondary anemia with stool positive for
blood has been reported frequently in hiatus
hernia. Occult blood was found in the stool
the symptoms and the diseases they simulate
are outlined in Table 2. Rudloff and King4
have outlined the symptoms in 50 cases and
found the most frequent to be epigastric pain
aggravated by reclining, dysphagia, angina
of effort, pyrosis, and dyspnea. They feel
that the most helpful diagnostic symptom is
epigastric pain aggravated by reclining or
exertion. Harrington1 states that the symp-
toms depend on the amount of mechanical
of seven of the present cases and was not
found in eight cases. Only 15 of the 28
cases were examined for occult blood in
the stool. Nineteen cases had a red blood
count recorded and nine of these were less
than four million. Twenty-one had hemo-
globin levels recorded and 16 of these were
less than 14 Gm.
Duration of symptoms: The duration of
symptoms is difficult to ascertain because it
376
The Journal of the Medical Association of Georgia
depends on the completeness of the history.
In 24 eases in which the duration of symp-
toms was noted it varied from one day, in
two cases of massive hematemesis, to 43
years. The majority of cases, 50 per cent,
were found to have had symptoms from 1
to 24 months. The duration of symptoms is
shown in Table 4.
TABLE 4
Duration of Symptoms in 24 Cases
Hiatus Hernia
Duration Number
1 day 2
3-7 days : 4
1-24 months 12
3-12 years 3
20-43 years 3
Total 24
Admission diagnoses : There were 18 dif-
ferent impressions made on the 28 cases at
the time of admission. Some cases had two
or more impressions, giving a total of 46.
TABLE 5
Admission Diagnoses in 28 Cases of
Hiatus Hernia
Diagnosis: Nmber
Chronic cholecystitis 1 4
Cholelithiasis 3
Peptic ulcer 12
For diagnosis - _ 6
Malignancy, not specified 4
Carcinoma of liver 1
Carcinoma of stomach 1
Carcinoma of colon 1
Diaphragmatic hernia 4
Hematemesis 2
Myocardial infarction 1
Multiple vitamin deficiency 1
Mediastinal tumor 1
Renal pathology _ 1
Megacolon jj 1
Appendicitis 1
Intestinal obstruction 1
Alcoholic gastritis 1
Total 46
The admission diagnosis and the number of
each are shown in Table 5. The most fre-
quent diagnosis was peptic ulcer, with gall-
bladder disease and malignancy sharing the
second most frequent diagnosis. There were
only four cases in which the admission diag-
nosis was diaphragmatic hernia, and two of
these had been diagnosed elsewhere and
were known to have it. Some of the admis-
sion diagnoses were correct in that they were
present and associated with the diaphrag-
matic hiatus hernia, which was not sus-
pected.
Associated conditions : Diaphragmatic
hiatus hernia is often associated with one
or more other conditions, which may ac-
tually he the cause of the symptoms in some
cases. Rudlolf and King'’ found the most
frequent associated diseases to he diverticu-
losis of the colon (12 per cent), inguinal
hernia (12 per cent), cholelithiasis (8 per
cent), duodenal ulcer and diverticulum of
the duodenum (6 per cent each), hyperten-
sive cardiovascular disease (20 per cent),
and pulmonary tuberculosis (10 per cent).
In the 3,448 gastrointestional x-ray studies
by Brick4, duodenal ulcer was the most fre-
quent lesion diagnosed, being found in 20.4
per cent of the total cases. Hiatus hernia
with 8.93 per cent was the second most fre-
quent lesion found, being twice as frequent
as gastric ulcer or gastric carcinoma. In
the patients with hiatus hernia the incidence
of gastric carcinoma was 0.65 per cent as
contrasted to 3.48 per cent in the total pa-
tients studied. In 308 cases of hiatus hernia
Brick4 demonstrated by x-ray 77 associated
gastrointestinal lesions. The most frequent
were duodenal ulcer (31) , hypertrophic gas-
tritis (7), esophageal diverticulum (5),
duodenal diverticulum (15), and gastric
ulcer and gastric carcinoma (2 each). In
the present series there were 22 associated
lesions found in 14 patients. Exactly 50 per
TABLE 6
Associated Conditions in 14 of 28 Cases
Hiatus Hernia
Condition Number
Duodenal ulcer ~ 1
Myocardial infarction 1
Scoliosis 3
Rheumatoid arthritis i 2
Hypertensive heart disease 3
Cholelithiasis 1
Carcinoma cervix , _ 1
Diverticula jejunum 2
Diverticular colon 1
Congenital muscle deformity 1
Tuberculous adenitis 1
Diverticular duodenum — . 2
Inguinal hernia — 2
Gastric ulcer 1
Total 22
September, 1950
cent of these cases had an associated lesion.
These are shown in Table 6. Bockus'' lists
the frequently associated lesions as gastric
and duodenal peptic ulcer, gallbladder dis-
ease, hernia other than hiatus, and diverti-
culosis of the colon or duodenum or both.
Treatment and results: Treatment is out-
lined in Table 7. Quite often the only treat-
ment required is correction of the associated
lesions, which might be causing the symp-
toms. Conservative treatment is usually
adequate for the hiatus hernia, and surgery
is rarely indicated. Only three of the 28
cases reviewed here were operated. Two
had thoracotomy with repair of the dia-
phragm, one because of incarceration of
the hernia and one because of severe pain.
The other patient operated had only a left
phrenic crush.
TABLE 7
Treatment oj Diaphragmatic Hiatus Hernia
Correct associated conditions.
Avoid increase in intra-abdominal pressure.
Sleep in semi-recumbent position.
Walking or standing to relieve pain.
Diet :
Gradual weight reduction
Bland food if symptoms active
Small frequent feedings.
Antacids
Antispasmodics
Sedatives
Iron for anemia
Surgery — rarely required.
The remaining cases were treated con-
servatively, including five cases that had
massive hematemesis. The follow-up on
most cases was inadequate, but when last
seen practically all of them were improved.
Summary
A case of diaphragmatic hiatus hernia
has been reported briefly and 28 cases anal-
yzed and discussed. It is pointed out again
that diaphragmatic hiatus hernia is fairly
frequent in occurrence but is seldom sus-
pected, not looked for specifically, and fre-
quently not diagnosed. Associated condi-
tions are often found and may be respon-
sible for the symptoms. Conservative treat-
ment is usually effective.
377
REFERENCES
1. Harrington, S. W. : Various Types of Diaphragmatic
Hernia Treated Surgically, Surg., Gynec. & Obst. 86:735-755,
1948.
2. Kirklin, B. R.t and Hodgson, J. R. : Roentgenologic
Characteristics of Diaphragmatic Hernia, Am. J. Roentgenol.
58:77-101, 1947.
3. Stapleton, J. G. : Esophageal Hiatus Hernia, Canad.
M. A. J. 57:13-16, 1947.
4. Brick, I. B. . Incidence of Hiatus Hernia and Asso-
ciated Lesions Diagnosed by Roentgen Ray, Arch. Surg.
58:419-427, 1949.
5. Radioff, F. F. , and King, R. L. : Esophageal Hiatus
Hernia, Gastroenterology 9:249-252, 1947.
6. Bockus, H. L. : Gastroenterology, vol. 1, chap. 16,
Philadelphia, W. B. Saunders Company, 1943.
PRESENTATION OF THE PRESIDENT’S
GOLD KEY TO ENOCH CALLAWAY,
M. D.
David Henry Poer, M.D.
Atlanta
Dr. Irons, Dr. Meiling, Dr. Finesinger,
Dr. Richardson, members and guests of the
Medical Association of Georgia: In the fall
of 1919 a young physician, returning from
an active service in the United States Navy
during World War I, entered the practice of
medicine and surgery in his home town of
LaGrange. Eager and enthusiastic after
years of training and preparation for his
fifes’ work, Enoch was anxious to carry on
the professional activities of his illustrious
father, Dr. Enoch Callaway, Sr., who had
passed on to him the torch of service to
humanity at the tender age of nine.
One of the young doctor’s first acts was
to join the Medical Association of Georgia
through its component unit in Troup Coun-
ty. That was the beginning of a long and
diligent service to his State Medical Society,
and during it he received all of its honors,
including the presidency of his County and
District Societies, and a long tenure in office
in Council.
Finally, in 1948, when the State Associa-
tion met in Atlanta, it chose to elect him as
its President-elect for the year, and he has
filled this position with honor, dignity and
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
The Journal of the Medical Association of Georcia
distinction to the everlasting credit and
glory of this Association.
Who is this man upon whose shoulders
the Association has chosen to bestow its
highest honor, and sees fit now to extend
its approval for a job well done? One does
not have to go too far back to cover the rela-
tively brief span of Enoch Callaway’s life,
which began in 1893 in LaGrange, Troup
County, Georgia.
Practically all of his life, except for
periods of education and war service, has
been spent in his home city, of which he is
as much a part as the columns of his lovely
home.
At Bingham Boys School in Asheville he
was cadet lieutenant of the school battalion,
and went from there to the University of
Georgia, where he was a member of the
Sigma Alpha Epsilon social fraternity. It
is stated that while there he was, at least, an
energetic member of the Bulldog football
team, but I can find no reference to those
exploits by Lawrence Camp in any All-
American records.
He received the Doctor of Medicine de-
gree from Tulane University in 1916, and
while at that school he was a member of the
Alpha Kappa Kappa medical fraternity and
was head of the Honor Council for three
years. In off moments he “assisted*’ the
football team there.
From Tulane he went to Mississippi,
where he served as intern, resident and path-
ologist in the State hospitals at Natchez and
Jackson. It might be added that here (Jack-
son) he first came under the influence of one
of Lord Lister’s assistants, Dr. Philip Beek-
man, and it was under his direction that he
performed his first operation for so-called
“hopeless” cancer. At this time there was
laid the foundation of a continually increas-
ing interest in the control of this ofttime ter-
rible disease, and this reached its climax
with the development for his own home
folks of the important West Georgia Cancer
Society in 1949, now an important center of
service for that disease.
His Navy service in World War I has
been mentioned. He later became the Sec-
ond Commander of the LaGrange Legion
Post No. 1. His interests in the civic affairs
of his city, county and State are too numer-
ous to mention, and he long has been a ves-
tryman in the St. Mark Church, LaGrange.
His hobbies and sports have included
horses — he wanted secretly to become a
jockey, but refused to starve himself; farm-
ing— he owns one of the best farms in Troup
County; flower raising, and golf, at which
he plays a deceivingly good game.
To demonstrate his youth to his attractive
wife and teen-age children, he took up fly-
ing at the age of fifty-five and maintains his
pilot’s license in good order by active par-
ticipation in this (shall we say) suicidal
repast. In fact, it is the only way he could
cover the large State of Georgia during the
past two years to carry on the Association’s
business.
To top off all fancies and figurements. he
now plays the piano — just why, none of his
family is able to explain. Having done
practically everything else well, including
some boxing and wrestling as a college stu-
dent, his wife who is his best admirer and
critic states, “He was never intended to be a
pianist. The notes are scientifically perfect,
but the art of time and melody — oh, my!”
In 1923 he performed the most important
and valuable act of his career when he
married Miss Jennie Crowell, of Columbus,
and she remains his ever constant compan-
ion and inspiration, and also his most stim-
ulating critic and helpmate. His doctor son,
Enoch III, is now receiving training in psy-
chiatry at the Worcester State Hospital and
soon will be a member of the University of
Maryland staff in Baltimore. His most im-
portant daughter, Sail ie, of very attractive
September, 1950
379
teen age, with corresponding accomplish-
ments, is busy in Atlanta tonight receiving
honors for her achievements in science
courses in her high school. Other members
of this prominent Callaway famliy have dis-
tinguished themselves nationally by their
outstanding industrial and agricultural de-
velopments.
To all of this must be added his attain-
ments in his chosen fields of surgery and
cancer, because, after all, it is through his
work in these fields that he is best known to
us. As a member of the American College
of Surgeons and the Southeastern Surgical
Congress, he actively participates in the
teaching and enhancement of the art and
science of surgery. His early interest in
cancer has been mentioned and this has
grown each year. As pioneer member and
organizer of the American Cancer Society
in this State, he now heads the Georgia Di-
vision as Chairman of its Executive Com-
mittee. For many years he has served faith-
fully as an active member of the Cancer
Commission of this Association.
Most of this work, as we all know, is of a
charity nature, and this has taken a heavy
toll of his time and energy. He has partici-
pated in innumerable clinics, conferences
and meetings with lay and professional
groups in almost every county in this State.
His own modern Cancer Clinic stands for-
ever as a moving testimonial to his sincere
interests and devotion to this work.
This is but a brief sketch of the man our
Association honors tonight. In honoring
Enoch Callaway by presenting him with this
beautiful key, it honors itself by saying,
“Thank you, and Godspeed. May your good
works continue forever and ever.”
HEALTHGRAM
The most important factor in the development of
the infant mortality rate is the standard of nutrition
of the people and the most important factor in the
tuberculosis rate is the standard of overcrowding. S.
Leff, Med. Officer, Feb. 4, 1950. — Quoted in Am. J.
Pub. Health, April, 1950.
PRESIDENT’S ADDRESS
Walter C. Payne, M.D.
Pensacola
The following address by our neighbor. Dr. Payne
of Pensacola, speaks for itself. Indeed, it attracted
the attention of the Public Relations Department of
the A. M. A., and has been widely distributed by
that department. — Ed.
To hold the highest office in the Florida
Medical Association is an honor to be covet-
ed, a privilege to be enjoyed and a stimu-
lating experience fraught with memories
long to be cherished. For the opportunity of
serving yon in this capacity I am deeply
grateful. In the exercise of the office of
president, I have found the excellent coop-
eration of the membership to be the most
gratifying aspect of the work. It is this
cooperation which has made possible the
year’s accomplishments.
The other administrative officers and the
Board of Governors are to be commended
most heartily for their able assistance in
promoting the interests of the Association.
They have traveled far, have attended meet-
ings most faithfully and have given freely
of their time, experience and judgment. The
members of the various committees are
likewise to be highly commended for the
excellent manner in which they have dis-
charged their duties under the competent
leadership of their respective chairmen.
Some committees have of necessity given
more time and effort than others to their
particular tasks because of the nature of
their assignments, but all have labored
diligently as the need required. They have
earned my sincere appreciation and yours,
and on behalf of the entire membership I
thank them.
The Association is to be congratulated
on its good fortune in having had for more
than two decades Dr. Stewart G. Thompson
as its managing director. His wisdom, pa-
tience, efficiency and unflagging zeal have
380
The Journal of the Medical Association of Georcia
been a bulwark in time of trouble and a
neverending source of satisfaction across
the years. To him I am greatly indebted
for Ids courteous consideration and con-
structive assistance throughout my term of
office.
This is the fourteenth year that the dis-
trict meetings have proved their worth as an
important step in the progress of the Asso-
ciation. Until one attends officially all of
these meetings in close succession, as was
my privilege last October and the two years
before as chairman of the Board of Gover-
nors and as president-elect respectively, he
does not realize fully their great value.
They promote between the officers and mem-
bers informal discussion of their common
problems; they stimulate interest through
scientific programs; and they advance the
welfare of the Association through broad-
ened fellowship.
The Changing Times
At this seventy-sixth session of our state
society we hardly need reminding that dur-
ing the last quarter of a century we have
witnessed a radical change in medical eco-
nomics and in our public relations. The
older ones of us remember, with a feeling
of nostalgia, the time when the motives,
integrity and sincerity of purpose of the
medical profession were never questioned.
The doctor occupied a place in the public
esteem second to none.
The time has arrived for us to analyze
the situation without bias. We must find
out why a part of the public has become
dissatisfied and then do whatever is neces-
sary to remove the cause or causes of this
dissatisfaction. The public can he divided
into two groups: the distributors of medical
care and the consumers of medical care. We
as distributors must never overlook the fact
that the consumers are as vitally interested
in health problems as we are.
Voluntary Versus Compulsory Health
Insurance
We realize fully that through no fault of
ours the cost of medical and hospital care
has become a burden on people of moderate
income. No one knows better than the phy-
sician what a catastrophe it is when a fam-
ily in this income bracket is suddenly con-
fronted with the necessity of a major sur-
gical procedure. There is nothing that we
can do to lower the cost of medical and hos-
pital service, but we do have a definite
positive plan to so distribute this cost that
it can be met without undue financial hard-
ship on anyone.
I think we all, including the politicians,
agree that prepayment health and hospital
insurance is the answer. Where we violently
disagree is on the method of financing this
insurance. We believe that it should be
done on a voluntary basis; its political pro-
ponents believe that it should be compul-
sory. Necessarily, compulsory health insur-
ance would mean governmental control of
the practice of medicine.
All who keep abreast of the press and
radio statements of the Federal Security
Administrator, especially since his recent
tour of investigation in England, must real-
ize howT imminent is the threat of govern-
mental medicine. Surely no one can ques-
tion that we moved appreciably nearer state
medicine with the 1948 elections. Which
way we shall move, particularly in Florida,
in the coming election is of vital import not
alone to ourselves and our profession but to
every citizen in the nation; and indeed the
direction we shall take at this crucial time
will have international repercussions.
There is much more than medicine’s
cause at stake in this year’s congressional
races. The dominant overshadowing issue
is whether the American people are ready
to abandon ship and to exchange their inde-
pendence for state socialism. Socialized
September, 1950
381
medicine has become the blazing local point
in this controversy. If the nation’s doctors
need a great challenge to rally American
medicine to a supreme effort, we have it.
It is important, critically important, that we
doctors do everything within our power this
year to stop the march of socialism in this
country, stop it at the polls by aiding in
the election of members of the Congress who
will have the courage to stand out against
compromise and who will crusade for
American principles.
The people of America this year, more
than any other time in history, will be turn-
ing an appraising eye on our profession and
the program of medical care which we spon-
sor. The work of our voluntary health in-
surance system will be weighed in the bal-
ance against the extravagant claims and
promises of the proponents of a compulsory
system.
Failure to Inform the Public
Since the beginning of medical history,
the followers of Aesculapius have avoided
publicity. In so doing we have allowed the
public to receive its medical information
from persons with selfish interests, quacks
and members of off brand cults who adver-
tise freely. We have failed to realize that
the public, being vitally interested in medi-
cal matters, has a right to be properly in-
formed. And who is better qualified, by
reason of training and experience, to give
this information than the men and women
who have spent their lives rendering medi-
cal service? I do not believe we can escape
the fact that it is our duty and our respon-
sibility to supply this information.
Our Public Relations
In bygone years the medical profession
did little in giving publicity to its problems.
But times have changed, and it is hard to
believe that our ethics should not be adjust-
ed accordingly. The modern physician faces
problems which must be understood by the
lay public if these problems are to he solved.
Regimented medicine, state medicine, so-
cialized medicine, or call it what you will,
is truly an imminent threat. It is making its
advances in the open as well as in the darker
byways. Its advocates use every means of
propaganda and publicity possible. If the
medical profession is to combat this, it must
use similar weapons.
If an active campaign is to be waged
against regimentation, the old medical atti-
tudes regarding publicity and public rela-
tions must be changed. If our profession
confidently believes that it should resist all
efforts of governmental control, then it must
sell to the public the conviction that it has
more to offer than could be offered under a
federal or state program. We, in the medi-
cal field, conclude that forthright intelli-
gent attempts to inform the public are de-
sirable.
The Florida Medical Association, along
with the American Medical Association and
with other state associations, uses the radio,
motion pictures, exhibits, speeches, posters,
pamphlets, magazines and word of mouth,
as well as newspapers, to tell about medical
advances and the medical profession.
Remember that there is no group in exis-
tence with a greater potential force for ex-
cellent public relations than our profession.
Patients, friends and acquaintances all look
to their doctor of medicine not only for
health care but also for family guidance.
They call on him both to set a broken arm
and to sympathize with a broken heart. Be-
cause of his or her high standing, an indi-
vidual doctor can unwittingly harm the en-
tire medical profession by some example
of poor public relations.
We doctors must feel a keen responsi-
bility in keeping medicine a free science,
unchained and untrammeled. We must do
everything possible to keep American Medi-
cine what it is today, the best in the world.
382
The Journal of the Medical Association of Georcia
Every doctor must make a special point to
tell and to keep on telling the people more
and more about the work of our profession,
its trials, its successes, and even its failures.
There is no magic formula for accomplish-
ing all this. The only way 1 know to reach
our goal is to widen our horizon and join
our forces, thus weaving a nationwide
blanket of public good will which will pro-
tect us against the coldest ill wind that
blows.
To help us perform this service, our As-
sociation has a Bureau of Public Relations,
whose supervisor is Mr. William Harold
Parham. It is the function of this bureau,
through the press, the radio and the speak-
ing forum, to inform the public on medical
matters. It is also its function to tell our
story. Until recently there has been no one
to look after our interests and to get our
story before the public in a favorable light.
This bureau operates in close cooperation
with the Committee on Public Relations of
our Association and with the county so-
cieties as they carry on this important work.
In informing the public of our problems
through this excellent medium, we may well
emphasize that we, not the politicians, are
the ones who can best do the job. It is our
mission to convince the public, and I am
sure we can, that under state medicine serv-
ice would inevitably be far inferior to that
being rendered now under the practice of
medicine as a free enterprise. We should
go about this task in a dignified manner.
Your Board of Governors has, in fact, gone
on record as requesting that our arguments
against governmental control of medicine
be kept on a high plane. We should of course
avoid personalities and name-calling and
should confine our arguments to the issues
involved. There is no need to becloud these
issues with irrelevant matters for there are
plenty of good, sound, logical facts with
which to win our argument. There is like-
wise no point to blaming the public too
much. Let us look to ourselves, conduct
ourselves properly and inform the public
wisely; then we shall win confidence and
ultimately the battle for freedom.
State Grievance Committee
In the course of promoting better public
relations between the medical profession
and the public, there has recently come to be
recognized the need for a medium through
which patients may voice their grievances,
real or fancied, against the profession. To
meet this need, several state medical asso-
ciations have established a committee on a
slate level to which such complaints may be
presented. Such a committee is functioning
successfully in at least eight state associa-
tions (Colorado Indiana, Nebraska, New
Mexico, Oklahoma, Utah, Virginia and
West Virginia), and other state societies are
adopting this plan. At its 1949 midwinter
session, the House of Delegates of the Amer-
ican Medical Association approved a resolu-
tion commending those constituent associa-
tions which have already established such
a committee and urging the remaining ones
to adopt a comparable program.
I therefore recommend that this Asso-
ciation by action of its House of Delegates
authorize the establishment of a grievance
committee to hear and weigh complaints
from the public relative to the profession
and medical practices, and that this com-
mittee be composed of the five immediate
past living presidents. I further recommend
that this committee be empowered imme-
diately to make such surveys of the experi-
ences of other state medical associations as
it deems essential and to draft rules and
regulations to govern its activities, that the
necessary funds for operating expenses be
subject to the approval of the Board of
Governors and that an annual report be
made to the House of Delegates.
September, 1950
383
County Mediation Board
As a second specific recommendation, I
propose that each constituent county medi-
cal society he urged to establish a mediation
board, or similar committee by whatever
name, which will serve as a screening com-
mittee for ironing our misunderstandings
and differences between patients and physi-
cians and settling them amicably and as
quickly as possible. In many instances, such
complaints need not then be referred to the
grievance committee at the state level. Cer-
tainly it is to the interest of the profession
and the public alike that differences be
settled promptly and locally if possible, and
it would seem that the county medical so-
ciety is the logical unit to resolve such prob-
lems with diplomacy and dispatch. The
pattern of the mediation board at the county
level should as nearly as practicable follow
that of the grievance committee at the state
level. By this means public relations should
be steadily improved locally, and the work
of the state committee should be greatly
expedited, provided this board is widely
publicized and adequately kept before the
laity at all times.
President's Recommendations
Too often through the years the recom-
mendations of successive presidents have
borne no fruit because they have been al-
lowed to become buried in cold print in the
president’s address with no action taken
upon them. Accordingly, I am introducing
an innovation at this time which I trust will
in future become routine procedure. I am,
as a delegate, presenting my recommenda-
tions for a grievance committee at the state
level and a mediation board at the county
level to the House of Delegates in the form
of resolutions for action by that body. I
suggest that this practice be followed in the
future so that the Association may by formal
action benefit as it sees fit by the proposals
which are the fruits of the experience of its
presidents during tenure of office.
Office Personnel
In view of the vital importance of public
relations today, it seems not inappropriate
to make certain observations that may be
helpful reminders. We are inclined to pay
too little attention to our office personnel,
forgetting how strategically situated our
assistants are to be ambassadors of good or
ill will in their contacts with the laity. It is
highly important that we choose the mem-
bers of our office staffs with extreme care,
keeping the public relations aspect well in
mind. Then we must take the pains to edu-
cate them in the problems of our profession,
instructing them particularly in the human
interest values involved. Every doctor
should teach his receptionist to be courteous
and efficient, to think quickly, and to dem-
onstrate a personal interest in every patient,
particularly on the telephone.
With this training put into practice, these
young women are in a position to make
friends for the profession and to counteract
the all too frequent and the all too often
justified complaint of patients that they re-
ceive disinterested treatment, inefficiency
and even downright rudeness at the hands
of the doctors’ assistants. Many a physician
might find it a revealing experience to check
up on his office by telephoning for an ap-
pointment. In too many instances the public
attitude would become more understand-
able and excusable.
The medical service men, the pharmaceu-
tic representatives who call upon the doctors
regularly, are another public relations asset.
They spend much time in our offices, where
they contact both the laity and the office
personnel. We have the opportunity to make
of them excellent liaison agents; but we
must treat them courteously, show them due
consideration in the office and at the exhibits,
and make the effort to cultivate their friend-
ship. In the states, Oklahoma in particular,
where the medical profession has encour-
384
The Journal of the Medical Association of Georgia
aged and assisted the organization of this
group, the society formed has been most
helpful in furthering wholesome public re-
lations.
Code of Ethics
Every member of the Association recently
received a booklet entitled “Principles of
Medical Ethics of the American Medical
Association.” How many of you have read
it? For generations too many of us have
been content to practice on what we have
heard was our code of ethics, and far too
few have taken the time and trouble to read
and actually study this code. All of us
would do well to review, for example, Chap-
ter III, Article III. entitled “Duties of Phy-
sicians in Consultations.” The laity is not
versed in how properly to obtain a consul-
tation, and too often neither is the physi-
cian. When the ethical aspects of this fea-
ture of medical practice are properly under-
stood and are adhered to with suitable de-
corum, relations within the profession and
with the laity are always improved.
“The prime object of the medical pro-
fession is to render service to humanity;
reward or financial gain is a subordinate
consideration. Whoever chooses this pro-
fession assumes the obligation to conduct
himself in accord with its ideals.” So reads
the opening statement of the code, and the
concluding statement follows: “These prin-
ciples of medical ethics have been and are
set down primarily for the good of the pub-
lic and should be observed in such a man-
ner as shall merit and receive the endorse-
ment of the community. The life of the
physician, if he is capable, honest, decent,
courteous, vigilant and a follower of the
Golden Rule, will be in itself the best exem-
plification of ethical principles.”
I earnestly suggest that every county
medical society devote one program this
year to the code of ethics, important as it is
to public as well as professional relations.
In my opinion, no man or woman has the
right to practice medicine who will not take
the time to read and study and then follow
this code. It cannot be stated too emphat-
ically that if ever there was a time when
we of the medical profession need to con-
duct ourselves in a manner that will deserve
and receive from the public good will, con-
fidence and faith, it is now.
Conclusion
The American Medical Association is
103 years old. For more than 75 years
after its organization it interested itself al-
most exclusively in the preservation and
prolongation of life and health. It goes
without saying that we must continue our
scientific advancement, never forgetting
that it is the one road that leads to medi-
cine's goal of better health and longer life
for our people. In our enthusiasm for scien-
tific improvement we must not, however,
neglect the art of practice. Let us never
forget that medicine must be practiced with
the heart as well as with the head. Too, we
must teach the men and women coming into
our profession to appreciate their rich
heritage.
I should like to close by telling you a
story about a family all of us know and
love. The name of this family is the Prac-
tice of Medicine, and its two sons are called
Art and Science. Art is much the older of
the two boys, and before Science was born,
it was a happy and prosperous family.
Even after Science was born, it continued to
be a devoted family for a long time. It
happens, however, that an unfortunate
change has occurred — partiality has been
shown toward Science. As a result, he is the
robust personable son of the family. Even
though he is yet a young man, he has already
made his mark in the world, and his future
looks bright indeed. Art, on the other hand,
feels left out of his own family and suffers
from an inferiority complex. He is under-
September, 1950
385
nourished and anemic; in fact, if something
is not done for him, there is a chance that
Art may even die. It is your duty and mine
to have a heart to heart talk with this fam-
ily and to persuade it to give Art the same
loving and tender care that it is giving
Science, to the end that the Practice of Medi-
cine may once again be a united, devoted
and happy family.
SUMMER AND POLIOMYELITIS
The summer months and their accompanying heat
are always associated with poliomyelitis, commonly
called infantile paralysis. The reason for this is not
known, but apparently there is something in the
rise of weather temperature that fosters the activity
of the virus, which causes the disease, the Educational
Committee of the Illinois State Medical Society
observes in a Health Talk.
Fatigue, overexertion and chilling are factors in the
development of poliomyelitis. Overcrowded pools and
beaches should be avoided, but there is no reason why
a child can't swim or play in the water, provided the
stay in the water is not so long that the child will
get chilled. It has been established that if the virus
is present in the body, the chilling tends to lower the
body resistance.
Authorities agree that many persons harbor the
virus of poliomyelitis, without developing the strong
manifestations of the disease themselves, but they are
unconscious agents in transmitting the disease. Actually
the disease, in its' early stages, is difficult to diagnose
by the physician because of the absence, very fre-
quently, of symptoms and more often the development
of symptoms that are similar to other conditions.
The onset of the disease is rapid. The first stage
is comparatively mild. Sore throat, a ‘‘head cold,’
nausea and sometimes vomiting may be among early
symptoms. There may be some fever, diarrhea and,
conversely, constipation. There may be considerable
pain, particularly in the muscles of the legs and arms.
The appetite often disappears. Tremor or trembling of
the hands and other parts of the body and pain and
stiffness of the neck and back are important early
symptoms, all of which may occur in almost any
combination.
The virus causing poliomyelitis attacks certain nerve
cells in the spinal cord which control movement of
muscles. When the nerve cells are damaged or com-
pletely destroyed, the dependent muscle withers away
in the proportion to the amount of nerve damage. If the
damage to the nerve cells is slight, the results insofar
as crippling are slight. Seriously affected nerve cells
do not regrow. When this occurs, the paralysis is per-
manent.
It is generally conceded in ‘‘polio” season that
children should not be removed from their normal
routine. This is also true of adults. In this day and
age complete isolation cannot be achieved, and quar-
antine in poliomyelitis has not had the expected
results. There are some instances of an entire family
developing the disease, while in others a single case
in a large family has been reported.
Parents should be alert to the slight symptoms of
early poliomyelitis. A healthy youngster is not
ordinarily listless. Watch for fever and fatigue. Then
get the child to bed at once and call your physician.
Be suspicious during ‘‘polio” time, but don’t get
panic-stricken. Avoid crowds, chilling and fatigue, but
otherwise try to lead a routine life.
AVOID EXTREMES IN SUNBATHING
TO SECURE ATTRACTIVE TAN
For maximum benefits and minimum dangers in
sunbathing, these suggestions are offered in an article
in the July issue of Today's Health , published by
the American Medical Association.
1. Start with 10 minutes of exposure to sun on the
first day. By increasing exposure time 50 per cent
each day, a coat of tan should be acquired safely.
2. It is advisable to continue sunbathing all summer,
for the beneficial effects of the ultraviolet rays will
continue despite the deepened color of the skin.
3. Morning hours have been found most effective
for acquiring sun tan. The hours between 11 a.m. and
2 p.m. are most dangerous.
4. Ultraviolet light may be as intense on misty
or cloudy days as in direct sunlight. It can cause
severe burning.
5. The notion that skin burns more readily when
wet is a mistaken one. Sunbathing in shallow water
or on the shore of a lake or the ocean is more likely
to produce a hurn than sunbathing away from the
water, however. The sun's rays are reflected from the
water, which intensifies their strength. Reflections
from snow or ice are even more potent.
6. Lasting injury may be done if the eyes are not
protected from the sun’s rays. Dark glasses made of
ground glass or several thicknesses of cloth over
the eyes may be used.
7. Drinking plenty of water or other liquid when
sunbathing is essential. Sunstroke is due to dehydration.
Salt tablets are valuable, for salt tends to hold water
in the tissues.
8. After a sunbath, be sure to cool off completely
before plunging into cold water. Heart attacks some-
time result from such sudden changes, which put too
great a strain of adjustment on the circulatory system.
9. Children’s skins are more tender than those
of adults. Naps and planned diversions in the shade
or indoors are excellent for youngsters who tend
to play too long in the hot sun.
DOCTORS USE NEW DRUG
AGAINST TOXIC GOITER
Promising results in treating patients for toxic goiter
with a new synthetic drug, tapazol, are reported by two
doctors from Wayne University College of Medicine,
Detroit.
These findings should be considered preliminary.
The drug has been used in only 18 patients and obser-
vations have covered only a six-months period, Drs.
William S. Reveno and Herbert Rosenbaum say in
the August 19 Journal of the American Medical Asso-
ciation.
Tapazol is not now generally available to doctors.
Its use is limited to experimental studies.
The drug is an antithyroid compound with action
25 times as powerful as propylthiouracil, a compound
commonly used in treating overactivity of the thyroid
gland, according to the doctors. Abatement of symp-
toms occurred in patients with toxic goiter variously
five, six and eight weeks after administration of tapazol
was begun, according to the article. Two patients who
had relapsed after treatment with propylthiouracil
were relieved after 57 and 51 days of treatment with
tapazol, respectively.
“In the small group of patients observed, tapazol
exhibited effective antithyroid activity closely re-
sembling that of propylthiouracil but with a potency
approximately 25 times greater,” the doctors say,
adding:
“Toxic reactions were not encountered, but more
time and treatment of a larger number of patients will
be required for assessment of this highly important
factor.”
The Journal of the Medical Association of Georcia
386
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORCIA
Edcar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
September, 1950
URGES IMMEDIATE FIRST-AID TRAINING
IN CARE OF ATOMIC ROMB CASUALTIES
Immediate training of large numbers of
physicians or the public, or both, to care for
atomic bomb casualties was urged today by
Dr. Everett I. Evans of Richmond, Va., member
of the National Research Council’s Committee
on Atomic Casualties.
"If any large American city suffers atomic
bomb attack the numbers of burn casualties
will tax all preparations authorities are likely
to be able to provide,” Dr. Evans pointed out
in an article in the July 29 Journal of the
American Medical Association.
Dr. Evans is professor of surgery and director
of the surgical research laboratories at the
Medical College of Virginia; surgical consultant
to the Atomic Bomb Casualty Commission (Far
East Command), Tokyo, Japan; chairman of
the National Research Councils Subcommittee
on Burns, and a member of the council’s Com-
mittee on Surgery.
It is now well known that the temperature
in the immediate vicinity of an atomic bomb
burst may rise to several million degrees, and
that even in the “outer zone” radiant heat is
dissipated in such large amounts that severe
burns result. Dr. Evans said.
“A disturbing feature of all disaster planning
for burn care is the seeming complexity of this
care even when it is reduced to the barest
essentials,” he continued. "More disturbing is
the plain truth that so few physicians and fewer
lay persons are trained in even the simplest
methods of burn care.
“One can only conclude that unless proper
training (along the simplest lines) of large
numbers of physicians and/or the public in
burn therapy is instituted at once, the handling
of large numbers of burn casualties after bomb
attack on any of our cities must necessarily
end in complete chaos and panic, with the ac-
companying inexcusable loss of many lives
which otherwise might have been saved.
“The type of trained personnel required for
adequate burn care will vary according to the
severity of burn to be treated. In the outer zone,
the burns may involve mainly the exposed sur-
faces of hands and face unless they are secon-
dary to ordinary flame. Treatment of such
burns can properly be delegated to lay persons.
A simple but effective method of treatment to
reduce pain and aimed at prevention of infec-
tion of burned parts can easily be taught. Train-
ing for large numbers of first aid workers re-
quires relatively little effort and would be
highly effective.
“In the intermediate zone, more highly
trained and larger numbers of persons w ill
obviously be required. Physicians trained in
the therapy of shock and application of a
dressing will be needed in large numbers.
"In the zone nearest the bomb burst havoc
will prevail. Planning for care of the survivors
in this zone must be boldly realistic, lest medical
efforts completely lose their effectiveness.
“Any calculation, conservative or otherwise,
of the numbers of burn casualties to be expect-
ed in atomic attack results in requirements for
adequate reserves of plasma and/or whole blood
in such large amounts as to make it almost
out of question ever to expect such supply for
immediate delivery to a stricken city. For this
reason alone I consider it imperative that search
for a safe, effective, easily stored plasma substi-
tute be started at once.”
I Promising research in developing a substi-
tute for plasma has been done by a group of
physicians from the Mayo Clinic, Rochester,
Minn. A preliminary report on their research
with Dextran ( Dextran Ph, Swedish trade
name ) , a sugar industry byproduct which has
been regarded as a nuisance because it clogs
pipes in sugar mills, appears in the July Archives
of Surgery, published by the American Medical
Association.)
“No matter how lightly or how conservatively
one views the ‘burn problem’ which will con-
front a city recovering from an atomic bomb
attack, the one conclusion permissible is that
it will be stupendous,” Dr. Evans said. “It mav
be pointless to refer here to the numbers of
trained physicians, nurses and first aid workers
necessary to solve this problem. Only free men
with strong hearts and wills can accomplish the
gigantic task of providing by training and
discipline the necessary workers. Provision for
this training must be made at once, lest con-
templation of the magnitude of the task only
encourage despair.
“Adequate and intelligent provision for the
care of thousands of burned casualties in any
large American city is possible when strong
men meet the challenge of this task.”
COMPOUND F REPORTED EFFECTIVE
AGAINST RHEUMATIC ARTHRITIS
A synthesized adrenal hormone chemically
similar to cortisone and known as Compound
F is proving effective against rheumatoid arthri-
tis, researchers of the Mayo Clinic, Rochester,
Minn., said recently.
Announcement of the synthesis of Compound
F was made recently by a pharmaceutical com-
September, 1950
387
pany (Upjohn Company, Kalamazoo, Mich.).
The company did not say what this synthesis
will mean in terms of production, other than
to emphasize that the amount of Compound
F available does not allow distribution for
other than limited clinical testing at the present
time.
The report of trial of Compound F against
rheumatoid arthritis was made by Dr. Howard
F. Polley (one of the group from the Mayo
Clinic who originally reported the effects of
cortisone and ACTH against the disease) and
Harold L. Mason, Ph.D., in the August 26
Journal of the American Medical Association.
“Significant antirheumatic activity was
possessed by 17-hydroxycorticosterone (Com-
pound F ) ,” they say. “Minor structural altera-
tion from cortisone occurs in 17-hydroxycorticos-
terone. Our supply in the last year has permitted
trial on one patient, a woman 49 years old,
whose severe rheumatoid arthritis had been
present three years and who had responded well
to cortisone and to ACTH.
“A total of 0.9 gram of Compound F was
given intramuscularly in 12 days of metabolic
study (March 31 to April 11, 1949, inclusive).
Previously confined to a bed or wheel chair,
the patient became ambulatory. The sedimenta-
tion rate decreased (improved) from 85 to 24
mm. within 12 days. The over-all relief of
rheumatoid arthritis was an estimated 60 per
cent, as compared with 75 per cent relief from
1.0 grams of cortisone in 10 days and 85 per
cent relief from 1.2 grams of ACTH in 12 days.
“In this study a very marked antirheumatic
effect is graded as 4, a marked response as 3,
a moderate response 2, mild to minimal effects
1, and no effect is grade 0. Results of the ad-
ministration of cortisone and ACTH served as
a standard against which effects of other prepar-
ations were compared. The antirheumatic effect
of Compound F in this case was classified as
grade 3.
“When use of the preparation was discon-
tinued, improvement was lost more promptly
than after withdrawal of cortisone or ACTH.
While the patient was being treated with Com-
pound F, ber appetite became ‘very good’ but
not ravenous.
“Mild facial rounding (‘puffiness’) occurred
after nine days of Compound F in 50 to 100
mg. daily doses. Dull frontal headaches and
‘burning of the eyes’ also were described by
this patient. These symptoms could not be
related with certainty to the hormones which
were administered. Euphorogenic effects (a
feeling of cheerfulness and well being which
has been noted after administration of cortisone
and ACTH ) were not produced.
“Further trials using Compound F are being
undertaken.”
None of the other preparations tested showed
significant effect against rheumatoid arthritis
except extracts of the adrenal cortex.
OVEREATING ATTRIBUTED TO
ENVIRONMENT AND EMOTIONS
The important cause of obesity is overeating,
which may result from external factors, such
as the sight of tempting foods, or from emo-
tional disturbances.
This is brought out by Dr. Max Millman of
Springfield, Mass., in an article in the August
issue of Today’s Health , published by the
American Medical Association.
(The glands and abnormalities of metabolism
also can influence weight in some persons, ac-
cording to other medical authorities.)
“The bad example set by gluttonous parents
is damaging,” says Dr. Millman, a specialist
in internal medicine and visiting physician at
Mercy Hospital and Springfield Health Depart-
ment Hospital. “Children are more likely than
not to follow suit.
“Another powerful environmental cause for
overeating is found in our present day social
amenities, calling as they do for dinner parties,
banquets, cocktail parties and the like. And
there is the powerful influence of exposed trays
of candy, cookies and nuts in many living rooms,
as well as the pastries and desserts displayed
so enticingly in the windows of bakeries and
restaurants.
“It has been stated aptly that many people
overeat because of emotional starvation. They
find food a handy gratification. Instead of
drowning their sorrows in alcohol, they bury
theirs in calories. Many people worry them-
selves into obesity. The mental angle is por-
trayed perhaps best of all in the person who,
strange as it may seem, employs obesity as a
defense mechanism. He clings to his fat be-
cause it relieves him from certain responsibili-
ties, such as marriage, an unpleasant job or
rough playing with the boys.
“To some people, food symbolizes security.
They overeat, therefore, whenever they are
troubled by a sense of insecurity. Boredom
also may prove conducive to overeating. Suf-
ferers from an inferiority complex may en-
deavor to bolster their importance with obesity.
“The hazards of obesity are no longer ques-
tioned. Life insurance statistics show conclusive-
ly that excessive weight not only predisposes its
victims to a long list of serious conditions such
as diabetes, heart disease and high blood pres-
sure but shortens their life expectancy to a
shocking degree. For people between the ages
of 45 and 50, as little as 50 pounds of excess
weight diminishes their life expectancy by
fully 25 per cent.”
The Medical Association of Georgia will
hold its next annual session at the Bon Air
Hotel, Augusta, April 17-20, 1951.
The Journal of the Medical Association of Georgia
QO'
OOl
FIND CHLORAMPHENICOL USEFUL
AGAINST BACILLARY DYSENTERY
Good results in treating 35 patients for bacil-
lary dysentery with chloramphenicol ( Chloro-
mycetin, trade name) are reported by a research
group from Washington, D. C.
“Diarrhea usually subsided within three days,
and an uneventful recovery ensued in all 35
patients,” Drs. Sidney Ross, Frederic C. Burke,
E. Clarence Rice and John A. Washington, and
Sara Stevens, B.S., all of the Research Founda-
tion. Children’s Hospital, say in the Augus’t 26
Journal of the American Medical Association.
Although sulfadiazine also is effective against
the disease, its usefulness is limited, they point
out. Causative microbes frequently become re-
sistant to sulfa drugs, occasional patients are
sensitive to sulfa compounds, and administering
sulfadiazine to dehydrated patients in the tropi-
cal areas where the disease is most prevalent
may be hazardous.
NEW TEST FOR STOMACH CANCER
DEVISED BY NEW YORK DOCTORS
An ingenious balloon test for cancer of the
stomach has been devised by a group of doctors
from Cornell University Medical College and
New York Hospital, New York.
The process is reported in the August 12
Journal of the American Medical Association
by Drs. Frederick G. Panico, George N. Papa-
nicolaou and William A. Cooper.
A rubber balloon covered with short pieces
of braided silk and attached to the end of a
tube is swallowed into the patient's stomach
and then inflated, the doctors say. Cells from
the stomach lining cling to this balloon “brush ".
The apparatus is deflated and withdrawn and
the cells are removed by washing in a special
solution.
The cells are then examined by means of
the smear test, developed by Dr. Papanicolaou
and in wide use for detecting cancer of the
cervix in women. Describing the test, Dr. Papa-
nicolaou says:
“Cells at the surface of the growth tend to
be dislodged. A technique for collecting the
cellular debris, smearing it upon glass slides,
and staining it has been perfected so that the
various components may be studied. Interpre-
tation of the smear requires the services of a
careful and discriminating cytologist who has
had experience in this field.”
The balloon test was used in collecting cellular
material from the stomachs of 33 patients in
whom the diagnosis of a disease was confirmed
by surgery, the doctors report. Of this group
of 33, 17 had malignant disease and 16 had
diseases other than cancer.
Among the 17 patients with cancer, balloon
wash smears revealed no malignant cells in two
cases, suspicious cells in one case and malignant
cells in 14 cases.
Among the 16 patients with conditions other
than cancer, smears were negative for malignant
cells in 14. Two specimens were read falsely
as suggestive of malignancy.
HIGH STANDARD OF VETRERAN CARE
CREDITED TO MEDICAL LEADERSHIP
The excellent medical care which the govern-
ment is providing for war veterans is largely
the result of the Veterans Administration’s con-
stant adherence to the policy that the program
remain under the direction and jurisdiction of
medical personnel.
This opinion is expressed by a Special Ad-
visory Group to the Veterans Administration
in a report published in the August 12 Journal
of the American Medical Association. The group,
representing all divisions of medicine and surg-
ery and allied activities, was established by
Congress for the purpose of advising the vet-
erans administrator with respect to policy. Dr.
C. W. Mayo of Rochester, Minn., is chairman.
“As long as the Department of Medicine and
Surgery of the VA remains under proper and
authoritative medical control this type of
superior medical care will always prevail for
the veteran,” the group reported.
“If the time should come, however, when
such control is passed to lay, bureaucratic or
political hands, that will be the beginning of
deterioration of the program of medical care
for the veteran.
“Therefore, it is to the best interest of the
American people, the medical profession and
the veteran groups always to be on the alert
to see that this great enterprise of medical
care continues under the direction of highly
qualified American physicians. As long as the
veterans’ organizations continue to insist, as
they have in the past, that members of the medi-
cal profession conduct this program, it will
continue to provide a high type of service.”
The group considered the improved quality
and the high type of medical service maintained
since the end of World War II the more re-
markable because the veteran load increased
three-fold.
“This remarkable achievement in mass medi-
cal care has never been duplicated here or in
any other country,” it pointed out. “There
seems little doubt that the veteran who is
entitled to it by law does receive the finest
type of medical care in a country where medical
science has reached its highest development.
“For this the American medical profession
may justly be proud. It could not have been
done without the wholehearted cooperation and
support of American medicine in general and
of medical education in particular. The entire
program of gearing the medical care of the
veterans to the educational medical plants of
September, 1950
389
the country and the employment as consultants
of the finest medical brains in America have
made the program possible.’’
The group disagreed with the recommenda-
tion of the Hoover Commission that all govern-
ment hospitals be consolidated under a single
agency, saying:
“If this should be done it seems unlikely that
the veteran would receive any better medical
care than at present and it is likely that the
quality of medical service would ultimately de-
teriorate from its present high standard.”
Besides Dr. Mayo, the group is composed of
the following: Roy R. Kracke, M.D.,* vice-chair-
man, Birmingham, Ala.; D. A. Boyd, M.D.,
Rochester, Minn.; G. W. Brugler, M. D., Bos-
ton; G. F. Cahill, M. D., New York; A. C.
Christie, M.D., Washington, D. C.; E. Cockerill,
M.S.S., Pittsburgh; C. C. Coleman, M. D.,
Richmond, Va;. K. J. Densford, D.Sc., Minne-
apolis; H. A. Hunschep, Ph.D., Cleveland; W.
A. Hunt, Ph.D., Evanston, 111.; R. A. Kim-
brough, Jr., M.D., Philadelphia; D. M. Lierle,
M.D., Iowa City; C. F. McCuskey, M.D., Los
Angeles; F. M. McKeever, M.D., Los Angeles;
W. S. Middleton, M.D., Madison, Wis.; J. S.
Rodman, M.D., Philadelphia; A. R. Shands, Jr.,
M.D., Wilmington, Del.; D. T. Vail, M.D.,
Chicago, and J. S. Voyles, D.D.S., St. Louis.
*Dr. Kracke died on June 27, 1950.
TERRAMYCIN REPORTED EFFECTIVE
AGAINST TWO TYPES OF PNEUMONIA
Results indicate that terramycin, a newer anti-
biotic drug derived from a mold, is remark-
ably effective against both pneumococcic and
virus pneumonia, a group of New York doctors
report in the August 12 Journal of the American
Medical Association.
Terramycin proved to be valuable in treating
18 patients with pneumonia due to pneumococ-
cus microbes and seven patients with virus
pneumonia, Drs. George W. Melcher, Jr., Count
D. Gibson, Jr., Harry M. Rose and Yale Knee-
land, Jr., of the Columbia University College
of Physicians and Surgeons and Presbyterian
Hospital say.
“Results indicate that terramycin is remark-
ably effective in the treatment of both types of
infection,” the doctors point out.
The drug was administered by mouth in
the form of tablets or capsules. Vomiting and
nausea occurred in some patients as side effects
of terramycin, but these symptoms seemed less
severe than similar reactions observed in patients
following administration of aureomycin, ac-
cording to the doctors.
SEVEN TYPES OF INFANTILE DRIVERS
BELIEVED TO CAUSE TRAFFIC ACCIDENTS
Seven types of drivers who have never ma-
tured emotionally cause many traffic accidents,
according to an article in the July Today's
Health, published by the American Medical
Association.
These infantile driver types and their be-
havior patterns are described by Marion Glea-
son, research assistant for the department of
pharmacology and toxicology at the University
of Rochester, N. Y. :
1. The person who hasn’t outgrown the
childhood conviction that his wants come first.
His parents always sacrified their own con-
venience and pleasure to accommodate him.
Now he is the middle-of-the-road driver, the
double-parker, the horn-blower at intersections.
2. The person who was taught as a child
to obey without thinking. He becomes the
driver who obeys signals from other drivers
automatically and may drive into intersections
or pass other automobiles without thought of
other traffic.
3. The pampered type frequently is a well-
groomed and charming woman. As a child
she could get what she wanted by fluttering her
lashes and shaking her curls and she uses the
same technique with policemen to get away
with parking by fire hydrants and driving
through stop lights. She rarely has an accident
but causes many traffic tangles and occasionally
serious crashes.
4. This type was bullied by older brothers
and sisters and is the really dangerous driver.
He works out his old resentments by speeding
and sideswiping other autos.
5. Drivers who were overprotected or severe-
ly dominated as children account for a large
number of serious traffic accidents. Usually
in their late teens or early twenties, they find
undertaking responsible adult life difficult. They
are show-offs, daredevils, lawbreakers.
6. The type who was allowed to get by
with wrongdoing. The childhood feeling of
guilt may lead them from bad to worse conduct
in an unconscious search for guidance they
never received. They accept tickets and pay
fines cheerfully. The traffic ticket takes the place
of a spanking which the child wanted but
never had.
7. The type who was poor and had to make
secondhand textbooks and used bicycles do. He
has to prove to himself that his standard-make
model will get there just as fast as the most
expensive custom-made automobile. Although
he speeds, he is alert and rarely has an accident.
The accidents he causes are those of trembling
witnesses after he is half a mile up the road.
The Medical Association of Georgia will hold
its 1951 annual session in Augusta. The dates
are April 17, 18, 19 and 20. Bon Air Hotel will
be headquarters, with Partridge Inn participat-
ing. Please make your reservations now.
390
The Journal of the Medical Association of Georgia
GEORGIA DEPARTMENT OF PUBLIC HEALTH
TUBERCULOSIS: SUGGESTIONS FOR
IMPROVED CONTROL
H. C. Schenck. M.D.
Director Division of Tuberculosis Control
Georgia Department of Public Health
Atlanta
In any effort to control tuberculosis the physi-
cian engaged in general practice is, or should
be, the keystone. At one time or another he
comes in contact with almost everyone in the
community and this places him in a strategic
position to employ modern and accepted meth-
ods in detecting tuberculosis. He should also
be prepared to accept responsibility for the
observation and management of a large propor-
tion of the cases in his community. There is
no mystery involved in determining whether
a patient has tuberculosis in an active or con-
valescent stage, nor in planning the observation
and management of a case based on knowledge
gained at the time the diagnosis is made, nor
in observing from time to time the progress
of the case.
The rest regimen which should be advised
will depend on the degree of activity of the
disease at the time the case is being considered.
This can be ascertained through clinical study
of the patient, and by x-ray studies, sputum
examinations and blood sedimentation tests.
Other adjuncts to the rest regimen which may
be advisable in a given case are not difficult to
determine. For example, if a patient with mini-
mal pulmonary tuberculosis, presumably in an
active stage but with negative sputum, does
not do well on rest in bed and good food, and
it is found by x-ray examination that the dis-
ease is progressing, something else must be
considered immediately. Usually in such in-
stances hospitalization for study and a selected
method of treatment are advisable. In the past
thousands of patients who were unaware of
the fact that they had tuberculosis, healed their
lesions without doing anything about it. If
the same patients had been treated in sana-
toriums, or otherwise, undeserved credit would
have been given to the treatment or care re-
ceived. Before pneumothorax was widely used
many minimal and certain moderately and far
advanced cases went on to recovery on bed
rest alone. The point is that a great many nega-
tive sputum cases can get well on bed rest and,
moreover, such care may well be arranged for
in the home under medical supervision, thus
relieving the relatively few sanatorium beds for
other very necessary services, particularly for
positive sputum cases. They must be kept under
close medical supervision, however, so that
any change for the worse or failure to respond
to the care given may be detected before serious
damage results.
Patients with negative sputum, discharged
from sanatoriums, should have the same type
of medical supervision as those discussed above
and for the same reasons. Careful evaluation
of the amount of physical effort a patient may
indulge in is of vital importance. The patient
must be made to understand that his chance to
get well will be jeopardized by any undue exer-
tion and that the process of healing a tubercu-
lous lesion is a long-drawn-out affair. Also, he
should know that the development of a new
lesion means another year or two of “taking
the cure.” The family physician should be
prepared to give sound advice to his patient
so that the latter, having reached a period dur-
ing his convalescence in which he feels “as well
as he ever did”, will not be permitted to work or
exert himself to a harmful extent, remembering
that a long and careful “hardening process” is
necessary to prepare him for the resumption of
reasonably normal physical activity.
Should the Family Physician Treat
Tuberculosis?
Why should the family physician concern him-
self with the treatment of tuberculosis? Because,
first, there are over 10,000 clinically active and
convalescent tuberculosis patients in the State
and not one fourth of them can be hospitalized
because of a lack of available institutional facili-
ties; second, there are over a million persons
in Georgia who have been infected, many of
whom have developed or will develop active
tuberculosis; third, many other people are
going to be infected because we do not have
adequate control of positive sputum cases; and
fourth, the more cases that the family physician
treats the greater will be the number of positive
sputum cases that can be hospitalized until
they are sputum free.
The Physician and The Positive
Sputum Patient
Only by adequate control of the positive
sputum case can tuberculosis be controlled.
Every patient who has tuberculosis should be
presumed to have a positive sputum if he
coughs and raises sputum, or otherwise gets
up secretions from the trachea and bronchi,
until repeated laboratory examinations prove
the sputum to be negative. It should be re-
garded as essential for the physician to be
familiar with the various methods employed
by laboratories in making sputum examinations.
He should know when he can be satisfied to
accept the results of ordinary smear examina-
tions, when to ask for examination of sputum
by concentration methods, when for sputum
September, 1950
391
culture and animal inoculation, as well as the
indications for examination of gastric lavage
specimens and those who might he secured
by bronchoscopic or laryngoscopic methods.
When the patient is found with positive
sputum his care in the home is greatly compli-
cated, because there is the added problem of
preventing spread of the infection. It is espe-
cially desirable from a public health standpoint
to have all such patients treated and cared for
by trained personnel in sanatoriums. State or
local. If this is impossible, then every effort
should be made to put into practice in the
home effective measures to prevent any further
spread of the infection. The very sick patient
and the terminal case present very dangerous
situations and their care can be safely under-
taken only by personnel thoroughly trained in
the use of effective prevention measures. Bed
care, of course, is indicated in all positive
sputum cases. Many can be greatly benefited
by surgery and other collapse measures, and
selected cases may be benefited by the judicious
supplementary use of antibiotics. The probable
advantage of any procedure in a given case
should be carefully weighed against the probable
disadvantage before it is undertaken, and if
there is still doubt about what treatment should
be advised the chest specialist and chest surgeon
should be consulted.
Regardless of the number of sanatorium beds
the State provides for its citizens, and those
made available for Georgia veterans in veterans’
facilities, more than 75 per cent of our patients
(at least 8,000) must be treated and cared for
in their homes or in facilities which may be
provided by the community. Few communities
have facilities for the care, treatment and con-
trol of tuberculosis patients. They must con-
sider what they are going to do to remedy this
serious situation. To depend on the State and
Federal facilities to be developed to a point of
complete adequacy can only result in further
delay in developing a real program of tubercu-
losis case detection, case study, treatment, care
and control of infection. The development of
local sanatoriums in the larger population cen-
ters would be of distinct value.
Those communities which do not participate
fully in supplying the things they lack to make
tuberculosis control possible will continue to
have tuberculosis. To believe otherwise is to
ignore what has been happening in the past.
Some states with less adequate facilities than
ours have experienced a similar or even more
rapid decline in the death rate from tuberculosis,
while other states that have greater facilities but
which do no more than we are doing to control
infection in the homes and communities have
rates no better than ours. To spend a lot of
money for sanatorium treatment and neglect
the unhospitalized patient is wasting money.
Summary
The practicing physician, understanding how
handicapped the State and local health depart-
ments are in efforts to control tuberculosis, can
assist in many ways in the local efforts that
must be continued. They can and should help
in case-finding efforts, in case management, in
evaluating the clinical progress of patients, and
in guiding them through the long and tedious
convalescent period through which active cases
must go before their disease may be said to be
fully arrested. They can help by recognizing
the importance of the spread of infection and
preventing reinfection. They can help by re-
porting every case that comes to their attention
as required by law. They can help by informing
themselves fully of the extent of the tuberculosis
problem in the State as a whole as well as
in the city or county in which they live, so that
local planning may properly fit into a program
which includes the most efficient use of State
facilities. They can help by passing this in-
formation along to local governments so they
may understand what facilities are needed iij
order that the entire problem may be attacked
intelligently.
NEWS ITEMS
Two years ago the Council of this Association
authorized the employment of extra secretarial help.
At that time conditions in general were not favorable
for the employment of a suitable secretary. Part time
help has been necessary. Now we are very fortunate
in giving Miss Viola Berry, business manager and
executive secretary, the help which she has long
deserved. Meet, if you please, Miss Battie Eidson,
Atlanta, who joins our staff at the headquarters office
as of September 10. Miss Eidson knows physicians
and their problems, having for many years been secre-
tary to one of Georgia's prominent physicians.
* * *
The American College of Chest Physicians, Southern
Chapter, will hold its seventh annual meeting at the
Hotel Statler, St. Louis, November 12-13, 1950. Geor-
gia physicians on the program and their topics are:
‘‘Bacteriological Diagnosis in Tuberculosis,” by Dr.
Martin M. Cummings, Atlanta, and “The Surgical
Treatment of Asthma, Emphysema, Bullae and Blebs,”
by Osier A. Abbott, Atlanta. Dr. Carl C. Aven, also
of Atlanta, is a member of the Executive Council of
the Southern Chapter.
* * *
Dr. Mason Baird, Atlanta, recently attended the
International Congress of Ophthalmologist held in Lon-
don, England. Dr. Baird also visited Holland, Switzer-
land, Paris and other points of interest while abroad.
* * *
Dr. Needham B. Bateman, Atlanta, announces the
association of Dr. Harold A. Ferris, internal medicine,
and Dr. Ernest A. Dunbar, Jr., pediatrics, suite 526,
Candler Building, Atlanta.
* * *
The Bibb County Medical Society, Macon, recently
passed a resolution urging expansion of local hospital
facilities in Macon. The resolution called upon the
Macon Hospital Commission, Bibb County commission-
ers, and City Council to take expansion action. The
society also welcomed four new members: Drs. Herbert
M. Olnick, T. E. Rogers, Jr., B. W. Forester, and J. P.
Woodhall.
392
The Journal of the Medical Association of Georcia
Dr. Grady E. Black announces the opening of his
office in the Masonic Building, Griffin. Practice limited
to pediatrics. He graduated from the University of
Georgia School of Medicine in 1945 where he was
president of the student body his senior year. He
served an internship of one year at the University
Hospital, Augusta, and then returned there after
serving two years in the Army to complete two years
of training in pediatrics.
* * *
Dr. J. Gordon Brackett, East Point, announces the
opening of his offices at suite 814 Doctors Building,
478 Peachtree St., N. E.. Atlanta. Practice limited to
ear, nose, throat and broncho-esophagology.
* * *
Dr. Stewart D. Brown, Sr., Royston. recently an-
nounced the association of his son, Dr. Stewart D.
Brown, Jr., in the practice of medicine. Dr. Brown.
Jr., graduated from the University of Georgia School
of Medicine, Augusta, and received his training at the
Charity Hospital. New Orleans. He served three and a
half years in the Medical Corps of the United States
Army during the last war.
* * *
Dr. Napier Burson, Jr., Atlanta, announces the
opening aof his office for the practice of internal medi-
cine and gastroenterology at 34 Seventh Street, N. E.,
Atlanta.
* * *
Dr. Enoch Callaway, LaGrange, recently was the
guest speaker at the First Methodist Church of Hogans-
ville in the absence of the regular pastor, Rev. Carl
McGrady. Dr. Callaway is an outstanding lay leader
in the Episcopal Church in LaGrange, and appears
often as guest speaker in other churches.
* * *
Dr. Grady Coker: Canton, recently announced the
sale of his interests in the Coker-Jones Clinic, Canton,
to Dr. Arthur Hendrix. Dr. Coker will devote his
entire time at the Coker Hospital while Dr. Hendrix
will be associated with Dr. Robert T. Jones, III, at
the clinic.
* * *
Dr. Joseph B. Cooley, Lithonia. announces the
opening of his office in the Stewart Building, Lithonia.
He graduated from the University of Georgia School
of Medicine, Augusta, and has been practicing medicine
in Decatur and Atlanta since his discharge from the
Army Medical Corps in 1948.
* * *
Dr. R. L. Carter. Thomaston. recently spent a month
at the Tulane Hospital, New Orleans, studying and
observing in the Department of Obstetrics and Gyne-
cology. He spent some time at Tulane earlier this
year and returned to complete work in his specialty.
* * *
Dr. James IJ. Crawford. Atlanta, announces the
association of Dr. Benjamin M. Chambers at his office,
615 Grant Building, Atlanta. Dr. Crawford will limit
his practice to otolaryngology while Dr. Chambers will
confine his practice to ophthalmology.
* * *
Dr. Roger W. Dick son, Atlanta, was recently guest
at the staff dinner meeting of the Kennestone Hospital,
Marietta.
* * *
Dr. J. Leonard Dixon, formerly of Albany, has
been named chief of the surgical division of the new
Midland, Texas, Memorial Hospital. He is a former
assistant professor of surgery at Tulane L niversity
School of Medicine. At one time he was chief of
surgery for the famed Oschner Clinic in New Orleans.
The Midland Hospital is one of the finest to he opened
in the Southwest in recent years.
Dr. \ ilatan Domancic, a displaced person from
^ ugoslavia, has joined the medical staff of the Mil-
ledgeville State Hospital, Milledgeville, and has been
placed in charge of the tuberculosis ward.
* * *
Dr. Ernest A. Dunbar. Jr., Atlanta, announces the
opening of his office at 526 Candler Building, Atlanta,
and 116 College Avenue, Forest Park. Practice limited
to pediatrics.
* * *
The Fifth District Medical Society held its dinner
meeting at the Academy of Medicine, Atlanta, Septem-
ber 15. Program: "Pitfalls in the Use of Precision
Methods in the Management of Cardiovascular Disease"’,
Dr. Edgar Hull, of Tulane in New Orleans; “Clinical
Application of the Artificial Kidney”, Dr. John P.
Merrill, of Harvard, Boston. The society met in con-
junction with the Georgia Heart Association. Dr.
Carter Smith, president; Dr. J. H. Byram, vice
president, and Dr. L. Minor Blackford, secretary.
* * *
The Floyd County Medical Society, Rome, recently
endorsed the program of the County Health Depart-
ment to require chest x-rays of all food handlers in
Floyd County. The x-rays will serve to control the
spread of tuberculosis through cooks, waiters, butchers,
and others who come in contact with food before it
reaches the consumer.
* * *
The Fulton County Medical Society held its semi-
monthly meeting at the Academy of Medicine, Atlanta,
on August 6. Moderator — Dr. William C. Ward. Pro-
gram: “Evaluation of Systolic Murmurs on School
Examinations”, Dr. J. Gordon Barrow; "Late Sequelae
of Vena Cava Ligations”, Dr. Patrick C. Shea; “An
Effective Clinical Method for Determination of the
Coagulation Time: Its Value in Detection of Intra-
vascular Clotting”, Dr. Roy L. Robertson. Members
of the Floyd County Medical Society were special
guests.
* * *
The Georgia Chapter of the American Academy of
General Practice will hold its annual meeting at the
Hotel Dempsey in Macon, on October 26, 1950. There
is no registration fee, although the guests will be
required to pay for their luncheon. Besides the
members, all interested physicians in Georgia are
invited to attend. Dr. Joseph Crudup. President of
Brenau College, will make the luncheon address.
Immediately after the luncheon the scientific program
will begin. The speakers are: Dr. D. G. Miller, Jr.,
of Morgantown, Ky., subject to he announced; Dr.
John F. Denton. Atlanta. “Pelvic Pain”; Dr. Thomas
L. Ross, Jr.. .Macon, “Cardiac Emergencies”; Dr.
Edwin R. Watson, Macon, subject to be announced
(pediatrics); Dr. O. J. Bateman, Jr., Buffalo, N. Y.,
"Hormonal Therapy of Bone and Joint Disease”;
Dr. Robert B. Greenblatt, Augusta, “Uses and Abuses
of Hormonal Therapy.
Information concerning this meeting may be obtained
from Dr. J. B. Kay. President, Georgia Chapter. Byron,
or Dr. Albert R. Bush, Secretary, Hawkinsville.
* * *
The Georgia Medical Society held a special call
meeting at 612 Drayton Street, Savannah. August 1.
Medical mobilization and the Griffenhagen Report were
discussed. Dr. Sam Youngblood. Jr., secretary.
* * *
Dr. Harriett E. Gillette, Atlanta, recently helped with
the screening of applicants to the school for cerebral
palsied children which opened in Savannah earlier
this month. Dr. Gillette interviewed each child seeking
to enter the school and its parents to determine if
training was advisable. Quarters for the school were
September, 1950
393
donated by Hansel] Hillyet^ and consist of property
on Broughton Street.
* * *
Dr. Bryce W. Harris, formerly of Brunswick, an-
nounces the opening of his offices at 3550 Park Avenue,
Memphis, Tenn., for the general practice of medicine.
* * *
Dr. William C. Hathcock and Dr. John H. Reed
announce their association in the practice of ophthal-
mology and otolaryngology at 402 Grand Theatre
Building, Atlanta.
* * *
Dr. John H. Hines, formerly of Atlanta, announces
the opening of his office at Roswell for the practice
of medicine and surgery.
4 * * *
Dr. J. W. Hurst, Atlanta, Associate Professor of
Cardiology at Emory University School of Medicine,
recently addressed members of the private duty section
of the Fifth District, Georgia State Nurses Association.
His topic was: “Recent Advancement in the Manage-
ment of Heart Disease.”
* * *
The Jefferson County Medical Society recently held
its meeting at Pilchers Lodge near Stellaville. Guest
speakers included Dr. John R. Lewis, Jr., Atlanta,
who spoke on “Plastic Surgery”; Dr. Major Fowler,
Atlanta, who discussed the “Problems of Urology for
the General Practitioner”; and Dr. Reese Coleman,
Atlanta, an associate of Dr. Fowler was also a guest
at the meeting. Dr. James W. Pilcher, Louisville,
secretary.
* * *
Dr. S. P. Kenyon, Dawson, recently announced that
his suite of offices will be occupied by Dr. L. E.
Dickey, Jr., who will engage in the general practice
of medicine and surgery in Dawson. Dr. Dickey
graduated from the University of Georgia School of
Medicine, Augusta. He interned at the John Gaston
Hospital, Memphis, and just completed a year’s resi-
dency in surgery at the University Hospital, Augusta.
He served in the United States Navy during World
War If.
* * * •
Dr. G. Lombard Kelly, Augusta, president of the
Medical College of Georgia, recently announced that
Dr. John B. Brittain has been added to the faculty
of the Medical College of Georgia as assistant professor
of pharmacology. Dr. Brittain will work under Dr.
Raymond P. Ahlquist.
* * *
The Kennestone Hospital, Marietta, has announced
that qualified doctors everywhere in the state are wel-
come to practice there. Recently they opened their
facilities to three Atlanta urologists, Drs. Charles
Eberhart, James H. Semans, and Donald E. Beard.
Mr. Walter T. Altmann, administrator of the hospital,
said that “the Hospital Authority will keep outside
doctors coming in until Marietta’s needs have been
filled.’ The hospital finished in the red after its
first month of existence because of insufficient doctors
and patients.
* * *
Dr. Bernard S. Lipman, Atlanta, announces the
opening of his offices at 663 West Peachtree Street,
N. E., Atlanta. Practice limited to internal medicine
and cardiology.
* * *
Dr. Wood W. Lovell, Atlanta, announces the opening
of his office at 803 Medical Arts Building, Atlanta.
Practiced limited to orthopedics.
* * *
The Macon-Bibb County Health Center recently
announced that Dr. Z. E. Greer, of Cordele has been
named assistant health officer and Mr. C. M. Graham,
Jr., of Bulloch County has been assigned to the center
as a trainee. Dr. R. Frank Cary, Macon, made the
announcement. Dr. Greer, a graduate of the University
of Georgia School of Medicine in 1944, replaces Dr.
E. H. Prescott who left last December to become
health officer at LaGrange. Mr. Graham will train
at the center for three months before be is reassigned
by the state health department.
* * *
Dr. Rollo J. Mincey, Jr., Milledgeville, recently an-
nounced his association with Dr. L. A. Bailey at the
Scott Hospital, Milledgeville. He graduated from the
University of Georgia School of Medicine in 1943 and
interned at the Macon Hospital, Macon. Later he
served 27 months with the Army before entering into
general practice at Copyers for one year. He just
completed two years residency in obstetrics and gyne-
cology at St. Joseph’s Infirmary and Grady Memorial
Hospital, Atlanta.
* * *
Dr. JJ. H. Minchew, Waycross, recently presented
a paper entitled “Advances in Surgery of the Eye”
at the Ware County Medical Society meeting. A movie
showing the new method of cataract extractions was
shown. “Malnutrition in the Hospital Patient” was
part of the clinical program arranged by Dr. Ansley
Seaman in a movie pointing up the importance of
caloric intake to maintain a balanced nutritional status
to assure rapidity of recovery. Dr. W. F. Reavis, presi-
dent-elect of the Medical Association of Georgia, pre-
sided in the absence of Dr. W. A. Hendry, president.
Drs. A. W. DeLoach and Walter E. Lee, Jr., were
hosts to the supper meeting at the Hotel Ware. Guests
included Dr. Neal Youmans, Jesup, and Dr. M. D.
Clayton, Waycross.
* ❖ *
Dr. J. Phillip Muse, Brunswick, recently attended
the Southern Pediatrics Conference at Saluda, North
Carolina.
* * *
Dr. J. H. Nicholson, Madison, recently resumed his
medical practice after an absence of three months spent
on a tour of duty with the Medical Corps at Fort
Benning. He will continue to serve on the surgical
staff of McGeary Hospital in Madison and the Minnie
G. Boswell Memorial Hospital in Greensboro.
* * *
Dr. Rufus Payne, superintendent of Battey State
Hospital, Rome, recently announced that a new 70 bed
ward had been opened up, bringing the total number
of beds to 1,600. Another ward of similar capacity
is expected to be opened up shortly. The hospital had
only 500 beds when it opened in 1946. Dr. Payne said
that applications still greatly exceed the space avail-
able, despite the increase in beds. Twenty-five doctors
and 212 nurses are on the staff of the hospital.
* * *
Dr. Thomas J. Peacock, Milledgeville, superintendent
of the Milledgeville State Hospital, recently gave
a first-hand report on the big institution to the Rotary
Club of Brunswick. He cited statistics concerning the
number of patients, discharges, and other operating
routines. However, the high point of his remarks came
when he detailed the procedure followed by a surgeon
in the so-called “ice pick operation” to correct certain
types of mental disorders. Dr. J. W. Simmons, Bruns-
wick, introduced Dr. Peacock.
* * *
Dr. Quinton R. Pirkle, Hoschton, recently opened
an office with Dr. William Matthews at 3894 Peachtree
Road, Brookhaven. Dr. Pirkle will limit his practice
to surgery. He graduated from Emory University
School of Medicine and interned at Piedmont Hospital
in Atlanta. After serving three years in the Navy, he
391
The Journal of the Medical Association of Georcia
returned to the VA Hospital, Columbia, S. C. to
serve a residency on surgery.
* * *
Dr. T. E. Rogers, Jr., Macon, announces the opening
of his office for the practice of obstetrics and gyne-
cology at 700 Spring Street, Macon.
* * *
Dr. S. E. Sims, formerly of Atlanta, recently began
his duties as a member of the staff of Jordan Hospital,
Eatonton. He graduated from Emory University School
of Medicine and interned at Grady Hospital in Atlanta.
After spending two years in the Navy he returned
to Atlanta to become assistant resident in surgery at
Grady Hospital.
* * *
I)r. H. Wilder Smith. Swainsboro, recently attended
the Southern Pediatric Seminar at Saluda, N. C. He
graduated from the University of Georgia School of
Medicine, Augusta, in 1946 and served a year of
internship at Duval County Hospital, Jacksonville, Fla.
* * *
Dr. J. Gregg Smith, formerly of Gainesville, recently
was appointed Lowndes County Health Commissioner
by the Lowndes County Board of Health. Previously
he had served in a similar capacity at Hall County. A
graduate of the Medical College of Virginia, Rich-
mond, Dr. Smith served almost 27 years in the Navy
before retiring to enter into the field of public health.
* * *
Dr. William A. Steed, Augusta, recently announced
the opening of his offices at 305 Tenth Street, Augusta.
Practice limited to diseases of the eye, -ear, nose, and
throat. He graduated from the University of Georgia
School of Medicine. Augusta, and served a rotating
internship at Atlanta’s Grady Memorial Hospital. After-
wards he served four years in the army with overseas
duty in France, Belgium, and Germany and was dis-
charged with the rank of major. Dr. Steed then went
back to Grady Hospital to take three years of residency
training in eye, ear, nose, and throat work.
* * *
Dr. Virgil P. Sydenstricker. Augusta, was recently
appointed medical consultant to the Georgia Training
School for Mental Defectives at Gracewood. Dr. Syden-
stricker is also Physician-in-Chief of the LIniversity Hos-
pital, and professor of medicine at the Medical College
of Georgia, Augusta. During the last war he served
as advisor to the British ministry of health and was
awarded the King’s Medal for his survey of the
nature of nutritional dificiencies in the British Isles.
* * *
The Tenth District Medical Society held its meeting
at the City Hall, Madison, August 17. Program:
“Anesthesia in the Small Hospital”, Dr. Perry P.
Volpitto, Augusta; “An Outline of Some of the Newer
Therapeutic Measures in Medicine”, Dr. David R.
Thomas, Augusta; "Nonpenetrating Injuries of the
Abdomen , Dr. Thomas Goodwin, Augusta; “Medical
Public Relations”, Mr. Richard J. Eales, Atlanta;
Discussion, followed by Short Business Session. Dr.
A. M. Phillips, Macon, President of the Medical Asso-
ciation of Georgia, and Dr. Stephen T. Brown, Atlanta,
Chairman of the Public Relations Committee of the
Medical Association of Georgia also spoke. Following
the adjournment, a barbecue was held for the doctors
and their wives.
* * *
Dr. Russell Thomas, Americus, Chairman of the
Sumter County Board of Health, recently called a
meeting of the board to discuss problems concerning
the improvement of health services in Sumter County.
It was decided that eating places should be inspected
and improved as the first steps in erasing the health
problems in Americus and Sumter County.
The Toombs County Medical Society met in Vidalia
on August 23. Dr. Harold P. McDonald. Atlanta, spoke
on “The Prostate Gland.”
* » *
Dr. R. A. Vonderlehr, Atlanta, medical director in
charge of the U. S. Public Health Service Commu-
nicable Disease Center, recently announced the appoint-
ment of Dr. Sidney Olansky, of Washington, D. C., as
director of the venereal disease research laboratory in
Atlanta. For the past two years Dr. Olansky has been
in the private practice of dermatology and syphilology
besides serving as clinical instructor in medicine at
George Washington and Georgetown medical schools.
He is a native of Boston, Mass.
* * *
Drs. Exum W'alker and William W’. Moore, Atlanta,
announce the association of Dr. James R. Simpson in
the practice of neurological surgery at 133 Doctors
Building, Atlanta.
* * *
Dr. H. Eugene Weems, formerly of Macon, announces
the opening of his office in the Crowe Building,
Sylvester. He is associated with Dr. Norman J. Crowe
in the practice of medicine. A graduate of the Univers-
ity of Georgia School of Medicine, Augusta, Dr.
Weems is a veteran of four years service with the
Navy during and after World War II.
* * *
Dr. M. W’. W illiams, Camilla, who has been ill for
over a month, recently reopened his office with Dr.
A. A. McNeil. Jr., in charge. Dr. McNeil, a native
of Cairo, graduated from the University of Georgia
School of Medicine, Augusta, and spent two years
at King County Hospital. Brooklyn, N. Y., on a rotating
surgical internship. Later he returned to the same
hospital for one year’s residency training in pathology.
* * *
Dr. Peter B. Wright, Augusta, recently spoke before
the Augusta Kiwanis Club on the causes, effects, and
treatments of cerebral palsy. Dr. Wright is medical
adviser for the Augusta area of the Georgia Crebral
Palsy Society. Miss Clara Greene, chief pharmacist
at the Medical College of Georgia, made a short talk
explaining the work of the newly-organized Augusta
chapter of the Georgia Cerebral Palsy Society. A
motion picture showing work being done in a cerebral
palsy school was also shown. Dr. H. W. Hankinson
introduced the speakers.
* * *
The Fulton County Medical Society held its semi-
monthly meeting at the Academy of Medicine, Atlanta,
August 17. Moderator, Dr. C. W. Strickler, Jr. Pro-
gram: “Hypersensitivity and the Adrenal Cortex,” Dr.
William I’. Friedewald; Discussion led by Dr. Philip
K. Bondy; “Some Dangers in Use of the Miller Abbott
Tube,” Dr. Charles S. Jones; Discussion led by Dr.
J. W. Veatch, Jr.
* * *
The Ware County Medical Society held its meeting
at the Ware Hotel, Waycross, August 3. Dr. H. Ansley
Seaman presented the clinical program. Films on
operation of a patient for “milk leg” were shown. The
operation which showed ligation of the large femoral
vein where the blood clot forms in the vein pointed
up how this particular type operation prevented the
clot from moving up to the heart, lung or brain, thus
preventing fatality. This operation technic reduced
the time of illness and restored the patient to normal
activity, it was shown. Dr. Floyd E. Davis was elected
to the directorship in the vacancy of the Waycross
Blood Bank when Dr. Ed Roe Stamps, director, moved
to Macon. Dr. Dexter Clayton was welcomed as a
new member by Dr. W. F. Reavis, president-elect of
the Medical Association of Georgia. Dr. W. A. Hendry,
president, presided over the meeting to which Drs.
Ansley Seaman and Floyd E. Davis were hosts.
September, 1950
393
COMMUNICATIONS
FOURTH NAVAL DISTRICT
District Staff Headquarters
U. S. Naval Base, Philadelphia 12, Pa.
12 June 1950
E. D. Shanks, M.D., Secretary,
Medical Association of Georgia,
478 Peachtree Street, N. E.,
Atlanta 3. Georgia.
My dear Dr. Shanks:
To keep military Reserve Medical Officers of the
Armed Forces, Army, Navy and Air Force posted on
the latest developments in the field of medical science,
a Medico-Military Symposium for officers of the Fourth
Naval District will be held at the U. S. Naval Hospital,
Philadelphia, Pa. from October 23 to 28.
Commodore Richard A. Kern, MCR, USNR, Professor
of Medicine, Temple University School of Medicine,
and chairman of the symposium General Committee,
has announced that Rear Admiral Clifford A. Swanson,
MC, USN, Surgeon General of the Navy, will open
the meetings with an address on “The Physician as a
Naval Officer.”
Officers attending the symposium will be welcomed
by Rear Admiral Roscoe E. Schuirmann, Commandant,
of the Fourth Naval District: Brig. General Leonard E.
Rea, USMC; Cantain Clvde W. Brunson, MC, USN,
Commanding Officer of the Philadelphia Naval Hos-
pital; and Captain J. R. Thomas, Fourth Naval District
Medical Officer.
Speeches and panel discussions are scheduled in
aviation medicine, national defense in case of disaster
or attack, national preparedness, psychiatry, submarine
medicine, surgery and orthopedics. Physicians selected
to head the panels include Brig. Gen. .Tames P. Cooney,
Chief, Radiology Branch, Division of Military Applica-
tion. Atomic Energy Commission ; Dr. Perrin Long,
Professor of Medicine, Johns Hopkins University;
Captain John Poppen. MC. USN : Captain George
Lvons, MC, USN : Rear Admiral C. J. Brown, MC,
USN; Captain C. W. Schilling. MC, USN; Dr. Frank
Braceland: Dr. Joseph Hughes, Dr. Edward Strecker
and Dr. Christian J. Lamberton.
It is urged that officers make hotel reservations well
in advance, since no government housing facilities will
be available. The final session of the symposium will
be held Saturday morning, October 28. leaving the
afternoon free for officers to attend the Penn-Navy
football game.
The attendance to this symposium is not restricted
to Medical Officers of the Armed Forces. All members
of the Medical Profession are cordially invited to attend.
Would you be so kind as to publish this invitation
of this medical meeting in the Journal ?
Sincerely vours,
M. H. PORTERFIELD,
Commander, MCR. USNR
Assistant to Dist. Medical Officer,
Naval Medical Reserve Program.
American Urological Association
Atlantic Citv. N. J., July 15, 1950
Dr. Edgar D. Shanks. Editor
Journal of the Medical Association of Georgia,
478 Peachtree St., N. E.
Atlanta 3, Ga.
Dear Dr. Shanks;
Please publish in the forthcoming issue of your
journal the following notice:
“Urology Award — The American Urological Associa-
tion offers an annual award of $1,000.00 (first prize
of $500.00. second prize $300.00 and third prize
$200.00) for essays on the result of some clinical or
laboratory research in Urology. Competition shall be
limited to urologists who have been in such specific
practice for not more than five years and to men in
training to become urologists.
“The first prize essay will appear on the program
of the forthcoming meeting of the American Urological
Association, to be held at the Palmer House, Chicago,
Illinois, May 21-24, 1951.
“For full particulars write the Secretary, Dr. Charles
H. de T. Shivers, Boardwalk National Arcade Building,
Atlantic City. New Jersev. Es-ays must be in his
hand before February 10. 1951.”
Yours very truly,
COMMITTEE ON SCIENTIFIC RESEARCH
Miley B. Wesson, Chairman
Anson L. Clark
John E. Heslin.
GEORGIA. HEART ASSOCIATION
The Georgia Heart Association held its Second
Annual Meeting September 15 and 16 in conjunction
with the annual meeting of the Fifth District Medical
Society, in the Academy of Medicine and the Biltmore
Hotel in Atlanta.
The meeting featured nationally known authorities
on heart disease and a round-table discussion, “The
Layman Looks at Heart Disease”, in which outstanding
leaders in the fields of education, agriculture, industry,
labor and civic affairs posted questions to the visiting
speakers.
Guest speakers and their tonics were: Dr. Tinsley
R. Harrison. Professor of Medicine, Llniversity of
Alabama School of Medicine, who spoke on “Un-
usual Aspects of Chest Pain”; Dr. James Shannon,
Research Director, National Heart Institute. Bethesda,
Maryland, on “Trends in Cardiovascular Research”;
Dr. John Merrill, Peter Bent Brigham Hosnital,
Harvard University, “The Role of The Artificial
Kidney in Cardiovascular Diseases”; Dr. Edgar Hull,
Professor of Medicine. Louisiana State University, “The
Choice of Leads in Clinical Electrocardiography”: and
Dr. Euaene Ferris. Associate Professor of Medicine,
University of Cincinnati, spoke on "The Diagnosis
and Management of HvDertension”.
According to Dr. T. Sterling Claiborne, president of
the Georgia Heart Association, more than 300 physi-
cians from Georgia and neighboring states were present.
ROENTGENOLOGISTS WILL HOLD 50th
ANNIVERSARY MEETING IN ST. LOUIS
The American Roentgen Ray Society, which is
composed of physicians who specialize in x-ray diag-
nosis and treatment, will hold its 50th anniversary
meeting in St. Louis, September 26-29.
It was 50 years ago this year that a small group
of doctors gathered in St. Louis to organize a society
“whose principal purpose would be the study of the
roentgen ravs and their application to medicine and
science.” This society became known as the American
Roentgen Ray Society.
The scientific sessions and the scientific and com-
mercial exhibits will be held in the Hotel Jefferson
in St. Louis.
This year’s Caldwell lecture will be delivered on
Wednesday, September 27, by Dr. Henry L. Bockus,
professor and chairman of the Department of Internal
Medicine in the Graduate School of Medicine, Univer-
sity of Pennsylvania, Philadelphia. His subject will
be “The Role of Roentgenology in Gastroenterology.”
The convention program is being arranged by a
committee headed by President-elect B. P. Widmann,
M.D., of Philadelphia.
The society president is Dr. U. Y. Portmann, of
Cleveland.
The Journal would like to record the scientific
work of Georgia physicians. It earnestly requests,
therefore, that each physician in the State who
publishes a contribution in some other medical
periodical submit an abstract of the article for
these columns.
EMORY UNIVERSITY SCHOOL OF MEDICINE
in cooperation with
THE MEDICAL ASSOCIATION OF GEORGIA
announces the third annual
396
The Journal of the Medical Association of Georgia
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The Journal of the Medical Association of Georcia
398
OBITUARY
Dr. Judge ./. Bridges, aged 81. retired Atlanta physi-
cian. died at li is home, 458 Haas Ave., S. E., Atlanta,
after a long illness, July 25, 1950. I)r. Bridges was
born in Jackson County, Georgia the son of the
late Rev. W. H. Bridges and Angeline Randolph
Bridges. He graduated from the University of Georgia
School of Medicine, Augusta, in 1891. and later did
postgraduate work at Tulane University of Louisiana
School of Medicine, New Orleans, La. Beginning
medical practice in Trion, he later moved to Bethlehem
where he married Miss Rose Elizabeth Bedingfield
in 1895. After several years’ practice in Bethlehem,
Bogart and Auburn, he moved to Atlanta. At this
stage of his medical career be became famous as a
typhoid fever and pneumonia doctor as well as a pedi-
trician. Dr. Bridges was a member of the Baptist
Church and of the Odd Fellows. Surviving are his
wife; six sons, Fred T„ Horace G., and Dr. Glenn J.
Bridges, all of Atlanta; Ralph W. Bridges, Modesto,
Calif.; John Bridges, Birmingham, Ala.; and Roy
D. Bridges, Lithonia; three daughters, Mrs. V. C.
Durham. Savannah; Mrs. Guy Malcom, Athens, and
Mrs. Forrest Maughon. Atlanta; three sisters, one
brother; fifteen grandchildren, and five great-grand-
children. Funeral services were held at the Moreland
Avenue Baptist Church with the Rev. W. H. Barrett
and the Rev. B. W. Hancock officiating. His sons
served as pallbearers. Burial was in Greenwood Ceme-
tery, Atlanta.
* * *
Dr. William Harold Campbell, aged 84, prominent
Columbus physician who retired five years ago, died
August 10, 1950. Dr. Campbell was born in Harris
County, Georgia the son of the late Philander J. and
Martha Zachary Campbell. He graduated from the
Louisville Medical College, Louisville, Ky., in 1891,
and had practiced medicine in Columbus for 50 years.
Dr. and Mrs. Campbell celebrated their fiftieth wedding
anniversary in 1944. He w;as a member of the First
Baptist Church. Survivors include his wife, the former
Miss Mary Lou White; a son, Hal Campbell, Columbus,
a daughter, Mrs. W. H. Willingham, Columbus, and
three grandchildren. Funeral services were held at
the Striffler Chapel with the Rev. W. Howard Ething-
ton officiating. Burial was in Riverdale Cemetery,
Columbus.
* * *
Dr. Marian E. Farbar, aged 69, for 16 years resi-
dent physician at Valdosta State College (formerly
the Georgia State Woman’s College), died May 4, 1950.
Dr. Farber was born in Otoe County, Nebraska, in
1881. She received her Registered Nurse’s degree
at the Chicago Baptist Hospital, Chicago, in 1905 and
her M.D. degree from the University of Illinois College
of Medicine, Chicago, 111., in 1910. She interned at
the Deaconess Hospital. Spokane, Wash., and did post-
graduate work at the University of Chicago College
of Medicine, Chicago, and Cornell University Medical
School, New York .City. Following her internship. Dr.
Farbar went to India as a medical missionary, where
she served for six years. After her return from India,
she was in general practice in the United States until
1926, when she went into the field of Health Educa-
tion at Ann Arbor, Mich., and at Earlham College,
Richmond, Ind. Dr. Farbar went to Valdosta State
College in 1934, when she served as resident physician
and as a teacher in the biology department. She con-
tributed articles to various medical journals and was
mentioned in one of Paul DeKruif’s books for her
research in brucellosis. She served at one time as
secretary-treasurer of the South Georgia Medical
Society, of which she was a member. She was also a
member of the Medical Association of Georgia, a fellow
of the American Medical Association. She was a
member of the Baptist Church. Survivors include
two sisters. Miss Frances Farbar, Chicago, 111., and
Mrs. L. R. Smith. Orlando, Fla.; a brother, Jerome
Farbar, Houston, Texas. A memorial service was held
in Valdosta with the Rev. Clifton H. White officiating.
Cremation was in Orlando, Fla.
* * *
Dr. Edward Rutledge Freeman, aged 34, Columbus
physician, was found shot to death in his office at
1340 Fourth Avenue. July 22, 1950. He was born in
Phenix City, Ala., where he had lived all his life.
He was the son of the late Millard Berry Freeman
and Myrtice Rutledge Freeman. Dr. Freeman was
graduated from Emory University School of Medicine,
Atlanta, in 1943. He interned at the City Hospital,
Columbus. He was a member of the Muscogee County
Medical Society, the Medical Association of Georgia
and a fellow of the American Medical Association.
Survivors include his wife; two daughters, Myrtice Ann
and Frances Freeman; a brother, M. B. Freeman, Jr.;
a nephew, Billy Freeman, and several uncles and
aunts. Funeral services were held at Oaklawn Chapel
with the Rev. R. J. Haskew officiating. Honorary pall-
bearers were members of the Muscogee County Medical
Society. Burial was in Riverdale Cemetery, Phenix
City, Ala.
* * *
Dr. Emory G. Lower, aged 47, Atlanta physician and
former Georgia Tech instructor of 619 Myrtle Street,
N. E„ Atlanta, died in a private hospital, July 25,
1950. Dr. Lower, a native of New Virginia, Iowa, was
an instructor in biology at Georgia Tech until about
eight years ago when his increasing medical practice
forced him to give up teaching. The Atlanta physician
was a member of Beta Kappa Phi medical fraternity,
and was a graduate of the University of Tennessee
College of Medicine, Memphis, Tenn., in 1937. He did
postgraduate work at University of Chicago, Chicago,
111. He was a member of the Fulton County Medical
Society, the Medical Association of Georgia, the South-
ern Medical Association, and a fellow of the American
Medical Association. He was a member of the North
Aevnue Presbyterian Church and a Mason. Surviving
are his wife, Mrs. Jeannette V. Lower, Atlanta; his
mother. Mrs. Elsie Lower, Atlanta; a sister. Mrs.
Malcolm Betha, Birmingham, Ala.; and two brothers,
Howard Lower, Atlanta, and Donald Lower, Fredericks-
burg, Va. Funeral services were held at Spring Hill
with Dr. W. C. Robinson and Dr. Thomas Anderson
officiating. Burial was in East View Cemetery, Atlanta.
WANTED — Roentgenologist for mental
liospital. Attractive salary and partial
maintenance. Two excellent colleges in
immediate vicinity. Submit full informa-
tion, three references and small photo-
graph in first letter. Address Superintend-
ent, Box 325, Milledgeville, Ga.
SURGEON WANTED — A modern progres-
sive South Georgia town is now building
a 30-bed hospital, which will be completed
in the near future. Will serve fifteen to
twenty thousand people. Badly need a sur-
geon with experience, since there is not one
in the county. Write, JMAG, 478 Peach-
tree St., N. E., Atlanta, Ga.
FOR RENT OR LEASE: Modern building,
equipped as 10-bed hospital for surgical,
obstetrical and general practice. Also may
he used as offices. Located in South
Georgia. For full information, write Medi-
cal Placement and Mailing Service, 768
Juniper St., N.E., Atlanta, Ga.
THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia, October, 1950 No. 10
PERITONEAL DRAINAGE
J. Benham Stewart, M.D.
Macon
Since the early days of medicine there
has been constant discussion on the subject
of drainage. On many occasions a paper
has been written which seemed definitely to
establish a form of treatment. Shortly there-
after another paper would be published with
equally good arguments for the opposite
method of treatment. It is the purpose of
this discussion to try to establish some gen-
eral principles with regard to drainage of
the peritoneal cavity. Steinberg, in his re-
cent book on abdominal injuries and their
treatment, stated that the aim of peritoneal
drainage is fourfold: (1) to avoid the de-
velopment of abscess; (2) to control bleed-
ing by pressure of a foreign body; (3) to
prevent extension of infection; and (4) to
remove the circumscribed products of in-
flammation. There is considerable question
as to whether any of these aims are actually
accomplished by drainage except under cer-
tain specialized conditions.
A general review of the literature for the
past few years shows that most authors are
opposed to drainage of the peritoneal cavity
except for specific indications, particularly
the presence of localized abscess or some
localized infection which it is desired to pre-
vent from spreading. It is, however, equally
obvious that despite the papers written on
the subject and the widespread condemna-
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
tion of drainage in the literature, most surg-
eons resort to this procedure more frequent-
ly than is considered necessary in the litera-
ture, and many of them use drains in almost
every case of abdominal surgery. The ques-
tion arises whether the literature on the sub-
ject is more theoretical than practical, or
whether, knowing the facts in the case, we
surgeons do not have the courage to follow
what we know to be correct.
Many observers, such as Kirk, Miller,
Shipley and Bailey, believe that drainage
in early peritonitis not only does nothing
toward relieving the condition, but also ac-
tually interferes with healing. Animal ex-
perimentation has proved that, in the dog
at least, drains do not prevent formation of
an abscess; furthermore, they actually con-
tribute to the formation of abscesses locally
at the site of the drain. It is known that
even multiple drains placed throughout the
abdomen in the case of peritonitis do not
drain the peritoneal cavity. Experiments
have been performed which show that if the
source of infection is removed or stopped,
forty-eight to seventy-two hours after a gen-
eralized peritonitis the peritoneum will be
free of infection and of adhesions except at
the site of the drain. There infection still
remains, and relatively dense adhesions
exist. When the peritoneum is closed tightly
in animals with approximately the same in-
fection, the peritoneal cavity is completely
clear at this time without even the local
infection that existed when drainage was
employed. Also, the mortality rate in ani-
mals following drainage of the peritoneal
cavity in severe infections is almost 100
400
The Journal of the Medical Association of Georgia
per cent, whereas stopping the leak and
closing the abdomen tightly produces a
fairly high percentage of recovery. The
available statistics on mortality in the hu-
man with and without drainage are almost
identical.
The healing process in the body takes
place first by the outpouring of polymor-
phonuclear leukocytes, which combat the
infection, killing off the causative organisms
and rendering others inactive. These cells
then act as phagocytes, taking away the
debris of their fellow cells and the destroyed
organisms together with other cellular
debris caused by the battle. With drainage,
these particularly needed leukocytes are
allowed to flow out of the body along the
course of the drain. This loss not only
weakens the body mechanism for killing the
organism, but materially hinders the clean-
ing up process which follows. There also is
some question whether we can assume that
all motion along the drainage highway that
we establish is going to be in one direction.
It seems impossible that we could establish
a one way highway whereby pathogenic or-
ganisms would come out of the body and
none would enter. Certainly the dressing
around a wound provided with drainage
cannot be free from contamination from
without.
In 1905 Yates performed a great deal of
experimental work in regard to drainage of
the peritoneal cavity. His investigations
proved conclusively that in the normal peri-
toneum drainage occurs around the tube for
approximately six hours, but that in a di-
seased peritoneal cavity the length of the
period of drainage is much shorter. After
this initial six-hour period the drainage
tube is effectively sealed within a small
tract. The adhesions about the tube become
more and more dense the longer it remains
in place, and the portion drained is merely
that small area which immediately sur-
rounds the tube. There is considerable evi-
dence to show that the tube itself acts as a
foreign body, producing inflammation and
inviting bacterial contamination whether
any existed previously or not.
At an earlier time, in 1897, Clark an-
alyzed 1,700 cases at Johns Hopkins Uni-
versity. He concluded that not only is drain-
age useless, but in many cases actually
harmful.
Cottis reported that a careful search of
the literature failed to reveal any instances
in which a surgeon who had adopted the
policy of nondrainage in cases of general-
ized peritonitis ever reverted to the use of
drains. He stated that the great danger from
peritonitis is not the infection itself but
the mechanical intestinal obstruction or
ileus that complicates it. From his experi-
ence as Chief of Surgical Service, James-
town General Hospital, and from his survey
of the literature, he concluded that obstruc-
tion is more common in those cases in which
drainage is employed than in others. He
believed that if the source of the infection
can be removed and if the peritoneum is
intact, that is, has no areas denuded, pri-
mary closure in the peritoneum without
drainage is the method of choice.
Dixon, Martin and Ochsner, in discussing
peritonitis, assumed that everyone is in
favor of closing the peritoneum without
drainage. They added one feature which -
in my limited experience has proved espe-
cially valuable, and that is the placing of a
small Penrose or rubber dam drain down to
the peritoneum in the wound after the peri-
toneum has been tightly closed. In the pres-
ence of contamination of the peritoneum
and of local or generalized peritonitis, it is
almost impossible to prevent some infection
from contaminating the wound at the time
of operation. It is likewise impossible to
sterilize the wound after the peritoneal
cavity has been closed. Since there is no
October, 1950
401
peritoneal lining of the wound, and there is
usually bruised muscle in the wound, it
makes an ideal place for an infection to
flourish. This likewise is not a large cavity,
and drainage is desired only around the
point which can actually be touched by the
drain. This drain should be removed in
stages beginning approximately forty-eight
hours after completion of the operation.
Dr. Fraser B. Grud of McGill University
condemned hard rubber drains and glass
tube drains and also stated that the perito-
neal cavity cannot be drained, but in any
case in which there is infection he advocated
the placing of massive packs soaked in
liquid paraffin and bismuth and iodoform
paste into every portion of the peritoneal
cavity around the intestines. He added that
he makes no attempt to close the abdominal
incision, but waits approximately forty-
eight to seventy-two hours, at which time the
infection has in his experience been com-
pletely cleared. The packs are then removed
with the patient asleep, and the wound is
closed without drainage. Dr. Grud believed
that if there is the slightest doubt, the peri-
toneal cavity should be packed as described.
I have found no other reference in the litera-
ture to such therapy. Although he considers
it to be the ideal form of treatment and re-
ports almost no mortality with it, it seems
somewhat radical.
In reporting on the results in 936 cases of
acute appendicitis, Tashiro and Zinninger
discussed a previous report in which they
concluded that, unless extensive necrosis or
actual fecal contamination of the perito-
neal cavity is present, it is better to close
the peritoneum and drain the wound down
to it. In the earlier paper they gave as rea-
sons for such a procedure:
1. Wounds in which the peritoneal cavity
has been drained are prone to hernias.
2. Drains form a portal of entry for in-
fection from without.
3. Drains are foreign bodies and may
stimulate adhesions, which may result in
intestinal obstruction.
4. The obtaining of drainage from re-
mote portions of the peritoneal cavity by
drains is unlikely.
These authors related that the results in
their series of 936 cases seem to indicate
that this form of treatment needs some re-
vision. They agreed with the opinion that
drains in the pelvis or paravertebral gutter
cannot drain distant portions of the peri-
toneal cavity, but they were of the opinion
that it drains localized pockets of pus, and
that in cases of definite contamination there
are fewer pelvic abscesses following drain-
age. In the cases of ruptured appendix in
which the peritoneum was closed tightly,
pelvic abscesses developed in 24.1 per cent,
whereas in the cases in which drainage was
employed such abscesses developed in only
12.1 per cent. While these figures do not
coincide with the other figures given in this
discussion, a further study of their paper
reveals that in those cases in which there
was drainage, the mortality rate was 12.1
per cent, but in those in which there was no
drainage it was 8.6 per cent.
Statistics in any paper or discussion are
useless unless all of the facts are at hand,
I
and usually these facts are not presented
in the discussions. For example, Tashiro
and Zinninger reported the percentages of
cases with drainage but did not describe
specifically the details and their reasons for
draining in each case. Likewise, in regard
to the percentages on mortality, it is not
known how serious the condition was in
each of the fatal cases before the operation
was performed. It would be necessary to
know at least these facts in order really to
evaluate the figures given. This is, however,
a large series of cases and the report comes
from an excellent clinic, so there is added
one more link in the already confusing
402
The Journal of the Medical Association of Georcia
chain of discussions on the subject of drain-
age in peritoneal contamination.
Summary
In the literature much evidence has ac-
cumulated on both sides of the question of
drainage. The consensus of opinion from
the leading clinics over the country at the
present time is, however, that unless there is
definite localized pus or a highly localized
massive contamination of the peritoneal
cavity, it is better to close the peritoneum
tightly and drain the wound.
BIBLIOGRAPHY
1. Buchbinder, J. R. ; Droegemueller, W. A., and Heilman,
F, R. : Experimental Peritonitis; Effect of Drainage on
Experimental Diffuse Peritonitis, Surg., Gynec. & Obst.
53:726-729 (Dec.) 1931.
2. Bunch, G. H., and Doughty, R. : Treatment of Acute
Appendicitis, Ann. Surg. 106:42-48 (July) 1937.
3. Cafritz, E. A.: Nondrainage of the Peritoneal Cavity
in Appendiceal Peritonitis, J.A.M.A. 108-1315-1317 (April
17) 1937.
4. Clairmont, P., and Meyer, M. : Erfahrungen uber die
Behandlung der Appendicitis, Acta chir. Scandinav. 60:55-134,
1926.
5. Clark, J. G. : A Practical Application in Abdominal
Surgery of Scientific Investigations on the Function, An-
atomy, and Pathology of the Peritoneum, Univ. Pennsyl-
vania M. Bull. 14:87-90, 1901.
6. Cottis, G. W. : The Fallacy of Peritoneal Drainage,
Am. J. Surg. 60:204-208 (May) 1943.
7. Dixon, J. L. ; Martin, G., and Ochsner, A.: Treatment
of Abdominal Injuries; Review of Eighty-Eight Personal
Cases, Am. J. Surg. 68:143-163 (May) 1945.
8. Gurd, F. B. : The Operative Treatment of Acute
Appendicitis with Perforation, Canad. M. A. J. 27:360-367,
1932.
9. Gurd, Fraser B. : A Specific Technique for the Treat-
ment of Acute Perforated Appendicitis, Am. J. Surg. 17:52-58
(July) 1932.
10. Kirk, R. D., Jr.: Treatment of Acute Peritonitis,
New Orleans M. & S. J. 83:76-80 (Aug.) 1930.
11. Lewis, D., and Penick, R. M., Jr.: Fecal Fistulae,
Internat. Clin. 1:111-130 (March) 1933.
12. Marchini, F. : L’abolizione del drenaggio nelle peri-
toniti purulente circoscritte e diffuse, specialmente da
appendicite. Arch. ital. chir. 28:549-602, 1931.
13. Miller, H. C.: The Problem of Draining the Peri-
toneal Cavity, Nebraska M. J. 15:401-404 (Oct.) 1930.
14. Shambaugh, P., and Boggs, R. : Peritoneal Drainage;
Resistance of the Sinus Tract to Infection, Arch. Surg.
30:1032-1035 (June) 1935.
15. Shipley, A. M. : Editorial: Drainage of the Peritoneal
Cavity and Intestinal Obstruction, Surg., Gynec. & Obst.
60:1016-1017 (May) 1935.
16. Shipley, A. M-. and Bailey, H. A.: Treatment of Ap-
pendicitis Complicated by Peritonitis, Ann. 96:537-544 (Oct.)
1932.
17. Steinberg, B. : The Cause of Death in Acute Diffuse
Peritonitis, Arch. Surg. 23:145-156 (July) 1931; correction
23:356 (Aug.) 1931.
18. Steinberg, Bernhard: Infections of the Peritoneum,
New York, Paul B. Hoeber, 1944.
19. Sworn, B. R., and Fitzgibbon, G. M.: Analysis of
2126 Cases of Acute Appendicitis, Brit. J. Surg. 19:410-414
(Jan.) 1932.
20. Tashiro. S., and Zinninger, M. M.: Appendicitis;
Review of 936 Cases at the Cincinnati General Hospital,
Arch. Surg. 53:545-563 (Nov.) 1946.
21. Warren. R. : Primary Closure of the Peritoneum in
Acute Appendicitis with Perforation; Report of Twenty
Cases, Ann. Surg. 110:222-230 (Aug.) 1939.
22. Yates, J. L. : An Experimental Study of the Local
Effects of Peritoneal Drainage, Surg., Gynec. & Obst.
1:473-492, 1905.
211 Doctors Building.
THE COLOR OF FECES FOLLOWING
THE INSTILLATION OF CITRATED
BLOOD AT VARIOUS LEVELS OF
THE SMALL INTESTINE
J. H. Hilsman, M.D.
Atlanta
The purpose of this report is to present
data on the color of feces following the in-
troduction of citrated blood into the human
small intestine at various levels. The ex-
periments were undertaken to determine
whether or not reliance could be placed on
the color of the feces in the localization of
a bleeding lesion.
Work done by Schiff and his associates1
on the introduction of large and small
amounts of blood into the normal stomach
has shown that the resulting stools can be
either bloody or tarry. They found that
when citrated venous blood was introduced
into the stomach, as by drinking, that at
least 100 to 200 cc. were required to pro-
duce a tarry stool. Under the same circum-
stances, but using fresh blood, Daniel and
EganJ showed that at least 50 to 80 cc.
were required. This seems to imply, there-
fore, that a bleeding gastric lesion must
bleed at least about 75 to 100 cc. in order
to cause the ultimate production of a tarry
stool.
On the other hand, when Schiff et al1 gave
large amounts of citrated venous blood (one
to two liters) per gastric tube to his subjects,
the resulting stools were either bloody or
tarry. Three out of four subjects given a
liter of blood had no tarry stools whatever,
but had bloody stools. Three subjects that
did pass a tarry stool, regardless of the
amount of blood that was given, did so in 20
hours or more; those that passed bloody
stools did so in 17 hours or less. Schiff con-
cludes that a grossly bloody stool does not
Read before the Medical Association of Georgia in annual
session, Macon, April 19, 1950.
October, 1950
403
necessarily indicate that the blood is enter-
ing the intestinal tract low in the small in-
testine or in the colon.
In this small intestinal study, the subjects
were patients from the usual hospital ward,
both medical and surgical; none of the sub-
jects had a history of gastrointestinal bleed-
ing or were receiving iron or bismuth ther-
apy. Each was intubated with a double-
lumen Miller-Abbott tube under fluorosco-
pic guidance. When any doubt existed as to
the location of the tip of the tube, a small
amount of a thin suspension of barium in
water was introduced, the site identified,
and the barium aspirated. Then, 200 cc. of
recently outdated bank blood*, containing
0.68 grams of sodium citrate, were intro-
duced through the tube into the predeter-
mined section of the small or large intestine.
The color of the first and second stools con-
taining gross evidence of blood and the time
of the passage of each after the introduction
of the blood were recorded.
In certain instances it was desirable to
speed the rate of passage of the blood. This
was accomplished by the subcutaneous in-
jection of 5 mg. of urecholine3 every two
hours until the first blood-containing stool
was passed. On other occasions an attempt
was made to delay the transport time by
the subcutaneous or oral administration of
0.85 to 1.28 mg. of atropine sulfate4 every
three hours.
Results (Table 1).
a) Blood instilled into the upper intes-
tine: When the blood was instilled into the
duodenum, jejunum, or upper ileum of 7
patients, the color of the resulting stools
was black in 4 instances (Cases 14, 23, 24,
and 26), dark brown with a reddish tint in
1 (Case 19), and bright red in 2 (Cases 7
and 10).
TABLE 1
Description of Patients and Results — Small Intestine
Case
No.
Age /Sex
Level of
instillation
of blood
Time of passage of first blood-
containing stool after instilla-
tion of blood (hours).
Color of first
blood-containing
stool
1
66/M
Low ileum
1
Bright red
2
34/M
Duodenum
2’
Bright red
3
68/F
Terminal ileum
3
Dark red
4
60/M
Jejunum
4’
Bright red
5
68/F
Low ileum
4
Dark red
6
38/M
Terminal ileum
4
Bright red
7
48/F
Upper ileum
5
Bright red
8
65/F
Duodenum
6’
Dark red
■ 9
29/M
Upper ileum
6’
Dark red
10
52/M
Upper ileum
8
Bright red
11
39/M
Mid-ileum
9
Dark brown with
red
tint
12
20/F
Mid-ileum
12
Dark brown with
red
tint
13
70/ M
Mid-ileum
13
Dark brown with
red
tint
14
42/F
Duodenum
14
Black
15
38/M
Mid-ileum
15”
Dark brown with
red
tint
16
30/ M
Terminal ileum
15
Black
17
42/F
Low ileum
17”
Dark brown with
red
tint
18
47/F
Terminal ileum
18
Black
19
52 /M
Upper ileum
19
Dark brown with
red
tint
20
60/F
Mid-ileum
20
Dark brown with
red
tint
21
66/M
Terminal ileum
20
Dark brown with
red
tint
22
52/F
Terminal ileum
20
Dark brown with
red
tint
23
36/M
Upper ileum
21
Black
24
33/F
Upper ileum
24
Black
25
31/F
Low ileum
27
Bright red (pinkish)
26
33/F
Jejunum
29
Black
27
57/F
Mid-ileum
34”
Black
•Dark red in color.
404
The Journal of the Medical Association of Georcia
In those 4 instances in which the color
was black, the time between the instillation
of the blood and the passage of the stool
ranged from 14 to 29 hours in contrast to a
transport time of 5 and 8 hours respectively
in the 2 cases in which the stool color was
bright red.
When the transport time of the blood in-
stilled into the upper small intestinal tract
of 4 patients was purposely hastened by
urecholine, the color of the stools was bright
red in 2 instances (Cases 2 and 4) and dark
red in the remaining 2 (Cases 8 and 9).
All stools were passed in 2 and 6 hours
after the instillation of the blood.
b) Blood instilled into the mid-ileum :
When the blood was instilled into the mid-
ileum of 4 patients (Cases 11, 12, 13, and
20), the color of the stools was dark brown
with a reddish tint; these were passed in 12
to 20 hours, except in Case 11, in which the
stool was passed in 9 hours. When the trans-
port time of 2 patients (Cases 15 and 27)
was apparently prolonged by atropine, the
color of the stool passed in 15 hours was
dark brown with a reddish tint (Case 15),
whereas that passed in 34 hours was black
(Case 27).
c) Blood instilled into the lower ileum :
When blood was instilled into the lower or
terminal ileum of 10 patients, the color of
the stool was black in 2 (Cases 16 and 18),
dark brown with reddish tint in 3 (Cases 17,
21, and 22), dark red in 2 (Cases 3 and 5),
and bright red in 3 (Cases 1, 6, and 25).
The black stools were passed in 15 and 18
hours; the dark brown with reddish tint, in
17 to 20 hours; the dark red, in 3 and 4
hours; and the bright red, in 1 to 4 hours.
The stool of one patient (Case 25), passed
in 27 hours, was pink in color and consisted
of a mixture of blood and barium. Only
one patient in this group (Case 17) received
atropine.
Comment. The results clearly indicate '
that when a given amount of blood is intro-
duced into the small intestine, the color of
the faces passed thereafter would appear to
depend not on the level at which the blood
is introduced, but on tbe length of time the
blood remains within the intestinal lumen.
The longer the blood remains in the intes-
tine, the darker is its color when passed in
the stool.
In the observations made, the same
amount of blood was instilled in all in-
stances. Had larger amounts been intro-
duced, even into the upper intestinal tract
or stomach, the color of the stools passed
may well have been red instead of black as
a result of rapid transport due to hyperperi-
stalsis induced by a larger bulk. It is not an
uncommon experience that at times the
color of stools passed by patients with mas-
sive hemorrhage from a duodenal or gastric
ulcer is definitely red. This is possible, as
there is not sufficient time for alteration to
take place from red to black, either because
the blood passes through the small intestine
too quickly or because there is such a large
amount present the mechanism for altera-
tion is overwhelmed.
TABLE 2
Description of Patients and Results — Colon
28
36/M
Cecum
2
Bright red
29
56/M
’Cecum
6 (?)
Dark red
30
52/F
Cecum
11
Dark red
31
45 /F
Ascending colon
17
Dark red
32
28/M
Prox. Transv. Colon
22”
Bright red
33
42/F
Cecum
60”
Black
’ Urecholine used in an attempt to shorten the time of passage of the blood through the intestinal tract.
” Atropine used in an attempt to prolong the transport time.
October, 1950
105
A limited number of experiments were
performed upon the colon. When blood wTas
instilled into the cecum of 4 patients (Table
2), the color of the stool in two of them
(Cases 29 and 30) passed successively in 6
to 11 hours, was dark red, and that of one
(Case 28), passed in 2 hours, was bright
red. In one patient (Case 33), who received
atropine and in wffiom the transport time
was 60 hours, the color of the stool was
black. Two additional patients had blood
instilled into their colon, into the ascending
colon of one (Case 31) and into the proxi-
mal transverse colon of the other (Case 32) .
The color of the feces passed thereafter in
each was red, despite the fact that the blood
in both remained within the colon a suffi-
ciently long time for alteration to take
place. This finding suggests that the me-
chanism for changing the color of the blood
from red to black probably operates orad
to the ascending colon, most probably in
the small intestine. However, the number
of experiments performed on the colon is
too small to permit general conclusions. It
is planned to study this aspect of the prob-
lem further.
Summary
1. Observations have been made on the
color of the stools passed after a given
amount of citrated blood was instilled at
various levels of the human small intestine.
2. The results indicate that under the con-
ditions of the experiment the color of the
feces depends on the length of time the
blood remains in the small intestine rather
than on the level at which the bleeding oc-
curs. The longer this time, the more likely
is the stool to be black.
REFERENCES
1. Schiff, D. ; Stevens, R. J.; Shapiro, N., and Good-
man, S. : Am. J. Md. Sci. 203:409 (March) 1942.
2. Daniel, W. A., and Egan, S. : J.A.M.A. 113:2232
(Dec.) 1939.
3. Starr, L. , and Furguson, L. K. : Am. J. M. Sc. 200:372
1940.
4. Elsom. K. A., and Drossner, J. D. : Am. J. Digest.
Dis. 6:589 (Nov.) 1939.
GASTROINTESTINAL ALLERGY
Remissions in Chronic Eczema Following
Administration of Phthalanilic Acid.
John L. Jacobs, M.D.
Atlanta
It is well known that many cases of
chronic eczema do not give positive skin
tests when tested with the usual inhalant and
food antigens. During the past year we have
observed that many of these cases give
strongly positive skin reactions when tested
with Escherichia coli. However, such bac-
terial reactions are common also in indi-
viduals not suffering from eczema,1 being
roughly comparable in incidence to reac-
tions to Endo’s concentrated house dust
extract,2 thus making it difficult to evaluate
the relationship between the skin hypersen-
sitivity to the colon bacillus and the eczema.
In order further to study this possible
relationship, from a series of 26 successive
patients with a chief complaint of eczema,
8 were selected who showed a dominant
(large in comparison to that produced by
other sensitizing agents) skin reaction to
Escherichia coli. These patients were treat-
ed with phthalanilic acid. Phthalanilic acid
has been found to reduce the number of
intestinal coliform organisms;3 is poorly
absorbed, rapidly excreted by the kidneys
and of low toxicity.1 Three or 4 grams daily
appear to be sufficient if taken at intervals
of 8 hours,4 5 and administration of the drug
may be continued without ill effects for
considerable periods of time. This series of
8 patients, whose skin reactions to Escheri-
chia coli ranged from 10 to 28 mm. in di-
ameter, is presented in Table 1.
The patients, ranging from l^/o to 72
years of age, suffered from severe, chronic
From 490 Peachtree Street and the Medical Service ot
Grady Memorial Hospital, Atlanta.
Read before the Medical Association of Georgia in annual
session, Maccn, April 19, 1950.
406
The Journal of the Medical Association of Georgia
TABLE 1
Results of Treatment with Phthalanilic Acid in Selected Eczema Cases Hypersensitive to Escherichia coli.
3 to 4 grams of phthalanilic acid (sulphathalidine) were administered daily to each patient for the period
indicated.
Diameter
of skin DESCRIPTION OF ECZEMA
Patient
reaction
to E. coli
Age
Extent
Appearance
Medication
Results
mm.
yrs.
Face and
Weeping on
Phthalanilic acid
Completely clear
P. E.
14
72
extremities
legs, rest dry
in 6 wks.
W. E.
13
70
Extremities
and body
Dry, scabby
excoriated
patches
Phthalanilic acid;
Vit. B complex
Gradual improvment;
almost entirely
clear in 6 mos.
G. B.
28
36
Fingers of
both hands
Red, weeping,
or vesicular
Phthalanilic acid
Completely clear
in 2 wks.
K. F.
10
1%
Face, ears,
popliteal and
antecubital
spaces
Red, papular,
coalescent
Phthalanilic acid
Almost completely
clear in 3 wks.
H. W.
27
20
Arms, ears,
neck, breast,
left popliteal
space
Red, papular,
dry
Phthalanilic acid
Markedly improved
in 2 wks.
B. J.
12
23
Arms, hands,
face and neck
Annular, or
solid, dry
Phthalanilic acid
Almost completely clear
in 2 wks.
F. M.
12
58
Arms, hands,
legs, feet
Red, dry or
weeping in
solid areas
Phthalanilic acid
Bile salts
Completely clear
in 3 wks.
G. C.
15
21
Palmar surfaces
of both hands
Red, eczematous
patches
Phthalanilic acid
and minerals
Markedly improved
in 6 wks.
eczema involving large skin areas for which
the usual methods of treatment had been of
little benefit. The extremities were involved
more frequently than other parts of the
body, and the appearance of the eczema
varied greatly in each case. The substances
other than phthalanilic acid used in the
treatment of several cases (bile salts, vita-
mins, and minerals) were not effective when
given alone. Skin tests were performed by
the intracutaneous injection of a suspension
containing 5,000 million organisms per cc.
(Hollister-Stier) and the average diameter
of the reactions, observed about 24 hours
after injection, was approximately 16.3
mm. For controls an equal number of con-
secutive cases with asthma, hayfever or
vasomotor rhinitis only, chosen alphabeti-
cally from our files, were similarly tested
(Table 2) and showed much smaller reac-
TABLE 2
Hypersensitivity to Escherichia coli in controls with severe hay fever, vasomotor rhinitis or asthma, with no
history of eczema , angioneurotic edema , urticaria , gastrointestinal allergy or severe constipation .
Patient
R. L.
C. O.
C. M.
K. A.
M. L.
M. E.
M. J.
N. J
Age
44
19
21
27
19
47
15
50
Allergy
Vasomotor
rhinitis
Asthma
Asthma,
Vasomotor
rhinitis
Asthma
Asthma,
hay fever
Hay fever
Asthma,
Vasomotor
rhinitis
Asthma
Diam. of
skin re-
action to
E. coli
0
4
0
10
8
12
6
9
in mm.
October, 1950
407
tions, averaging only approximately 6.1
mm. in diameter. Patients with eczema, an-
gioneurotic edema, urticaria, or gastrointes-
tinal disturbances of probable allergic
origin were excluded from this control se-
ries. Skin reactions to Escherichia coli in
eczematous individuals were, roughly, al-
most 3 times the diameter or 9 times the
area of those in the controls, indicating that
the reactions observed are due to hyper-
sensitivity and not simple irritation.
As may be seen from Table 1 the clinical
improvement of these cases following ad-
ministration of phthalanilic acid was strik-
ing, especially in view of the intractable
nature of the conditions treated. The two
oldest patients showed the slowest improve-
ment. In 5 cases (P. E., H. W., K. F., G. B.,
and G. C.) after the skin was practically
clear, treatment with phthalanilic acid was
discontinued, whereupon the eczema re-
turned. On resuming treatment the eczema
again improved. For example patient P. E.
was first given phthalanilic acid, for exten-
sive eczema of the face and extremities on
Oct. 18, 1948. On Nov. 11 he had greatly
improved, and by Dec. 2, after about 6
weeks of treatment, was practically clear.
Phthalanilic acid was then omitted and he
did wrell for about a month, follow ing which
the eczema gradually reappeared, until on
Feb. 24, 1949, the skin of the extremities
was again red and rough, with many eczema-
tous papules, often in patches. Phthalanilic
acid therapy was then resumed and by
Mar. 31, about 6 weeks later, his skin was
again practically clear. The case of G. B.
is more striking because her responses to
therapy and relapses were more rapid. This
patient, after other unsuccessful treatments,
was given phthalanilic acid for eczema of
the fingers on Nov. 15, 1948. In less than
two weeks her skin was entirely clear, and
treatment was discontinued. Until about
April 20, 1949, she did fairly well, but
then relapsed, and returned May 24 with
severe eczema of the fingers. Phthalanilic
acid therapy was recommended and by June
7 her fingers were clear, and treatment dis-
continued. On June 13 her fingers started
breaking out again with numerous small
vesicles, and on June 16 phthalanilic acid
treatment was resumed. By June 19 her
hands were improving rapidly, and by June
23 practically clear. These observations
strongly suggest that in these cases admin-
istration of phthalanilic acid had a benefi-
cial effect on the eczema.
Eczematous individuals not hypersensi-
tive to Escherichia coli would be highly de-
sirable as controls, but are difficult to find,
as hypersensitivity to the colon bacillus is
very common. In our series of 26 cases we
had one such individual who was not im-
proved by treatment with phthalanilic acid,
indicating that, so far as our observations
go at present, administration of phthalanilic
is not useful in eczema unless hypersensi-
tivity to E. coli is present. This assumption
is reinforced by observations on the 4 pa-
tients of this series whose tests showed very
prominent or dominant allergies to foods in
addition to hypersensitivity to the colon
bacillus. Two of these patients showed no
improvement on phthalanilic acid, one
showed slight improvement, and one marked
improvement. The last two cases were given
elimination diets at the same time as phthal-
anilic acid, so that the improvement noted
was not necessarily due to the drug. In spite
of this, of the five control cases either not
hypersensitive to E. coli or with additional
strong hypersensitivities to food demonstra-
ble of skin tests only one, or 20 per cent,
showed marked improvement on adminis-
tration of phthalanilic acid, as compared
with 100 per cent of our series of 8 cases in
which hypersensitivity to the colon bacillus
was dominant. This suggests that phthalan-
ilic acid was helpful only in cases hyper-
408
The Journal of the Medical Association of Georgia
sensitive to the colon bacillus, and that the
mechanism of action may have been reduc-
tion in the number of coliform organisms
in the intestinal tract. Further controls of
this type are under study.
Of the above series of 26 cases 10, or
38 per cent, gave a history of severe chronic
constipation. Of the 8 patients shown in
Table 1 with a dominant hypersensitivity
to E. coli 5, or 62 per cent, had severe con-
stipation, whereas of the remaining 18
eczema cases only 3, or 16 per cent, fell
into this group. This suggests a possible
association between hypersensitivity to the
colon bacillus and constipation, which
would not be unexpected inasmuch as al-
lergy of the colon might well increase spas-
ticity of that organ. Of these 10 cases, 6
reported more regular bowel movements
following administration of phthalanilic
acid or related compounds; in the other 4
cases the results were not noted. Interpre-
tation of such improvement is difficult as
phthalanilic acid has a laxative effect on
some individuals. Further study of this
subject is being carried out.
Of the above 26 eczema cases 7, or ap-
proximately 27 per cent, also gave a history
of urticaraia. Of the 8 individuals with a
dominant hypersensitivity to E. coli 3, or
37 per cent, had had urticaria; of the re-
maining 19 patients 4, or 21 per cent, fell
into this group. There appeared, therefore,
some tendency for urticaria to be associated
with hypersensitivity to the colon bacillus.
In these patients the association of urticaria
and constipation was very striking. Five
of the 7 patients with a history of urticaria,
or 71 per cent, were also in the group of 10
individuals with severe constipation; one
gave a history of occasional constipation
and one had normal bowel habits. This
would seem to be additional evidence of a
possible relationship between urticaria and
hypersensitivity to E. coli, since in this
series severe constipation occurred much
more frequently in individuals with a domi-
nant hypersensitivity to E. coli.
Summary
The above findings suggest that a close
relationship exists between administration
of phthalanilic acid and improvement of
eczema in a certain group of individuals
characterized by a dominant hypersensi-
tivity to Escherichia coli. The incidence of
such cases (8 of 26 consecutive cases of
eczema, or approximately 30 per cent) is
high in this small series which, if confirmed,
would indicate that hypersensitivity to the
colon bacillus may be an important factor
in allerg ic eczema. This might explain why
many cases of chronic eczema do not give
positive skin tests when tested with the
usual inhalants and food antigens. These
individuals also appear to have a high in-
cidence of chronic constipation, with which
urticaria is often associated.
REFERENCES
1. Swineford, O., Jr., and Holman, J.: J. Allergy, 20:292,
1949.
2. Faulkner, D. T., and Jacobs, J. L. : Unpublished
Observations.
3. Miller, A. Katherine: J. Nutrition, 29:143, 1945.
4. Mattis, P. A.: Benson, W. M., and Koelle, E. S. :
J. Pharmacol. & Exper. Therap. 81:116, 1944.
5. Bargen, J. A.: M. Clin. North America 30:919, 1946.
CARBOHYDRATE STUDIES IN PA-
TIENTS WITH ADDISON’S DISEASE
TREATED WITH TESTOSTERONE
PROPIONATE AND CORTISONE*
Harley E. Cluxton, Jr., M.D.
Savannah
Introduction: The normal adrenal cortex
produces several different steroid hormones,
some of which, like desoxycorticosterone,
act to maintain a normal salt and water
balance; others, like corticosterone and al-
lied substances, compounds A and E (corti-
•This is a part of the metabolic study of the effects
of testoseterone propionate in Addison’s disease which was
done at the Mayo Clinic in 1948 as partial fulfillment of
the requirements for the degree of Master of Science in
Medicine given by the University of Minnesota.
Dr. Cluxton, Director of Medical Research, Armour Labora-
tories, Chicago, 111., as of October, 1950.
Read before the Medical Association of Georgia in annua]
session, Macon, April 19, 1950.
October, 1950
409
sone), have effects on carbohydrate metab-
olism, and a third group which has andro-
genic effects. The treatment of Addison’s
disease with desoxycorticosterone acetate,
since it is concerned only with the metabol-
ism of salt and water, leaves much to be
desired in the correction of the abnormal
metabolism in this disorder. A number of
the steroids of the adrenal cortex resemble
testosterone in many respects both chemical-
ly and physiologically. When testosterone
propionate is given intramuscularly to the
human there occurs regularly a depression
in the urinary excretion of nitrogen, inor-
ganic phosphoius, sulfate, sodium, potas-
sium and chloride and a gain in body
weight due to retention of water and salt
in association with increased protein anabol-
ism. The effect of testostei'one propionate
on carbohydrate metabolism in adi'enal cor-
tical insufficiency merits further investiga-
tion. A detailed metabolic study of 3 pa-
tients with Addison’s disease was carried
out. Howevei-, in this report only the per-
tinent data on the carbohydrate effects of
testosterone propionate and cortisone are
included.
The patients : The 3 patients selected for
this study were classical examples of Addi-
son’s disease. Each had had his or her dis-
order for a considerable period of time and
had been studied on several occasions be-
fore the study was undertaken. All had
adequate renal function as manifested by
noxmal blood urea levels. Studies of liver
function which included the van den Bergh
reaction, bromsulfalein dye retention, thy-
mol turbidity, cephalin-cholesterol floccula-
tion, as well as serum protein and albumin-
globulin ratios were all normal.
The first patient (Subject P) was an 18
year old female who had had Addison’s
disease since July, 1947. At this time she
was in a mild crisis of adrenal cortical in-
410
The Journal of the Medical Association of Georcia
sufficiency. Her history, physical findings
and laboratory data were classical. The
basis for her disease was presumed to he
adrenal cortical atrophy. Her symptoms
eventually were controlled with 2 mg. of
desoxycorticosterone acetate and 5 gm. of
salt per day. She had continued in good
health.
of 3 mg. daily and has remained in good
health.
The third patient (Subject M) was a 26
year old male with Addison’s disease since
the summer of 1946. The diagnosis was
made in February, 1947. His history and
physical findings were typical of Addison’s
disease. The laboratory data supported the
The second patient (Subject U) was a
woman, aged 41 years, who had Addison’s
disease of nine years’ duration, presumably
due to bilateral adrenal cortical tubercu-
losis. The right kidney was removed in
1935 because of renal tuberculosis. The
onset of her Addison’s disease was insidious
until 1939, at which time she presented the
characteristic clinical picture. Subsequent
laboratory studies had been compatible with
the diagnosis of adrenal cortical insufficien-
cy. She had been treated for the most part
with desoxycorticosterone acetate in a dose
clinical impression. The cause of his disease
was unknown but was presumed to be adre-
nal cortical tuberculosis, since x-ray studies
of the chest revealed old fibrous tubercu-
losis at the left apex. The adrenal areas
showed no calcification. One skin test for
tuberculosis was interpreted as being posi-
tive. He was regulated on 2 mg. desoxy-
corticosterone acetate intramuscularly and
7 gm. of additional salt.
Methods of Study. General. — The pa-
tients lived continuously in a special meta-
bolic unit of the hospital during the entire
October, 1950
41.1
study. The metabolic unit is designed for
the careful measurement of intake and out-
put. The patients were up and about the
unit daily except during the performance
of glucose and insulin tolerance tests at
which time they were confined to bed. Their
activity was fairly uniform from day to
day. The study period for each patient was
of six days duration.
Treatment. — The patients were given
intramuscular injections of desoxycorticos-
terone acetate in sesame oil daily; the
amount given to any one patient was the
same throughout the study. Subject P re-
ceived 2 mg. daily, Subject U, 3 mg. daily,
and Subject M, 2 mg. daily.
To these basal treatments were added,
during separate periods of study, either tes-
tosterone propionate or cortisone. Subject
P received testosterone propionate, 25 mg.
intramuscularly daily for twenty-two days
(3 six day periods plus the four days dur-
ing carbohydrate studies), a total of 550
mg. Subject U received 37.5 mg. of testos-
terone propionate daily for sixteen days (2
six day periods plus four days during car-
bohydrate studies), a total of 590 mg. Sub-
ject M received 50 mg. testosterone pro-
pionate daily for fifteen days (2 six day
periods plus the three days during carbo-
hydrate studies), a total of 750 mg.
Subject P was given daily intramuscular
injections of 50 mg. cortisone for twenty-two
days (3 six day periods plus four days dur-
ing carbohydrate studies), a total of 1100
mg. Subject U was given intramuscular in-
jections of 50 mg. cortisone twice daily for
sixteen days (2 six day periods plus four
days during carbohydrate studies), a total
of 1600 mg. Subject M was not given corti-
sone.
Diets. — Each patient was permitted to
select his diet within the limits necessary
for an accurate metabolic study. Three
412
The Journal of the Medical Association of Georgia
menus were given twice within each six-day
period. In order to avoid fluctuations in the
content of the diets, the meat used for each
study was purchased at one time from the
same animal and was immediately cut into
weighed servings, wrapped and frozen; the
canned vegetables and other commodities
were bought in quantity for the entire study
from the same stock source. Each portion
of food in the diet was weighed on a torsion
balance.
Studies of carbohydrate metabolism.—
Determinations of the fasting blood sugar
were made on the first and fourth day of
each period. Carbohydrate studies which
consisted of an intravenous glucose toler-
ance test on one day, insulin and epine-
phrine tolerance tests the next day, a day
of rest (except in the study of Subject M),
and then fasting for twenty-four hours, were
done at the end of the last control period
just prior to beginning the periods during
which testosterone or cortisone were given.
Immediately following the last period of
either testosterone propionate or cortisone
therapy the carbohydrate studies were re-
peated. They were also done at intervals
following the discontinuation of the above
therapy until the results coincided with
those prior to therapy.
Glucose tolerance tests were performed
by administering 0.5 gm. of glucose per kg.
of ideal body weight in a 20 per cent solu-
tion intravenously during a period of thirty
minutes. Insulin tolerance tests were per-
formed by administering 0.05 units of in-
sulin per kg. of ideal body weight intraven-
ously, a solution of insulin containing 5
units per cc. being employed. The epine-
phrine tolerance test consisted of injecting
subcutaneously 0.5 cc. of a 1:1000 solution
of epinephrine immediately following the
insulin tolerance test. The twenty-four hour
fasting period was considered as beginning
in the morning which was fourteen hours
after the last meal. Blood sugar determina-
tions were made at six hour intervals during
the twenty-four hour fasting periods.
TABLE 1
Fasting levels of blood sugar on Subject P treated
with desoxycorticosterone acetate and
testosterone propionate
Period
1
Daily
DOGA
Treatment
Sugar
83
2
DOCA
(77-86)
79
3
DOCA
+ 25 mg. testos-
(77-82)
76
4
terone
DOCA
propionate
+ 25 mg. testos-'
(72-78)
72
5
terone
DOCA
propionate
+ 25 mg. testos-
(72-73)
73
6
terone
DOCA
propionate
(72-75)
70
7
DOCA
(65-72)
75
8
DOCA
■
(72-78)
73
9
DOCA
(72-82)
75
10
DOCA
(72-82)
74
11
DOCA
TABLE 2
(72-82)
77
(72-80)
Fasting levels of blood sugar of Subject U treated
with desoxycorticosterone acetate
and testosterone propionate
Period
Daily Treatment
Sugar
1
DOCA
75
(72-78)
2
DOCA
75
(72-78)
3
DOCA
+ 37.5 mg. testos-
73
terone
propionate
(65-82)
4
DOCA
+ 37.5 mg. testos-
78
terone
propionate
(75-82)
5
DOCA
81
(75-88)
6
DOCA
86
(85-88)
7
DOCA
84
(82-85)
8
DOCA
TABLE 3
81
(74-86)
Fasting levels of blood sugar of Subject M treated
with desoxycorticosterone acetate and
testosterone propionate
Period
Daily Treatment
Sugar
1
DOCA
82
(72-91)
2
DOCA
86
(84-91)
3
DOCA + 50 mg. testos-
80
terone propionate
(75-91)
4
DOCA + 50 mg. testos-
81
terone propionate
(75-91)
5
DOCA
86
6
DOCA
87
(86-88)
7
DOCA
85
(83-88)
October, 1950
413
TABLE 4
Fasting levels of blood sugar of two patients with
Addison’s disease treated with desoxycorticosterone
acetate and cortisone
Subject U
Fasting Blood Sugar
Period
Treatment
mg. per 100 cc.
1
DOCA
85.5
(80-91)
2
DOCA
85.5
(84-87)
3
DOCA
84.5
(84-85)
4
DOCA +
cortisone
89.5
(85-92.5)
5
DOCA +
cortisone
97.3
(91-101)
6
DOCA
89.7
(82-96)
7
DOCA
95.7
(94-97.5)
8
DOCA
84.7
(82-87.5)
9
DOCA
76
(76-80)
10
DOCA
Subject P
79
(73-85)
1
DOCA
74
(72-76)
2
DOCA
74.5
(72-77)
3
DOCA -f
cortisone
78.3
(72-83)
4
DOCA +
cortisone
84.5
(82-85)
5
DOCA +
cortisone
84.3
(83.5-85)
6
DOCA
67
(65-69)
7
DOCA
74.5
(71.5-77.5)
Results : Changes in the level of the fast-
ing blood sugar during testosterone pro-
pionate therapy were of small magnitude
and probably not significant. The increase
in the level of the fasting blood sugar dur-
ing cortisone therapy suggests a definite
change (tables 1, 2, 3 and 4).
Except for an exaggerated initial rise in
the blood sugar level during therapy with
cortisone there was little or no alteration in
the blood sugar curves during the glucose
tolerance tests, as compared with the con-
trols, when the patients were receiving either
testosterone or cortisone (figs. 1, 2, and
3).
Insulin tolerance tests revealed no change
in the degree of depression of the level when
the patients were being treated with testos-
terone propionate as compared to those
when they were receiving the basal treat-
ment of desoxycorticosterone acetate alone.
When Subjects P and U were receiving cor-
tisone, however, the insulin tolerance tests
showed a smaller depression of the blood
sugar level and a higher blood sugar level
at the conclusion of the test (fig. 4).
The epinephrine tolerance tests show in-
creased rises in the level of the blood sugar
when the patients were receiving either tes-
tosterone propionate or cortisone as com-
pared to the levels obtained when they were
receiving desoxycorticosterone acetate only.
There was a somewhat quicker rise in the
blood sugar level when Subject P was re-
ceiving cortisone as compared to that when
she received testosterone propionate ther-
apy, but there is no significant difference of
the two blood sugar levels at the conclusion
of the test (fig. 4).
During the course of a twenty-four hour
fast there was no appreciable difference in
TU
The Journal of the Medical Association of Georgia
the behavior of the blood sugar when the
patients received testosterone propionate as
compared to its behavior when they received
desoxycorticosterone acetate alone. How-
ever, when they received cortisone in addi-
tion to desoxycorticosterone acetate there
was much less fall in the blood sugar during
fasting, (fig. 5)
sulin tolerance tests, the patients remained
virtually free of symptoms. Although the
blood sugar levels were approximately the
same in all of these tests when testosterone
propionate was administered as they were
when the basal treatment alone was em-
ployed, the only clinical objective finding
noticed in association with hypoglycemia
During basal treatment with desoxycorti-
costerone acetate the subjective symptoms
and clinical objective signs of hypoglycemia
occurring in the course of the glucose toler-
ance and insulin tolerance tests and the
twenty-four hour fasts were moderate to
severe. On the contrary, even at comparable
blood sugar levels, symptoms and signs of
hypoglycemia were minimal to absent when
the patients were receiving testosterone pro-
pionate or cortisone. In the case of corti-
sone, hypoglycemia of significant degree
was not observed during fasting, and when
it did occur in the course of glucose or in-
during the therapy with testosterone was
slight sweating. Subject P had very severe
hypoglycemic symptoms and signs during
the various carbohydate tests when she re-
ceived only desoxycorticosterone acetate.
Her worst symptoms and signs occurred to-
ward the end of a twenty-four hour fast on
two occasions, when she became uncon-
scious and incontinent of urine and feces.
However, when she was receiving testos-
terone propionate she was alert, cheerful
and had no definite clinical signs of hypo-
glycemia during any of the above carbohy-
drate studies.
October, 1950
415
Discussion: In many patients with Addi-
son’s disease there is a tendency to hypogly-
cemia, particularly during fasting. Carbo-
hydrate oxidation is thought to be normal
or increased, but the ability to form glucose
and glycogen from intermediate products
of carbohydrate and protein metabolism is
impaired. Under some conditions, includ-
ing fasting, the glycogen depots in the body
may soon be exhausted. It is not always
possible to ingest enough preformed carbo-
hydrate to maintain the blood glucose level
to preserve adequate stores of glycogen in
the liver and muscles at all times. Thorn
and his associates1 have shown that hor-
mones of the adrenal cortex — desoxycorti-
costerone acetate, adrenal cortical extract,
corticosterone, and compound E (cortisone)
— in the order named — increase the ability
of the body to form glucose and glycogen
from the intermediate products of both car-
bohydrate and protein metabolism but the
influence of the above substances on electro-
lyte metabolism decreases in the order listed
above.
Long and his co-wTorkers2 showed that
corticosterone and its derivatives increased
the level of glucose in the blood of both
normal and adrenalectomized rats and mice
maintained in good health on a high daily
intake of sodium chloride. In addition, the
total store of carbohydrate in the body was
increased when the hormones wTere admin-
istered. It was suggested by Long that, since
there wras an increase in the excretion of
nitrogen, and in the absence of experimental
evidence for the transformation of fat to
carbohydrate, the most probable source of
the additional carbohydrate seemed to be
protein. In other wrords, the increase in the
excretion of nitrogen indicated the utiliza-
tion of an amount of protein which would
account for the newly formed carbohydrate.
Even during a fast, the conversion of pro-
tein to glucose proceeds at a rate sufficient
to sustain the concentration of glucose above
the level at which symptoms of hypogly-
cemia appear. On the contrary, during the
use of sodium chloride alone as treatment of
the adrenalectomixed animal the rate of
utilization of endogenous protein cannot be
increased to the point at which a normal
blood sugar level is maintained and glyco-
gen is deposited in the liver. Wells and
Kendall3 have shown that even the stimulus
to protein catabolism which is associated
with phlorhizination does not result in a
high excretion of glucose by the adrenalec-
tomized rat when maintained on sodium
chloride alone. The administration of cor-
ticosterone and related hormones increased
the glucosuria to that observed in the “nor-
mal” phlorhizinized rat. The source of the
glucose in this case was apparently protein
since the D:N ratio was 3.7:1.
The results of carbohydrate studies on
Subjects P and U following administration
of cortisone coincide with the experimental
and clinical observations above (table 4).
There was an increase in the fasting blood
sugar levels, a failure of the blood sugar
levels to drop to hypoglycemic levels during
a twenty-four hour fast, no appreciable
change in the glucose tolerance test, a small-
er depression of the blood sugar level and a
higher blood sugar level at the end of the
insulin tolerance test, and, finally, an in-
crease in liver glycogen as suggested by the
results of the epinephrine tolerance test.
The experimental and clinical observa-
tions of carbohydrate metabolism in adrenal
cortical insufficiency treated with testoste-
rone are few. Lollowing testosterone pro-
pionate therapy in normal rabbits, Lewis
and McCullagh4 observed no modification in
the glucose tolerance curves but there wTas
an increase in liver glycogen. Reports of
studies of carbohydrate metabolism in Ad-
dison’s disease treated with testosterone are
incomplete. However, the impression is ob-
416
The Journal of the Medical Association of Georgia
tained that hypoglycemia is corrected when
patients with Addison’s disease are treated
with testosterone. Talbot' reported that tes-
tosterone therapy in an 8 year old girl with
Addison's disease prevented a fall in the
blood sugar levels during fasting, even
though the patient was known to be subject
to attacks of hypoglycemia prior to testos-
terone therapy.
The carbohydrate studies in the 3 pa-
tients, Subjects P, U and M, during testos-
terone propionate therapy suggested an in-
crease in the liver glycogen as manifested
by the results of the epinephrine tolerance
test, no increase in the fasting blood sugar
levels, no appreciable change in the blood
sugar levels in the glucose tolerance tests,
the insulin tolerance tests or the twenty-four
hour fasts as compared with the same studies
performed when the patients were on basal
treatment with desoxycorticosterone acetate.
Except for the glucose tolerance tests and
the epinephrine tolerance tests, the blood
sugar levels occurring in the carbohydrate
studies during testosterone propionate ther-
apy were significantly lower than those ob-
tained during cortisone therapy. Although
this rather marked difference existed be-
tween the blood sugar levels following the
administration of cortisone and testosterone
propionate one clinical observation became
prominent: the patients tolerated hypogly-
cemia almost as well during testosterone
propionate therapy as they did during ther-
apy with cortisone. The only symptom or
sign of hypoglycemia noticed during thera-
py with testosterone or cortisone was mild
sweating. That this toleration of hypogly-
cemia was not fortuitous but related to the
therapy with testosterone propionate or cor-
tisone is borne out by the time relationships
between treatment and a return to the pre-
treatment tolerance for hypoglycemia. This
increased tolerance of the patients for hy-
poglycemia and the simultaneous increased
stores of liver glycogen as suggested by the
results of the epinephrine tolerance test
following testosterone propionate therapy
might be explained by the more ready avail-
ability of protein which could serve as a
precursor of glucose.
Conclusions: 1. The effects of testoste-
rone propionate on carbohydrate metabol-
ism as measured by means of determina-
tions of the fasting blood sugar, glucose,
and insulin tolerance tests, and the behavior
of the blood sugar during prolonged fasting
suggest an improvement in carbohydrate
metabolism since clinically the patients tol-
erated so well the low hypoglycemic blood
levels occurring in the above tests. The in-
creased liver glycogen as measured by the
epinephrine tolerance test points to the pos-
sible gluconeogenic action of testosterone
propionate.
2. The administration of cortisone in
doses of 50 to 100 mg. daily to the 2 female
patients had definite effect on carbohydrate
metabolism, as indicated by a diminished
hypoglycemic response to insulin, an in-
crease in liver glycogen as measured by the
epinephrine tolerance test, and a better
maintenance of the blood sugar level during
prolonged fasting.
REFERENCES
1. Thorn, G. W. ; Koepf, G. F. ; Lewis, R. A., and Olsen,
Elizabeth F. : Carbohydrate Metabolism in Addison’s Disease,
J. Clin. Investigation 19:813-832, 1940.
2. Long, C. N. H. ; Katzin, B., and Fry, Edith: The
Adrenal Cortex and Carbohydrate Metabolism, Endocrin-
ology 26:309-344, 1940.
3. Wells, B. B., and Kendall, E. C. : The Influence of
the Adrenal Cortex in Phlorhizin Diabetes, Proc. Staff
Meet., Mayo Clin. 15:565-573, 1940.
4. Lewis, Lena A., and McCullagh, E. P. : Carbohydrate
Metabolism of Animals Treated with Methyl Testosterone
and Testosterone Propionate, J. Clin. Endocrinol. 2:502-506,
1942.
5. Talbot, N. B.; Butler, A. M., and MacLachlan, E. A.:
The Effect of Testosterone and Allied Compounds on the
Mineral, Nitrogen and Carbohydrate Metabolism of a Girl
with Addison’s Disease, J. Clin. Investigation 22:583-593,
1943.
DISCUSSION OF PAPERS BY DRS. ATWATER,
HOCK. MULLINS, RICHARDSON, TURNER,
STEWART. JACOBS, HILSMAN
AND CLUXTON
Note: The papers referred to in the following dis-
cussions were published in two numbers of The
Journal, namely, September and October, 1950. — Ed.
October, 1950
417
DR. McCLAREN JOHNSON (Atlanta) : Mr. Presi-
dent, Ladies and Gentlemen: People seem to be
either violently opposed to gastroscopy or violently in
favor of it. I am neither, but my attitude has been
conservative and still is.
Some years ago I was even prejudiced against it.
Dr. Atwater’s technic is so smooth that after watching
him I have entirely lost that prejudice. I think gastro-
scopy should be used whenever it will help settle a
difficult decision, but not by any means as a routine
procedure.
With the help of Dr. Atwater and his gastroscope
I was able to avoid resorting to surgery in a 70-year-
old dentist, who now heartily approves of gastroscopy.
Very recently Dr. Atwater gave me needed reassurance
in a case of unexplained hematemesis. I intend to call
on Dr. Atwater for help whenever I need it, and J
believe I will do so with increasing frequency.
I am afraid I disagree with him a little on his
attitude about gastric ulcers. Certainly some of them
are benign, but I feel that we must consider each
gastric ulcer malignant until we can prove beyond
reasonable doubt that it is not a cancer. I call for
surigcal consultation as soon as I find a gastric lesion
of any type. I would far rather make a tentative
diagnosis of cancer, and change it later than to do
the reverse. As long as we maintain that state of
mind I believe we will make fewer tragic mistakes.
I should like to mention Dr. Richardson’s paper next.
There is a word of caution to be said about the
gastric analysis in differential diagnosis of benign
and malignant gastric ulcers. It is true that the
finding of achlorhydria is in favor of malignancy.
Unfortunately, it is not true that the presence of
hydrochloric acid indicates a benign lesion. The
largest gastric cancer that I have had resected success-
fully had a low normal hydrochloric acid reading and
a normal blood count.
As Dr. Richardson has pointed out, there are some
cases which have to have a simple gastroenterostomy,
but I have had so many unpleasant experiences with
this that I agree with him it should be reserved for
those cases only.
In either gastric or duodenal ulcer I personally
favor a partial gastric resection with an anastomosis
of the Hofmeister type.
Dr. Hock said we must be pancreas-conscious, and I
think that bears repeating. I think it also should be
stressed that if serum amylase and lipase tests are
done they should be done early, since subsequent
serial tests may show a trend which may have some
diagnostic value. Perhaps he will touch upon that
in closing, if he has time.
I feel particularly interested in Dr. Mullins’ paper
on adenocarcinoma of the colon and rectum because
so many of these patients can be saved. We should
take advantage of that fact by using the sigmoidoscope
and barium enema far more frequently. The tumors
which the barium enema misses should be seen by the
sigmoidoscope. The prognosis is good in these cases,
and the reward for diligence is great.
Dr. Jacobs’ paper is difficult to assimilate in one
sitting. I wish we could read some of it a second or
third time. I do want to make a plea, as one who
does not treat allergy, for a wider recognition of
allergy as a possible answer to some of our unanswered
problems.
The study reported by Dr. Hilsman is extremely
valuable. Too many of us have felt that bright red
blood must come from the most distal parts of the
colon. Actually, blood from any part of the digestive
tract can be red, as Dr. Hilsman has shown. Certainly
hlood in any amount or of any color demands an
immediate and thorough study of the entire digestive
tract by every means at our command.
In many cases I have seen harium in the rectum
within three hours after the barium was swallowed.
Such a patient would obviously pass red blood regard-
less of the level of the bleeding.
I was very much impressed by Dr. Stewart’s paper
on closed peritoneal drainage. As a medical man I
would not be impertinent enough to comment on it
except to say that I hope he is right, because it
appeals to me and it seems to me to be nearer nature’s
way.
The Drs. Turner spoke of intussusception, which
deals mostly with infants, so I shall not touch on
it because most of the “infants” I see are twenty-
one years of age or over.
Dr. Cluxton’s paper I am afraid is beyond my
scope and I will be wise and forego discussion of it.
Thank you.
DR. GRADY COKER (Canton) : Members of the
Medical Association of Georgia, I see no reason why
gastroscopy, as presented by Dr. Atwater, should not
be as valuable in diagnosis of gastric lesions as cysto-
scopy is in the diagnosis of bladder lesions, although
there is a great difference in the points of entrance
and the points of observation.
With reference to adenocarcinoma of the colon and
rectum, we men doing cancer work had a lot of experi-
ence in regard to this condition. What a pity it is
that the patients with lesions of the gastrointestinal
tract should not be as ready to tell us their subjective
symptoms as they are to tell us their objective symp-
toms in regard to skin lesions, cancers of the breast,
glands of the neck, and such things. I think probably
in regard to the treatment of cancer as a whole we
have made a lot of progress in those patients who are
observed from objective symptoms, but in regard to
the subjective cases it is a pity that so many of them
come to us with adenocarcinomas of the colon that
are past the stage when we can do anything about it
except to do conservative treatment.
I don’t think any man doing surgery of the colon in
connection with cancer can have any set rule. You
must use good common horse sense and do what you
think best, and keep the patient living as long as
possible, and as comfortable as possible.
Offhand, I recall a case that we had five or six
years ago, what we thought was an adenocarcinoma
of the lower ileum and cecum. It had a resection and
turned out to be regional ileitis, and the patient is
living today and is doing very well.
An elderly lady came to the Cancer Clinic four years
ago with an adenocarcinoma of the cecum. She was
76 years of age. We did not attempt to operate, but
in the meantime we gave her fraction x-ray treatments
every month or two. She is living today and is very
happy, and cannot palpate the mass in the area of
her cecum.
I have another man who has been living into his
third year, who had an obstruction near the cecum.
He refused resection. We did a side-to-side anasto-
mosis between the ileum and ascending colon, and he
is living today and doing fairly well.
We have two cases of transverse colon. On one we
did a two-step Milkulicz operation. Our most successful
cases are the multiple-step operations in these old
people. This woman lived for eight years and died
of pneumonia. We have one patient living after five
years, well and happy. Another patient has been
living two years with an adenocarcinoma of the ascend-
ing colon. She had a two-step Mikulicz operation, and
two months ago she came in and had a complete
hysterectomy. I don’t know what her future will be.
We have a patient in the hospital now who came
in with cancer of the sigmoid colon, who had a
first-step Mikulicz following an adenocarcinoma of the
breast six years ago. We have several cases of adeno-
carcinoma of the rectum. Unfortunately practically all
418
The Journal of the Medical Association of Georcia
of them, when we get them, are inoperable — I don’t
know why. They come into the Cancer Clinic, most
of them completely obstructed most of them with
multiple metastases. Some of them live a few months.
We have two or three of them who have been living
for more than a year with enterocolostomy.
I congraulate Dr. Mullins on this paper. It is
something that we as doctors should pay a little more
particular attention to — the subjective symptoms of
our patients who come in with a diagnosis, instead
of the objective symptoms.
In regard to the choice of operation in gastric and
duodenal ulcer, so ably presented by Dr. Richardson,
I have experienced in these cases most of our duodenal
ulcers, which we see a world of. We do just a simple
closure. Later, if they get an obstruction, with a low
acidity, usually we do a posterior gastrojejunostomy
unless they have had a lot of hemorrhage. We have
had one of those patients who had a resection and
who is now living with a recurrent marginal ulcer.
We had another one who had a resection; she is now
dead and gone. We had two others who had resections
and who have been living for over a year and doing
fairly well.
1 think probably here again, after you have exerted
all the radical surgery you can do, the vagotomy is
the last resource in relieving a lot of these patients.
In regard to intussusception, discussed by Drs. John
and August Turner, our experience in those cases
has been mostly in children. They have done satis-
factorily. Those we got late did not do all right.
Concerning peritoneal drainage, discussed by Dr.
Stewart, years ago we figured out all kinds of drainage
in regard to the perforated appendix an'd abdominal
abscesses. Before the time of sulfa drugs, penicillin
and other things, we used to lose a lot of cases of
ruptured appendix, as did all of you. Since the dis-
covery of those drugs we have lost only one perforated
appendix, and that case was inoperable before it came
to the hospital.
We very seldom drain, and when we do drain all
we use is a soft Mikulicz drain down into the peritonea]
cavity. Most of our cases now are closed primarily.
Sometimes, in perforated gastric ulcers, we stick
the Milkulicz drain up under the diaphragm. I don’t
know why but it is one of those curious things that
surgeons develop a habit of doing every now and then.
I would say it is a surgeon's idiosyncrasy. That is
the best way I can explain it.
I don t think we have to worry so much about peri-
toneal drainage of the abdominal cavity, with all the
new drugs we have discovered in the last few years.
In regard to the studies on gastrointestinal allergy,
by Dr. Jacobs, feces following the instillation of citrated
blood at various levels, by Dr. Hilsman, and testosterone
propionate and cortisone, by Dr. Cluxton, these papers
were ably presented. I enjoyed hearing them. I have
had no experience with them. I congrtulate the essay-
ists on their papers, and I shall not attempt to discuss
them. Thank you.
DR. MAX MASS (Macon) : Mr. Chairman and
gentlemen: It has been an instructive and gratifying
experience to work with Dr. Richardson in the roentgen-
ologic evaluation of his cases of peptic ulcer.
I must admit that I approached the problem with
a great deal of misgiving because of the unfavorable
reports by radiologists and gastroenterologists early
in 1945. I have learned since that much of the un-
favorable side effects, such as high-grade retention,
persistent ulcer pain, diarrhea, flatulence and inability
to gain weight, were largely the result of either improper
selection of cases, the employment of vagotomy alone
in patients with duodenal ulcers and high acid values,
or a failure to appreciate the physiological mechanism.
^ ith the performance of complete vagotomy, com-
bined with gastroenterostomy, and improvement of
surgical technic, I believe 1 am beginning to see for
the first time a clearly defined improvement of post-
operative results.
First of all, I have experienced the relief of aw-aiting
with apprehension the immediate postoperative develop-
ment, such as persistent pain, delayed emptying with
clinical signs of obstruction, generally followed by a
long period of convalescence, with frequent radiographic
follow-up studies.
It has been my experience that, once complete
vagotomy has been done in conjunction with gastro-
enterostomy, a single radiographic study, after a rela-
tively short hospital stay, is all that is necessary. 1
seldom see the patients after this single study.
The radiologist is sometimes impressed with startling
and often paradoxical roentgen findings. The patient
may say he feels fine, eats everything, has no distress,
sleeps well, has gained weight; and yet, as in Case
No. 2 presented by Dr. Richardson, after six hours
a 75 per cent gastric retention is noted. After 24
hours it was estimated a 50 per cent retention was
still present, and a small amount of barium was still
present in the stomach after 48 hours. Uniformly the
ulcer pain has dramatically disappeared.
This was evident particularly in Cases Nos. 3 and 4.
In one instance the pain persisted because of incom-
plete vagotomy, and was almost completely abolished
when all the fibers were sectioned, whereas in the
other case, which had a long, grievous history of
intractable pain as a result of a marginal ulcer, the
patient is now almost completely relieved and the
ulcer healed.
I would like to emphasize one point in particular,
mentioned by Dr. Richardson: When gastroenterostomy
is combined with vagotomy in duodenal ulcer, some of
the persistent mild symptoms for some months after
operation may be explained on the basis of the un-
resected peptic ulcer which is slowly undergoing
healing.
I wish to congratulate Dr. Richardson on his devoted
application to this problem. It is my feeling that we
have entered upon a new era in the surgical manage-
ment of duodenal peptic ulceration. Thank you.
DR. THOMAS HARROLD (Macon) ; Gentlemen of
the Association, I would like to emphasize two points.
First, in discussing the paper on carcinoma of
the rectum and sigmoid, 1 would like to bring out
that in my experience this is the most hopeful of all
the major carcinomas. We get far better results in
carcinoma of the rectum and sigmoid than in carcinoma
of the stomach. We get much better results than we
do in carcinoma of the cervix, and perhaps compar-
able results in carcinoma of the fundus of the uterus.
We get better results with carcinoma of the rectum
and sigmoid than we do with carcinoma of the
breast.
I should like to emphasize also that many of these
cases, which at first seem inoperable, actually are
operable, and you will get surprising results in some
of the bad cases, because not all of the induration
that you feel at operation is malignant disease. There
is always a lot of inflammatory reaction around it. On
several occasions I have gone ahead and resected what
seemed to be a very bad growth, with hope of only a
palliative result, only to have the patient do surprisingly
well and live for a number of years.
I think the reason for the good results in carcinoma
of the rectum and sigmoid is because of the location
of these growths. That is one place where you can really
get outside of a growth and scoop out the pelvis and
do a good job. There are few other places in the
body that permit as complete a radical operation as
we can do in this region.
Therefore, I for one deplore the present tendency
to be so-called conservative in operating on these
October, 1950
419
lesions and attempting to do less than a complete
abdominoperineal resection. After all, even in the
hands of those who recommend them, only around 15
per cent of the cases of carcinoma of the rectum and
sigmoid are in the debatable group where there is a
question of attempting to do a low resection and
restore the continuity of the canal.
1 believe that every time you try to restore the
continuity of the canal you decrease the radical nature
of the operation and you are inviting recurrences.
Also, the operative mortality in almost all reported
series is higher in the cases in which an attempt is
made to restore the continuity of the canal. Colostomy
is not a bad thing if it is properly handled.
One point that I would like to make in regard to
Dr. Stewart’s paper, on drainage of the abdomen, is
to emphasize the point he brought out, that most of
the deaths and severe complications following periton-
itis are due either to a mechanical obstruction or,
more often, to a paralytic ileus. In my experience most
of the cases of paralytic ileus are either caused or
aggravated by a severe infection of the abdominal wall,
which is often overlooked.
I have seen many patients flatten out and improve
miraculously after removing the sutures in the skin
and permitting drainage of hidden or suspected pus
in the abdominal wall.
I would like to emphasize the value of placing a
drain down to the peritoneum to avoid the infection
of the abdominal wall that comes in these contaminated
cases. That is where you get your toxemia, and fre-
quently, at least, a contributing factor to the paralytic
ileus so commonly accompanying these cases.
I have enjoyed this surgical symposium very much
this afternoon. Thank you.
DR. M. FERNAN-NUNEZ (Dublin) : In my experi-
ence over many years as a pathologist I have been
constantly amazed by finding, at the autopsy table, a
cancer of the colon that was not ever) suspected in
life. These cases usually have been treated as gastric
conditions, because their symptomatology may closely
simulate that of almost any variety of gastric condition.
As Dr. Hilsman showed so clearly, they may even
have tarry stools, even though they are low down in
the colon. They may have achlorhydria; they may
have epigastric pain; they may have all the classical
symptoms of a peptic ulcer or a gastric cancer.
After having tried to work them out. usually the
surgeon or the internist has labeled them as a psycho-
genic gastrointestinal reaction, and called them neu-
rotics, sometimes even “nuts”.
Any case of apparent gastric disorder that you
cannot pin a label to with pretty great clarity should
be given a very careful colonic study. If you will do
this you will pick up in the early stages many cases
of colonic cancer that might be amenable to surgery,
as was pointed out by Dr. Harrold.
WHY BREAKFAST IS IMPORTANT
Good food is essential to health, but it is astonishing
how many persons omit certain foods or even skip
meals to reduce expenses.
Considering health from the standpoint of dollars
and cents is not economy, a Health Talk issued by the
Educational Committee of the Illinois State Medical
Society points out.
The body needs fuel, just as a furnace or an auto-
mobile or any other source of power. In the machinery
of the body, food fuel is converted and distributed
among the organs to maintain a normal state of health.
Breakfast is therefore important. Why? Because
ordinarily at this meal the body has been without
food for eight or ten hours, the longest interval between
meals.
An adequate breakfast restores the energy level
needed to carry out the day’s work with efficiency. It
prevents midmorning fatigue and maintains a high
level of productivity during the morning hours.
In children, breakfast should supply every element
necessary for good nutrition as well as provide for
growth and energy. Ripe or cooked fruit or fruit juice;
hot or cold cereal with milk; toast, bread or rolls with
margarine or butter; and a substantial dish such as
bacon and eggs, plus a glass or two of milk, should
be included.
For the adult whose daily activities do not call for
great energy, fruit, toast or rolls, and a beverage will
frequently suffice, particularly if the noon meal is
balanced.
Persons engaged in physical labor, however, require
a heavier meal, including eggs or meat or some other
hot dish, such as potatoes. This is in addition to fruit,
cereal, bread and beverage.
With the high cost of living steadily going higher,
and suggestions for economy of food persistently being
recommended, it is well to remember that a good
functioning healthy body is the one unit that can
achieve and maintain that economy. The farmer must
have a healthy body to manage his farm. It is he
who provides food for the world. The executive in the
office must have a healthy body to direct the many
activities that keep the machinery of world affairs
moving. The clerical or office workers must have a
healthy body to keep this machinery intact. And the
child must have a healthy body to form the pattern
of the world of tomorrow.
Breakfast is a well chosen word. Breaking the fast
after hours of sleep is important. During sleep the
body is at rest physically, but some energy is still
being consumed. And new energy must be provided
for the day’s work ahead. This cannot be done on
one or two meals. It is the distributed daily intake
of food that keeps the body balanced.
A body poorly nourished is like an automobile with-
out gasoline. Unless your doctor orders it, don’t cut
down on your food. Let a physical examination de-
termine the state of your health — then eat your meals
accordingly.
AUREOMYCIN SHOWS PROMISE AS
TREATMENT FOR MUMPS
Results obtained in treating three patients
with mumps suggest that aureomycin, an anti-
biotic drug, may be of definite value in this
disease, according to two doctors from Sayre,
Pennsylvania.
Two women treated for mumps with aureo-
mycin showed definite improvement within 24
hours after receiving the first dose of aureo-
mycin, Drs. Wilfred D. Langley and John
Bryfogle say in the August 12 Journal of the
American Medical Association. Aureomycin was
given to both women on the second day after
swelling in the glands began.
Another patient, a man, received the drug
less than 24 hours after symptoms of mumps
were first noticed. Forty-eight hours after treat-
ment was begun, he showed definite improve-
ment.
“While no definite conclusions can be drawn
from treating three patients in the manner de-
scribed, the results obtained would suggest that
aureomycin may be of definite value in this
disease,” the doctors point out.
420
The Journal of the Medical Association of Georgia
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edcar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
October, 1950
DOCTOR DRAFT LAW
(Public Law 779 — 81st Congress)
(Chapter 939 — 2d Session)
(s. 4029)
an act
To amend the Selective Service Act of 1948, as
amended, so as to provide for special registration,
classification, and induction of certain medical,
dental, and allied specialist categories, and fnr
other purposes.
Be it enacted by the Senate and House of
Representatives of the United States of America
in Congress assembled. That section 4 of the
Selective Service Act of 1948, as amended, is
hereby amended by adding at the end thereof
the following subsections:
“(i) (1) Notwithstanding any other provi-
sion of this title, except subsections 6 (j) and
6 (o), the President is authorized to require
special registration of and, on the basis of
requisitions submitted by the Department of
Defense and approved by him, to make special
calls for male persons qualified in needed —
“(A) medical and allied specialist cate-
gories who have not yet reached the age of
fifty at the time of registration, and
“(B) dental and allied specialist categories
who have not yet reached the age of fifty
at the time of registration.
Persons called hereunder shall be liable for in-
duction for not to exceed twenty-one months
of service in the Armed Forces. No such person
who is a member of a reserve component of
the Armed Forces shall, so long as he remains
a member thereof, be liable for registration or
induction under this subsection, but nothing in
this subsection shall be construed to affect the
authority of the President under any other
provision of law to call to active duty members
and units of the reserve components. No person
in the medical, dental, and allied specialist
categories shall be inducted under the provisions
of this subsection after he has attained the fifty-
first anniversary of the date of his birth.
“(2) In registering and inducting persons
pursuant to paragraph 1 1 ) of this subsection,
the President shall, to the extent that he con-
siders practicable and desirable, register and
induct in the following order of priority:
“First. Those persons who participated as
students in the Army specialized training pro-
gram or similar programs administered by
the Navy, and those persons who were de-
ferred from service during World War II for
the purpose of pursuing a course of instruc-
tion leading to education in one of the cate-
gories referred to in clauses (A) and (B)
of paragraph ( 1 ) of this subsection, who
have had less than ninety days of active duty
in the Army, the Air Force, the Navy, the
Marine Corps, the Coast Guard, or the Public
Health Service subsequent to the completion
of or release from the program or course of
instruction (exclusive of the time spent in
postgraduate training).
“Second. Those persons who participated
as students in the Army specialized training
program or similar programs administered
by the Navy, and those persons who were
deferred from service during World War II
for the purpose of pursing a course of in-
struction leading to education in one of the
above categories, who have had ninety days
or more but less than twenty-one months of
active duty in the Army, the Air Force, the
Navy, the Marine Corps, the Coast Guard,
or the Public Health Service subsequent to
the completion of or release from the pro-
gram or course of instruction (exclusive of
the time spent in postgraduate training).
“Third. Those who did not have active
service in the Army, the Air Force, the Navy,
the Marine Corps, the Coast Guard, or the
Public Health Service subsequent to Septem-
ber 16, 1940.
“Fourth. Those not included in the first
and second priority who have had active
service in the Army, the Air Force, the Navy,
the Marine Corps, the Coast Guard, or the
Public Health Service subsequent to September
16, 1940. Inductions of persons in this priority
shall be made in accordance with regulations
prescribed by the President which may pro-
vide for the classification of such persons
into groups according to the number of full
months of such service which they have had
and for the induction of the members of any
such group after the induction of the mem-
bers of any other such group having a lesser
number of full months of such service.
In the selection of individuals from among the
categories established by subsection (i) for
induction, the President is authorized, under
such rules and regulations as he may prescribe,
to provide for the deferment of any individual
whose deferment is found to be equitable and
in the national interest, taking into consideration
the length of his previous service in the Armed
Forces (including the Coast Guard and the
Public Health Service) of the United States,
the extent of his participation in the Army
specialized training program or similar pro-
gram administered by the Navy, reasons of
hardship or dependency, and the maintenance
of the national health, safety, or interest.
October, 1950
421
“(3) It is the sense of the Congress that the
President shall provide for the annual defer-
ment from training and service under this title
of numbers of optometry students and pre-
medical, preosteopathic, preveterinary, pre-
optometry and predental students at least equal
to the numbers of male optometry, premedical,
preosteopathic, preveterinary, preoptometry and
predental students in attendance at colleges and
universities in the United States at the present
levels, as determined by the Director.
“(j). The President shall establish a National
Advisory Committee which shall advise the
Selective Service System and shall coordinate
the work of such State and local volunteer
advisory committees as may be established to
cooperate with the National Advisory Commit-
tee, with respect to the selection of needed
medical and dental and allied specialist cate-
gories of persons as referred to in subsection
(i). The members of the National Advisory
Committee shall be selected from among indi-
viduals who are outstanding in medicine, den-
tistry, and the sciences allied thereto, but ex-
cept for the professions of medicine and den-
tistry, it shall not be mandatory that all such
fields of endeavor be represented on the com-
mittee.
In the performance of their functions, the
National Advisory Committee and the State and
local volunteer advisory committees shall give
appropriate consideration to the respective needs
of the Armed Forces and of the civilian popu-
lation for the services of medical, dental, and
allied specialist personnel; and, in determining
the medical, dental, and allied specialist per-
sonnel available to serve the needs of any com-
munity, such committees shall give appropriate
consideration to the availability in such com-
munity of medical, dental, and allied specialist
personnel who have attained the fifty-first anni-
versary of their birth.
Sec. 2. Notwithstanding the provision of
section 203 of Public Law 351, Eighty-first
Congress, commissioned officers of the reserve
components called or ordered to active duty
with or without their consent, shall, if other-
wise qualified, be entitled to the benefits of
section 203 of Public Law 351, Eighty-first
Congress.
Sec. 3. Section 202 of the National Security
Act of 1947, as amended, is hereby amended by
adding at the end thereof the following sub-
sections :
“(g) Under such regulations as he shall pre-
scribe, the Secretary of Defense with the ap-
proval of the President is authorized to transfer
between the armed services, within the author-
ized commissioned strength of the respective
services, officers holding commissions in the
medical services or corps including the reserve
components thereof. No officer shall be so trans-
ferred without (1) his consent, (2) the consent
of the service from which the transfer is to be
made, and (3) the consent of the service to
which the transfer is to be made.
“(h) Officers transferred hereunder shall be
appointed by the President alone to such com-
missioned grade, permanent and temporary, in
the armed service to which transferred and be
given such place on the applicable promotion
list of such service as he shall determine. Fed-
eral service previously rendered by any such
officer shall be credited for promotion, seniority,
and retirement purposes as if served in the
armed service to which transferred according
to the provisions of law governing promotion,
seniority, and retirement therein. No officer
upon a transfer to any service from which pre-
viously transferred shall be given a higher
grade, or place on the applicable promotion list,
than that which he could have attained had
he remained continuously in the service to which
retransferred.
“(i) Any officer transferred hereunder shall
be credited with the unused leave to which he
was entitled at the time of transfer.”
Sec. 4. Notwithstanding any other provision
of law, where any person who served on active
duty as a physician or dentist in Armed Forces
(including the Public Flealth Service) of the
United States subsequent to September 16, 1940,
thereafter has been, or shall be, recalled to
active duty as a physician or dentist in the
Armed Forces (including the Public Health
Service) of the United States, such person may,
under regulations prescribed by the President,
be promoted to such grade or rank as may be
commensurate with his medical or dental educa-
tion, experience, and ability.
Sec. 5. No person inducted under the pro-
visions of this Act shall be entitled to the benefits
of the provisions of section 203 of Public Law
351, Eighty-first Congress.
Sec. 6. For the purposes of this Act, the
term “allied specialist categories” shall include,
but not be limited to, veterinarians, optome-
trists, pharmacists, and osteopaths.
Sec. 7. This Act, except for section 2 and
section 5, shall terminate on July 9, 1951.
Approved September 9, 1950.
A.M.A. CLINICAL SESSION
The Fourth Clinical Session of the American
Medical Association, designed primarily for the
general practitioner, will be held in Cleveland,
December 5-8.
The scientific sessions and the scientific and
technical exhibits will be presented in the Cleve-
land Municipal Auditorium. Meetings of the
House of Delegates will be held in the Statler
Hotel. These sessions of the body elected to
govern the affairs of the A.M.A. are attracting
more and more non-delegate physicians each
year.
Outstanding clinical teachers with recognized
ability as speakers will headline the scientific
demonstrations. Actual cases will be presented
4-22
The Journal of the Medical Association of Georcia
and discussed. Diagnoses, treatment and pre-
ventive measures as they fit into daily practice
will receive the greatest attention.
Each clinical session will be limited to an
attendance of 100 physicians. These small
groups will make it possible for the general
practitioner to enter actively into the discussion
and to inquire about his own cases. Leading
men in each of the fields under discussion will
be available to help with the problems pre-
sented.
In obstetrics, difficult cases of interest will
be featured. Especially stressed will be the
general subjects of breach deliveries, induction
of labor, indications for cesarean section, ob-
stetric analgesia and anesthesia, and hemor-
rhages.
Clinical discussions featuring actual pediatric
patients have been programmed. The care of
premature infants, acute diarrhea in children,
rheumatic fever, preventive medical measures
and psychiatric care for small children are
among the interesting topics scheduled.
Because of the unusual interest displayed last
year in the section devoted to management of
heart cases, there will be a similar session this
year. It will include discussions on hyperten-
sion, recent advances in drug therapy, including
ACTH as it applies to heart disease, acute
arterial occlusion and cardiac arrhythmias.
Of special interest will be discussions on
Parkinsonism, the use of the electro-encephalo-
graph, electric shock therapy and psychotherapy.
With more cases of fluid balance appearing
because of the larger number of geriatric pa-
tients, there will be discussions on fluid replace-
ment in shock, renal repairment, dehydration
and other topics.
Of unusual interest will be the new studies
and clinical histories involving traumatic surg-
ery. This will include material on reconstruc-
tive surgery, emergency analgesia and emerg-
ency surgical measures.
Taken up in detail will be the management
of post operative or inoperable cancer patients.
The use of analgesics and the effects of hormone
and radiological treatment will be discussed.
An excellent program has been arranged
covering diabetes. This will include diagnosis,
vascular complications, special consideration in
pregnancy and surgery, and dietary problems.
Very timely will be the panel discussions and
demonstrations on the diagnosis of poliomye-
litis, the treatment of respiratory failure and
the management of paralytic cases. There will
be demonstrations of physical therapy and reha-
bilitation measures for poliomyelitis cases.
Papers covering practical problems in derma-
tology and syphilology will be presented. Deep
fungous infections and industrial, allergic and
contact dermatoses will be demonstrated and
discussed. Emphasis will be put on the newest
developments in syphilology.
New developments and refinements of older
techniques will feature the discussions on
anesthesiology. Spinal anesthesia, management
of the surgical case, intravenous administration
and other practical problems will be reviewed.
Outstanding speakers will discuss ulcers,
jaundice, infectious hepatitis, cirrhosis and
other gastro-intestinal diseases. Newest advances
in medicine and the use of many newer drugs
and their application to the general practice
of medicine will be presented in another section.
Of special interest will be the discussions on
the use of antibiotics, hormones and antispas-
modics.
Outstanding features of the scientific ex-
hibits will be special demonstrations on frac-
tures, diabetes, rheumatism and arthritis. Ex-
hibits will be presented on cancer, pediatrics,
chest diseases, surgical procedures and other
subjects correlated with the clinical presenta-
tions.
Once again color television will take its place
on the program. A schedule of surgery, clinical
treatment and examination will be telecast
from the Western Reserve School of Medicine
to the auditorium. It will be sponsored by
Smith, Kline & French Laboratories.
The annual General Practitioner Award has
come to be regarded as one of medicine’s
highest honors and a definite step toward in-
creasing the recognition of the family doctor.
This year’s selection will be made at the Cleve-
land meeting.
The steadily climbing registration of general
practitioners at the clinical sessions and the
comments of those participating indicate these
meetings are valuable means of keeping abreast
of developments in medicine. It is hoped that
a record number of physicians will take ad-
vantage of the opportunity in December to
attend. The program has been designed with
that in mind.
ADVISE EXTREME CAUTION IN
USE OF NEWER INSECTICIDES
Extreme caution in using newer insecticides
containing the chemicals HETP, TEPP and
parathion was advised today by a group of pri-
vate and governmental physicians and research
men who are members of or consultants to the
American Medical Association’s Committee on
Pesticides.
These insecticides are used principally for
controlling aphids, mites and other fruit and
vegetable crop insects. They are not used for
controlling insects attacking man or animals
or for insects in households and storage rooms.
Recommendations concerning the prepara-
tions were made in a report which appears in
the September 9 Journal of the American Medi-
cal Association.
Several deaths and moderate to severe poison-
ings have resulted from exposure to the chemi-
cals in their production or use, Dr. Herbert
October, 1950
423
K. Abrams of the California Department of
Health, Berkeley, and Drs. Donald 0. Hamblin
and John F. Marchand, medical director and
assistant medical director of the American
Cyanamid Company, New York, said.
Authenticated cases of poisoning reported
total 198 to date, a comparatively large number
of persons in relation to the short period in
which the chemicals have been in use, the
doctors added. This number is not believed
to include all the accidents that have occurred.
Insecticides containing HETP, TEPP and
parathion are sold under a large number of
trade names, according to S. A. Rohwer, D.Sc.,
and H. L. Haller, Ph.D., assistant to the chief
and assistant chief of the Bureau of Entomology
and Plant Quarantine, U. S. Department of
Agriculture, Washington, D. C.
HETP, TEPP and parathion may be absorbed
through the skin, respiratory tract, eyes or
gastrointestinal tract. Dr. David Grob of Johns
Hopkins University and Hospital, Baltimore,
said.
Although TEPP is the most potent of the
three chemicals, the greater over-all danger to
man and domestic animals is from parathion
because of its greater stability in water and
greater solubility in fatty mediums, including
the outer layer of fruit and leaves, Dr. Grob
pointed out.
He listed these safety measures to reduce
exposure and minimize absorption of the insecti-
cides:
1. Clean protective clothing is required. The
type depends on the nature of the product and
degree of exposure.
2. Workmen engaged in manufacture or
packaging of the chemicals should be protected
by adequate exhaust ventilantion. Personnel
applying aerosols of the chemicals, including
pilots, should wear face masks. Wind dispersal
should be avoided to unprotected personnel or
domestic animals.
3. Personnel should remove protective cloth-
ing and wash hands, arms and face thoroughly
with soap and water before eating, drinking or
smoking. Insecticides containing parathion may
persist for varying periods as residues on plant
tissue. Precautions in reference to harvest and
the like should be observed for safety of all
concerned.
4. Inflammable insecticide containers should
be burned and any area in which the insecticides
are spilled should be decontaminated by clean-
ing and washing. Waste should be burned or
buried.
5. A periodic blood test helps to prevent
cumulative effects in exposed personnel by
indicating those who should be removed from
exposure.
Toxic effects of the three chemicals are simi-
lar and are referable to the nervous system, Dr.
Grob said. The first symptoms to appear usually
are loss of appetite and nausea, which are soon
followed by vomiting, abdominal cramps and
excessive sweating, he added.
Kenneth DuBois, Ph.D., of the Toxicity Lab-
oratory and Department of Pharmacology of
the University of Chicago said that animal ex-
perimentation has shown that repeated exposure
to parathion may result in subacute poisoning,
but no evidence of cumulative toxic effect has
been observed with HETP or TEPP. Parathion
is highly toxic to all species of animals, he
concluded.
Dr. A. J. Lehman, chief of the Division of
Pharmacology, Food and Drug Administration,
Washington, D. C., Albert Hartzell, Ph.D., head
entomologist of the Boyce Thompson Institute
for Plant Research, Yonkers, N. Y., and J. C.
Ward, M.Sc., chief of the Pharmacology &
Rodenticide Section, Insecticide Division, U. S.
Department of Agriculture, Washington, D. C.,
advised that it is “quite unlikely that a para-
thion spray residue problem will become serious
if spray schedules recommended by qualified
entomologists are followed.”
“The extreme toxicity of (these) insecticides
suggests that they can be harmful to beneficial
forms of life, including certain insects, fish and
wild life,” they continued. “Their use on live-
stock and pets is not recommended. With the
exception of direct application to domestic ani-
mals, little hazard exists with HETP and TEPP.
“Parathion presents a greater hazard. In the
case of apples and pears, for example, if para-
thion is applied strictly in accordance with the
recommendations of the U. S. Department of
Agriculture, normal weathering should result
in residues no greater than a fraction of a part
per million. Traces of this magnitude would
not constitute a health problem. This is not
necessarily true in the case of citrus fruit. The
evaluation of the health hazard from residues
such as this is being made at a (Food and Drug
Administration) hearing now in progress (in
Washington, D. C.).”
A.M.A. MEETS IN CLEVELAND
DECEMBER 5-8
What does a good family doctor do when
he takes a holiday?
He heads for a medical meeting, of course,
and goes right on talking about cardiac arrhyth-
mias and gastrointestinal upsets and all the
rest of the diseases that are plaguing mankind.
Better start now, Doctor, plotting a scheme
for a colleague to take your OB calls for a
week so that you can get out of the office for
a holiday and that “clinical refresher” awaiting
you at the A.M.A. Cleveland Session for Gen-
eral Practitioners, December 5-8.
Cleveland won’t offer the abalone steaks and
cable cars of San Francisco or the boardwalk
and beach of Atlantic City — but it will offer
you, besides the four days of demonstrations
and lectures, ample opportunity to take care
of the inner man at fine restaurants with eve-
The Journal of the Medical Association of Georcia
424
nings of relaxing entertainment at its most
modern theatres.
Clinical sessions will be under outstanding
teachers with attendance at these meetings
limited so that you can enter into the discus-
sions and inquire about your own problems.
Doctors will hear leading medical authorities
discuss treatment of actual cases of cancer.
The scientific exhibit will offer special demon-
strations on fractures, diabetes, rheumatism
and arthritis. Technical exhibits will feature the
latest developments, in drugs, equipment, books
and allied medical products.
Meetings of the House of Delegates will be
open to all members of the medical profession,
and visitors in related fields are welcome to
attend the sessions which will be held Tuesday
and Wednesday, December 5 and 6.
Color telecasts of surgery, clinical treatment
and examination at University Hospital in
Cleveland are earmarked as one of the high-
lights of the meeting.
Another outstanding event will be the elec-
tion of America’s typical family doctor to re-
ceive one of medicine’s highest honors — the Gen-
eral Practitioner’s Award. Doctors in line for
this recognition are nominated annually by
local and state medical societies and elected
by the House of Delegates. The award goes
to the doctor who best exemplifies the profes-
sion’s standards of service to patients, com-
munity and country.
Last year’s Clinical Session in Washington,
D. C., drew over 4,000 doctors from every part
of the United States. This year, the A.M.A.
has issued a blanket invitation to all members
of the Canadian Medical Association, which
should increase normal attendance.
WHAT IS THE HEALTH FUTURE
OF YOUR CHILD?
Good planning is important in developing health
in your child, the Educational Committee of the Illinois
State Medical Society advises in a Health Talk.
“A little child shall lead them” is particularly true
and applicable today in health matters, because good
health information is a regular part of every school
curriculum.
Even in kindergarten and nursery schools good
health habits are emphasized, so that the child returns
home with pointed information on cleanliness, nutrition,
correct posture and other simple health facts. Thus
from the school into the home go simple illustrations
of good health habits.
With the child as the source of information, a wise
parent will put the instruction into effect. The teacher’s
efforts will be wasted if the parent refuses to super-
vise the child's resultant activities in the home.
The teacher or school nurse will notice, for example,
that the child's vision is poor, a physical weakness,
correction of which, sometimes with glasses, may
bring an apparently slow child up to par.
Identification and correction of defects form an-
other key to good physical and mental health. Wise
indeed is the parent who has each child physically
examined, from top to toe, every year from babyhood
on and, when defects are located, adopts the advice
of the family doctor.
The prevention of disease is important and can he
accomplished, to a great extent, through immunization
against diphtheria, whooping cough, smallpox, measles,
tetanus and typhoid. Most of these diseases are con-
tagious and can spread rapidly into epidemics.
In health matters, a parent cannot live just for
today. Bad health habits are more difficult to correct
when the child grows older. Because the child's mind
is especially susceptible to impressions, good training
should be the early responsibility of the parent.
The environment of the home, particularly a happy
home where the father and mother are emotionally
stable, with good health habits, is a significant factor
in the emotional development of the child. Meals,
for example, need not be elaborate, but simple and
nutritious. The daily hath, which should be carried
out by the growing child, is a good health habit and
should become routine to the child.
Attention to the nails, the brushing of teeth, good
table manners are all social “musts” for later life.
So, to repeat, planning is essential for the child’s
good health, mental and physical. Why not plan to
make your child’s birthday an annual health event?
A physical examination by the family doctor on that
day is a good health habit. Planning your child's
health, when he is dependent on you, will pay dividends,
not only to the child, but to the health of the nation.
May 1 is Child Health Day throughout the nation.
Let it be the occasion to check your answer to the
thought — what is the health future of your child?
ARMY AUTHORIZES APPOINTMENT OF WOMEN
DOCTORS AS RESERVE CORPS OFFICERS
Appointment and concurrent assignment to active
duty as Reserve Officers of women physicians, dentists,
and allied specialists, has been authorized, it was an-
nounced recently by the Department of the Army.
This marks the first time authorization has been
given for women to be commissioned in the Medical,
Dental, Veterinary, and Medical Service Corps Reserves.
They will be brought on duty under regulations cur-
rently providing for the commissioning of male officers
in these Corps. Some women did serve in the Army
as physicians and technicians during World War II,
but their commissions have expired.
As Reserve officers on active duty, these women
will be given opportunities for clinical practice and
advancement which are now available to male officers
in comparable grades, Major General R. W. Bliss,
Surgeon General of the Army, pointed out. Appoint-
ments will be in grades front first lieutenant to colonel,
depending upon age, experience, and professional quali-
fications. The pay, allowances, dependency and retire-
ment benefits which accrue to male officers will apply
to the women medical reservists. Women physicians
and dentists will also draw the S100 a month profes-
sional pay allowed above the base pay of their com-
missioned rank. They will be eligible for service in
every type of military medical facility, with the excep-
tion of forward medical installations in combat zones.
General Bliss said his office had received numerous
letters during the past year from women physicians
desiring military service.
LINKS HIGH BLOOD PRESSURE TO
AMERICAN WAY OF LIFE
Is high blood pressure produced by the mass-produc-
tion economy and “cash culture” of western civiliza-
tion?
A doctor from the Hypertension Clinic of the
Massachusetts General Hospital, Boston, believes it
may be, in some cases.
Dr. Robert Sterling Palmer reports his study of 50
patients with high blood pressure in an article in
the September 23 Journal of the American Medical
Association.
“The feature of this study of 50 personalities is
October, 1950
425
similarity rather than diversity and uniformity rather
than individuality,” he says. “A practical, adaptable
and rather conciliatory attitude to life was common.
They tended to be independent, resolute, industrious
and efficient. They could fit in well with their group
and were popular in their circle of friends or fellow-
workers.
"Outstanding talent or interest in music, art or
literature, or unusual scholarship was not found, nor
were there special skills, originality or even special
interests other than in the occupation affording liveli-
hood apparent in any of them. In their aptitude for
their particular occupation, however, the majority
seemed to he somewhat above average.
“The predominant character traits which the physi-
cian sees and which the patient recognizes in himself
are those with survival value in our competitive cash
culture. This is the personality’s protective coloring
induced by the prevailing normal climate. This per-
sonality pattern is not specific for hypertension but
is characteristic of our times.
“Tension results when this outer coat does not ht
the patient’s inner disposition. This is the strain of
integration or adaptation. This cultural factor in the
causation of disease presents a problem, doubtless
insurmountable in one or in several generations. '1 his
is not a reason for failure to state the problem or to
attempt to do something about it.
“It is suggested that personality traits found are
not specific for hypertension but rather are character-
istic of our time, and that hypertension, in some
cases, may be symptomatic of the suppression of the
patient by the demands of our culture.”
POSTWAR DISTRIBUTION OF DOCTORS
MORE EVEN THAN PREWAR
Family doctors in private practice, who provide the
bulk of medical care for the nation, were more evenly
distributed in 1949 in relation to state population than
in 1938.
This is shown by a study recently published as
Bulletin 78 of the American "Medical Association’s
Bureau of Medical Economic Research.
“Despite the tremendous population shifts during
the 1940’s and the high level of national prosperity,
which would tend to draw physicians to the heavily
populated industrial states, general practitioners have
redistributed themselves into a more even pattern
than was found before World War II,” said Frank
G. Dickinson, Ph.D., of Chicago, director of the
bureau.
“The figure in our study on physician-population
relationships by states that is important to most people
is the distribution of family doctors who actually
have their offices open for private practice. It is not
the distribution of the total number of doctors. There-
fore, in our computation we eliminated doctors in the
government services and armed forces, on hospital duty
on a full-time basis, retired physicians and those in
administrative and other such positions which take
them out of private practice.
“A separate study was made to show the distribu-
tion of full-time specialists — those who do no general
practice — in private practice because these physicians
draw- their patients from wider areas and, on the whole,
are located in the cities. •
“However, we found that full-time specialists, like
family doctors, were more evenly distributed in rela-
tion to state populations in 1949 than in 1938.
“These conclusions are based upon statistical meas-
ures of relative variations in the state physician-
population ratios.
“A” AVERAGE NOT REQUIRED FOR
ADMISSION TO MEDICAL SCHOOLS
An A average in premedical college work is not
required for admission to medical schools, Dr. Donald
G. Anderson of Chicago, secretary of the American
Medical Association’s Council on Medical Education
and Hospitals, said today.
According to a recent report to the council, 10
per cent of students admitted to medical schools in
the United States during the academic year 1949-1950
had no better than a C+ scholastic average in pre-
medical college work. Many others, Dr. Anderson
pointed out, had B averages.
RADIOLOGIC SOCIETY TO MEET
Announcement is made by Dr. Warren W. Furey,
M.D., of Chicago, president of the Radiological Society
of North America, that the 36th annual meeting of
the society will be held in Chicago, December 10
through the 15th.
Headquarters for the meeting will he the Palmer
House in which all scientific and technical sessions
will be held. Scientific exhibits are also to be dis-
played in the hotel.
More than 60 papers as well as refresher courses
feature the convention program, according to Dr.
Furey.
Dr. Wendel G. Scott of St. Louis, Missouri, will
present the annual Carmen Lecture. All members of
the medical profession are welcome and invited, says
Dr. Furey.
DAILY OFFICE WORK MAY CAUSE
NECK RIGIDITY AND HEADACHE
Office work literally gives a pain in the neck to
some typists and bookkeepers, according to a Chicago
eye, ear, nose and throat specialist.
“Numerous headaches are due to prolonged con-
traction of the neck muscles,” says Dr. Noah D.
Fabricant in the June issue of Todays Health, pub-
lished by the American Medical Association.
“Some people’s daily work causes an accumulation
of pain-producing substances in the muscles of the
neck and back,” Dr. Fabricant continues.
“A person forced to hold his head rigidly in a
particular position may get a headache. Bookkeepers,
typists, proofreaders and dressmakers are especially
susceptible to this type. They often find comfort in
sitting with the head forward, chin in hands.
“Treatment for rigid, hypertonic neck muscles con-
sists mainly of heat and massage. Heat can be applied
at home in the form of an electric pad, a hot-water
bottle or hot towels, or from an electric bulb with a
reflector or an infra-red lamp. Obviously, one must
be careful not to burn the skin.
“Physical therapy in all forms must be applied
skilfully; otherwise it can do more harm than good.”
CARE OF THE FEET
Improperly fitting shoes are the most common cause
of painful feet, yet many people, women in particular,
pay more attention to style than to comfort in the
selection of shoes, the Educational Committee of the
Illinois State Medical Society points out in a Health
Talk.
Shoes should be fitted to give the wearer stability
and balance in walking. Certainly the body structure
is not in proportion with extremely high and narrow
heels, which are present day dictates of fashion.
Since arches do not usually “fall” or “break” of
themselves, it is reasonable to assume that external
irritation is responsible, and usually the shoes and
stockings are the culprits. On the other hand, arthritis
frequently causes painful feet, especially in older per-
sons. Disturbances of the circulation may be responsible
for foot pains and nerve inflammations.
The condition “fallen arches” seems to occur most
often in women and results from some injury to one
of the main bones of the foot known as the astragalus.
People who stand long hours are likely to be dis-
turbed by painful feet due to continuous strain on
the arches. In such cases the pain is the result of
426
The Journal of the Medical Association of Georcia
rigidity of the tissues and of spasms of the muscles
in their effort to overcome the strain.
Twenty-six joints exist among the hones in each
foot from ankle to toe tip and since joints are purely
mechanical methods of changing the direction of
force, they play a large part in the flexibility of the
feet.
Callouses and corns are two common ailments. The
former is a thickening of the normal skin caused by
excessive pressure for a prolonged period of time.
Corns, on the other hand, are thickenings of the skin
together with the callous, but in the central portion
there is a core that penetrates into the deeper tissues.
Both of these conditions can be avoided, if adequate
attention is paid to the care of the feet.
Bunions are a protrusion of the bone, usually at the
base of the large toe. Women are the chief victims
of this condition, caused bv the spreading of the
metatarsal bones. Their development is again encour-
aged by the wearing of high heels.
Ingrown toenails are another source of painful feet.
These can be avoided if the nail is cut at right angles
to its growth. The corners should be square rather
than rounded. This will prevent the nail from pene-
trating the soft skin tissues.
Since the feet accumulate dirt and perspiration,
they should be bathed frequently and carefully with
warm soapv water. Special attention should be paid
to the webbing between the toes to prevent the growth
of bacteria and fungi.
Since feet carrv the weight of the body, posture
plays an important part in the care of the feet. Stand-
ing with the feet pointing outward, instead of forward,
causes undue strain on the ligaments connecting the
foot bones, especially on the inner side of the long
arches. The resulting slight ache often grows to
severe pain.
A little common sense in the selection of foot gear
and personal habits of good hygiene in the care of the
feet will do much to keep you free of painful feet.
THREE-DIMENSIONAL PHOTOGRAPHY
OF HEART IN ACTION DESCRIBED
Three-dimensional x-ray photography of the heart
and its chambers in action is described in the June
10 journal of the American Medical Association by
two Stockholm (Sweden) licentiates in medicine.
0. Axen and John Lind of the Karolinska Institute
at Norrtulls Hospital report that this is performed
by means of synchronized roentgenograms (x-ray pic-
tures) in two planes at right angles. A special table
permits the taking of 10 pictures in one ray direction
and 10 at right angles in the course of eight seconds.
A contrast is obtained by the injection of an opaque
material into the veins. The series of photographs
permits following the passage of the contrast medium
through the different chambers of the heart.
By the dual photography, frontal and lateral views
of the heart in the same phase of the respiratory
and heart cycle can be obtained, the authors point out.
A “three dimensional” view is provided by placing
side by side the photographs taken simultaneously
from the two positions.
“This renders possible a three-dimensional apprecia-
tion of the capacity and configuration of the separate
chambers of the heart,” they report. “The method
is of aid in the establishment of normal standards
in the living subject, and it affords increased oppor-
tunities for detection of abnormalities in the size or
shape of the cavities of the heart and the great
thoracic vessels.
“Moreover, the taking of roentgenograms in two
different projections facilitates more nearly precise iden-
tification of each anatomic portion of the heart. Serial
photography gives a concept of the dynamics of the
heart. The dye (opaque material used) can be accur-
ately localized in the heart, and the changes in
capacity of the chambers during the heart cycle can
be estimated better.”
The series of photographs is taken automatically
by turning on a switch after the injection of the
contrast medium. The speed can be varied from five
to 10 seconds for the series, if desired.
NEWS ITEMS
Dr. Robert T. Anderson, formerly of Atlanta, an-
nounces his association with Dr. Fred Coleman at
the Coleman Hospital, Dublin, in the practice of
medicine.
* * *
Dr. W. E. Barfield, of Jackson, has moved to Savan-
nah to continue the oractice of Dr. M. J. Epting
who is at the Parris Island, S. C. Marine Depot. This
is the third time Dr. Epting has served his country,
having served in World Wars I and II.
* * *
The Medical Association of Georgia recently issued
a Certificate of Distinction and a gold lapel button
to Dr. W. B. Brock, of Tallapoosa, for 50 years of
service as a medical doctor. Dr. Brock was born in
Haralson Countv, Georgia, March 25, 1871. He at-
tended school in Tallapoosa, and is a graduate of
Vanderbilt University. He practiced medicine in
Tallapoosa for 53 vears and has given his life to the
service of humanitv. Dr. Brock makes his home ten
months of the year a> 500 Majorea Ave., Coral Gables,
Fla., and comes to Tallapoosa for the summer.
* * *
Dr. Enoch Callawav, of LaGranse has been re-
elected president of the Georgia Division, American
Cancer Society. Dr. Robert Pendergrass, Americus,
was made vice-pre=ident. Dr. Calvin Stewart. At-
lanta; Dr. Thomas Harrold. Macon; Dr. J. T. McCall,
Rome: Dr. John Denton. Atlanta, were re-elected, and
Dr. Wadley Glenn, Atlanta, was elected as a new
member, of the board of directors.
* * *
The Crawford W. Long Hospital, Atlanta, held its
regular monthly staff meeting on September 12 at
the hospital. Program: Pediatric Section, “Fetal Mor-
tality Statistics for June,” bv Dr. J. C. Flanagan;
Medical Section, “Sarcoidosis”, Dr. Max Michael;
Surgical Section. “Management of Carcinoma of the
Breast”, by Dr. Calvin Stewart. At this meeting. Dr.
L. C. Fischer, president of Crawford Long Hospital
and Dr. Hugh Wood, Dean of Emory Universitv School
of Medicine, made short talks in regard to Crawford
Long Hospital's association with Emory University.
* * *
Dr. H. B. Dean. Unadilla, recently went to Norris-
town. Pa., where he is a member of the staff of the
Psychoanalytical Hospital and the Psychoanalytical
Institute of Philadelphia. He plans to do advanced
work in pediatric psychiatry. Drs. Jean Douglas McRee
and Christine Jameson Ellis McRee have moved to
Unadilla to take over Dr. Dean’s practice. They have
been stationed in Alaska with the United States Army.
* * *
Dr. William A. Dodd, a native of Macon and formerly
of Dublin, announces the opening of his office in
Wrightsvi'le. He is a graduate of the University of
Georgia School of Medicine, Augusta, and is a member
of the Laurens County Medical Society, the Medical
Association of Georgia, the American Medical Associa-
tion and the Georgia Heart Association. He served
an internship at the Macon Hospital, Macon, and a
residency at the Crawford W. Long Memorial Hospital,
Atlanta.
* * *
The Fulton Countv Medical Society held its semi-
monthly meeting at the Academy of Medicine, Atlanta,
on September 7. Program: Moderator — Dr. J. D.
Martin. “Benign Giant Cell Tumor of the Svnovium”;
Dr. Robert P. Kelly; “Internal Drainage of Pancreatic
October, 1950
427
Cyst”, Dr. William G. Whitaker, Jr.; “The Use of
Radio-active Iodine in Diseases of the Thyroid”, Dr.
Charles Huguley, Jr. Members of the Newton and
Gwinnett County Medical Societies were special
guests.
* * *
Dr. Harold Scott Gamble, formerly of Columbia, Ala.,
announces the opening of his office in the Bailey
Building, Camilla. Dr. Gamble is a graduate of the
Medical College of Alabama, Birmingham, Ala., and
did postgraduate work in surgery at the University of
Pennsylvania School of Medicine, Philadelphia, Pa.
He interned at Grady Hospital, Atlanta; taught an-
atomy at Louisiana State University School of Medicine,
New Orleans, La., and practiced in Hartford, Headland
and Columbia, Alabama. During World War II, he
served at the Naval Hospital in Dublin.
* * *
Dr. J. E. Garner, Thomaston, recently had some
postgraduate work in anesthesia at Presbyterian and
Cook County Hospitals in Chicago.
* * *
Col. L. Holmes Ginn, Jr., of Berryville, Virginia,
has been named Third Army surgeon and stationed at
Fort McPherson. Col. Ginn entered the Army in
1927 upon graduation from the Medical College of
Virginia, Richmond, and interned at Walter Reed
Hospital, Washington. During World War II he
served in the North African and Tunisian campaigns,
the invasions of Sicily and Italy, and he served as
surgeon, 15th Army from 1944 to 1946.
* * *
Augusta physicians who have returned to service
with the Armed Forces are Dr. E. C. Hopkins, Dr.
Theodore Everett and Dr. J. R. Palmer, Jr. Those
who volunteered were Dr. H. B. Haston, Jr., and Dr.
E. H. Dixon.
* * *
Dr. Clarence L. Laws and Dr. William F. Friedewald,
Atlanta, announce their association for the practice of
allergy and internal medicine at 410 Medical Arts
Building, Atlanta.
* * *
Dr. Edward S. Marks, a native of Toccoa and form-
erly of Memphis, Tenn., recently joined the staff of
Kennestone Hospital, Marietta. An Army veteran of
three and one-half years of service, Dr. Marks had
previously been chief of thoracic surgery at Walter
Reid Hospital at Washington, D. C.
* * *
Dr. Robert B. Martin, III, Cuthbert, of Patterson
Hospital staff, has been accepted as a Fellow of the
American College of Surgeons. Dr. Martin served
four years of military duty in World War II. He
returned to Patterson Hospital in 1946 and has re-
mained with the institution since that time.
* * *
Dr. Thomas A. McGoldrick, Jr., Savannah, recently
conducted postgraduate clinics and gave a lecture on
“Diseases of the Spleen” at the Veterans Administra-
tion Hospital, Dublin, for its medical staff. Members
of the Laurens County Medical Society were invited
to hear Dr. McGoldrick.
* * *
Dr. Charles Mulherin, Augusta, president of the
Richmond County Medical Society, has pledged full
support of the society to the Crusade of Freedom
campaign.
* * *
Dr. J. N. Mullins has returned to Chatsworth to
resume full time practice after spending a year
doing graduate surgery at Georgia Baptist Hospital,
Atlanta, where he was assistant resident surgeon. His
offices are located in the Cohutta Bank Building,
Chatsworth.
Dr. Fenwick T. Nichols, Jr., medical officer of the
Savannah Organized Naval Reserve, has been called
to active duty. Lieutenant Nichols was stationed in
the Pacific theater for eighteen months during World
War II.
* * *
Dr. Vernon Powell, Atlanta, was guest speaker at
the quarterly meeting of the Fulton-DeKalb Chapter
of the American Academy of General Practice at the
Academy of Medicine, Atlanta, on September 13. Dr.
Powell spoke on “The Newer Treatments of Rheuma-
tism and Arthritis”.
* * *
The Piedmont Proctologic Society held its annual
meeting in Hendersonville, N. C. on August 26. Dr.
C. R. Deeds, of Hendersonville, N. C., was elected
president; Dr. J. M. Stockman, of Knoxville, Tenn.,
vice-president; and Dr. C. S. Drummond, of Winston-
Salem, N. C. was re-elected secretary. The next meet-
ing of the society will be held on Saturday, March 31,
1951, at Knoxville, Tenn.
* * *
Dr. Fred H. Simonton, Chickamauga, has been ap-
pointed a member of the Georgia Board of Health and
he will serve a term of six years. The appointment
comes as a worthy appraisal of his experience in
public health service, his years of research work, and
distinctive ability in his field.
* * *
Dr. Lewis S. Sims, Jr., Lincolnton, has returned to
Naval Medical Service. He reported for duty at the
Naval Air Station, Jacksonville, Fla., September 15.
* * *
Dr. Carter Smith, Atlanta, was elected president
of the Georgia Heart Association at its second annual
meeting held recently in Atlanta. Other officers are:
Dr. Harry T. Harper, Jr., Augusta, vice-president;
Dr. Gordon Barrow, Atlanta, secretary. Directors are:
Dr. Goodloe Y. Erwin, Athens; Dr. Henry Tift, Macon;
Dr. Herbert Tyler, Thomaston; and Dr. John L.
Elliott, Savannah. Dr. T. Sterling Claiborne, Atlanta,
former president of the association. Dr. Carter Smith
and Dr. Harry T. Harper, Jr. will be Georgia’s dele-
gates to the Assembly of the American Heart Associa-
tion.
* * *
The annual meeting of the Southeastern States
Cancer Seminar will be held in Jacksonville, Fla. on
November 8, 9, 10, 1950 at the George Washington
Hotel auditorium. The Duval County Medical Society
is in charge of arrangements and will serve as host
to the hundreds of physicians expected to attend. This
annual seminar is sponsored by the Florida Division
of the American Cancer Society and the Florida State
Board of Health with the cooperation of the Florida
Medical Association. There is no tuition. The pro-
gram has been arranged so as to appeal to all doctors
and covers the entire field of malignant disease.
* * *
Dr. Edward Roe Stamps, Macon, has recently opened
office in the Bibb Building for the practice of urology,
He is a graduate of Emory University School of Medi-
cine, and served internship at Grady Memorial Hos-
pital, Atlanta. Following his discharge from the Army,
Dr. Stamps entered the practice of urology as a
junior partner in the office of Dr. W. F. Reavis
and Dr. L. W. Pierce, of Waycross, where he has
been located for the past four years.
* * *
Dr. Cleve Thompson, Jr., formerly of Millen, re-
cently opened his offices in Waynesboro, for the prac-
tice of medicine and surgery. Dr. Thompson gradu-
ated from the University of Georgia School of Medi-
cine, Augusta, in 1949, and interned at Macon City
Hospital, Macon. He will be associated with his
father, Dr. Cleve Thompson, formerly of Millen, where
*28
The Journal of the Medical Association of Georgia
he owned the Milieu Clinic. The two physicians plan
to occupy offices which they will construct on Fourth
Street, near the Burke County Hospital, Waynesboro.
* * *
Dr. Thomas J. Van Sant, a native of Woodstock,
announces his association with Dr. D. Lloyd Wood,
Dalton, for the practice of medicine and surgery. Dr.
Van Sant graduated from the l niversity of Tennessee
College of Medicine. Memphis, Tenn., and interned
at St. Joseph's Infirmary, Atlanta. For the past three
years he has done postgraduate work in internal medi-
cine at Kennedy Hospital, Memphis, Tenn.
* * *
Dr. P. L. Williams, Jr., a native of Cordele, an-
nounces his association with his father. Dr. P. L.
Williams, Sr., Cordele. in the practice of medicine
and surgery. Dr. Williams was graduated from the
University of Georgia School of .Medicine, Augusta,
in 1947. and interned at Greenville General Hospital,
Greenville, S. C. He was resident of the Macon
City Hospital. Macon, and chief resident in surgery
during the past two years.
* * *
Dr. William B. Fackler, Jr., formerly of Lawson
VA Hospital, Chamhlee. announces his association with
the Clark and Holder Clinic, LaGrange.
* * *
Dr. Walter W. Daniel, Atlanta, was recently guest
speaker at the Clayton-Fayette Medical Society. His
subject was “Etiology of Eclampsia.”
* * *
Dr. Lewell S. King and Dr. Emory H. Main. College
Park, announce the removal of their offices to 105
Princeton Avenue, College Park, for the ' practice of
surgery and internal medicine. The above named
offices were formerly occupied by the late Dr. Charles
H. Daniel.
* * *
The Fulton County Medical Society held its semi-
monthly meeting at the Academy of Medicine, Atlanta,
on September 21. Program: Moderator — Dr. Elizabeth
Gambrell. ‘‘Blood Magnesium”, Dr. Amey Chappell;
“New Laboratory Aids in Diagnosis Thyrotoxicosis”,
Dr. Philip K. Bondy; "Thyroid Adenoma", Dr. David
Henry Poer.
* * *
Brief History of Adel Physicians: Dr. J. B! Oliphant
is a graduate of the University of Georgia School of
Medicine, Augusta, and interned in Augusta and Balti-
more. Md. He has had postgraduate work in obstetrics
in New York and New Orleans. He formerly prac-
ticed in Augusta, but has been practicing in Adel
since 1934.
Dr. Fred Clements, son of Dr. H. W. Clements,
graduated from the University of Georgia School of
Medicine, Augusta in 1943, and interned one year at
the Macon Hospital, Macon, prior to his military
service. He spent three years with the Army and a
great part of his time was spent in a general hospital
in England. In 1948 he took a postgraduate course in
surgery at the New York Polyclinic Medical School and
Hospital, New York. He has been practicing in Adel
since 1946.
Dr. W. R. Schnauss graduated from the University
of Georgia School of Medicine, Augusta, in 1916, and
served his internship at St. Lukes Hospital, Duval
Medical Center, and St. Vincent’s Hospital, all in
Jacksonville, Fla. His first private practice wras in
Jacksonville, Fla. He is a veteran of World W’ar I.
Dr. H. Wr. Clements graduated from the LJniversity
of Georgia School of Medicine, Augusta, in 1900. Be-
fore coming to Adel, he practiced in Hahira, Lenox,
and Ray City. He has done postgraduate work in
Chicago and New York.
Dr. L. R. Hutchinson graduated from the Atlanta
Medical College in 1914 and interned at Grady Hos-
pital in Atlanta. Except for a few years in Miami
and in the Army, he has practiced in Adel. Dr.
Hutchinson has attended clinics at Emory University
and Chicago.
* * *
Dr. Albert A. Rayle. Jr.. Atlanta, was recently named
by Emory University to its medical staff. Dr. Rayle
was graduated from Emory University School of Medi-
cine, Atlanta, in 1944. and also attended Columbia
University College of Physicians and Surgeons, New
^ ork City. He is associated with his father, Dr.
Albert A. Rayle, 478 Peachtree Street, N. E., Atlanta.
* * *
The Georgia Vocational Rehabilitation Division re-
cently held a w:eek long conference at the General
Oglethorpe Hotel on Wilmington Island, Savannah.
The first session began with the portion of the program
devoted to physical restoration of handicapped persons.
Dr. Thomas P. Goodwyn, Atlanta, state medical con-
sultant to the vocational rehabilitation workers, pre-
sided. Speakers and their subjects were: Dr. John L.
Elliott, Savannah, "Rehabilitation of Tubercular
Patients"; Dr. Osier A. Abbott, Atlanta, “Chest Con-
ditions Feasible for Rehabilitation”; Dr. T. G. Pea-
cock, Milledgeville, “Rehabilitation of Persons Dis-
charged from Mental Institutions”; Dr. Joseph S.
Skobba, Atlanta. "Psychiatric Conditions Feasible for
Rehabilitation"; Dr. Marion C. Pruitt, Atlanta, Rectal
Diseases Considered Feasible for Rehabilitation”; Dr.
Alton V. Hallum, Atlanta, “Visual Defects that Respond
to Treatment”; Dr. Ben H. Clifton, Atlanta, “Nervous
Conditions”; Dr. Jeff L. Richardson, Atlanta, "Prob-
lems of High Blood Pressure”; Dr. Robert Ellison,
Augusta. “Surgical Treatment of Heart Conditions”;
Dr. Ernest F. Wahl. Thomasville, “Treatment of Ulcers
in the Stomach and Intestinal Tract”; Dr. James K.
Fancher, Atlanta, "Endocrinologic Conditions Feasible
for Rehabilitation", and Dr. Frank F. Kanthak. Atlanta,
“Deformities of the Jaw”.
* * *
The Second District Medical Society held its dinner
meeting at Radium Springs, Albany, October 12. Pro-
gram: Call to order by Dr. Robert M. Joiner, Moultrie,
president. Reading of minutes; introduction of visi-
tors, announcements, appointment of committees. Scien-
tific program: “Experience with ACTH, and Cortisone
in Various Endocrine and Non-Endocrine Conditions”,
Dr. Robert B. Greenblatt, Augusta; “The Problem of
Gout”, Dr. George R. Dillinger, Thomasville; “Koda-
chrome Clinic — Pediatric Cases”, Dr. Mack Sutton,
Albany, and Cervical Smear as a Routine Office
Procedure”, Dr. Charles G. Bellville, Bainbridge.
Officers are Dr. Robert M. Joiner, Moultrie, president;
Dr. Milton Berry Bowman, Albany, vice-president; and
Dr. Frank A. Little, Thomasville, secretary.
* * *
The South Georgia Medical Society held its regular
meeting at the Country Club, Valdosta, September 12.
Surgery under combat conditions was vividly illustrated
to members of the society as they viewed actual photo-
graphs taken during World War II at the 74th field
hospital center on Okinawa. The film was taken by
Dr. William C. Roberts, of Panama City, Fla., while
he was on combat duty in the South Pacific during
World War II. It has been proclaimed by the Surgeon
General of the Army as the only film of its kind in
existence. The photography was done by Dr. James
A. Johnson, Jr., of Manchester, also assigned to the
field hospital. The film is to be used for Armed
Services training purposes and has been copyrighted
in the name of Dr. William C. Roberts. Dr. James
L. Campbell. Jr., Valdosta was program chairman for
the meeting. In a brief business meeting, two com-
mittees were appointed by Chairman Dr. John Raymond
Smith, of Hahira, in response to communications from
the American Medical Association. Dr. Alex G. Little,
Valdosta, was named chairman of the public relations
committee and asked to choose his own committee.
October, 1950
429
Dr. W. R. Schnauss, Adel, Dr. Earle S. McKey, Jr.,
and Dr. Bennet C. Owens, both of Valdosta, were
named to the hospital medical committee. A com-
mittee headed by Dr. James L. Campbell, Jr., Valdosta,
was named to make recommendations concerning insur-
ance programs in the county. Dr. Campbell introduced
a request from Dr. Daniel B. Terry, of Homerville,
that Blue Cross and Blue Shield be considered. A
representative of an insurance company from Jackson-
ville, Fla. asked that his firm be considered also. Other
members of the committee are: Dr. W. W. Turner,
Nashville; Dr. J. B. Oliphant, Adel, and Dr. John
Raymond Smith, Hahira. Dr. Jesse Parrott, Hahira,
secretary.
* * *
The Seventh District Medical Society held its meet-
ing at Fairyland Club on Lookout Mountain, September
27, as guest of Walker-Catoosa-Dade Medical Society.
Program: Invocation by the Rev. George H. Murphy,
pastor of the Church of Good Shepherd, Lookout Moun-
tain; Address of Welcome, Dr. Howard C. Derrick,
LaFayette; Reading of minutes; report of committees
and councilor. Introduction of new members. Scien-
tific program : Address by Dr. A. M. Phillips, Macon,
president of the Medical Association of Georgia;
'‘Differential Diagnosis of Diseases of the Lungs”,
Dr. Rufus F. Payne, Rome; “Chemotherapy and Anti-
biotics”, Dr. Paul B. Beeson, Atlanta; "Instructions
for the Psychosomatic Patient”, Dr. Hal M. Davison,
Atlanta. Questions for the essayists conducted by Dr.
Davison. Officers are: Dr. Lee H. Battle, Rome, presi-
dent; Dr. S. B. Kitchens, LaFayette, secretary-treasurer,
and Dr. Lloyd Wood, Dalton, councilor.
The Woman’s Auxiliary to the Seventh District Medi-
cal Society held its meeting at the Fairyland Club,
Lookout Mountain, September 27. Program: Welcome
by Mrs. Howard C. Derrick, LaFayette; Response by
Mrs. Inman Smith, Rome; Reading of minutes, reports
from county auxiliaries, new business and election of
officers. “A Discussion of Nutrition”, Dr. Hal M.
Davison, Atlanta. Officers are: Mrs. Harry Mull,
Rome, District Manager; Mrs. Emmett Brannon, Rome,
Vice District Manager, and Mrs. William Harbin, Jr.,
Rome, secretary.
COMMUNICATIONS
1950 DIABETES DETECTION DRIVE
AMERICAN DIABETES ASSOCIATION, Inc.
New York 18, N. Y., September 12, 1950
To: Secretaries of County and State Medical Societies:
Plans for Diabetes Week — November 12-18, 1950 —
are now far advanced, and over 500 State and County
Medical Societies have indicated their intention of
taking part in this year’s program.
There is still time for your medical society to form
a Committee on Diabetes and to participate in the
Diabetes Detection Drive. Why not present this matter
now to your society for action?
The Diabetes Detection Drive, sponsored by the
American Diabetes Association, is the only large-scale
health education and disease detection program de-
veloped exclusively by the medical profession. It offers
physicians an unusual opportunity to sponsor and
implement a constructive public relations program, as
well as a way of performing a genuine service for the
citizens of their local communities. No chronic disease
can be so easily and inexpensively detected as diabetes,
nor can any other similarly serious illness be so effec-
tively managed — always providing that the medical
profession takes an aggressive lead in carrying through
such a program.
In order to be a success, the Diabetes Detection
Drive — which has been approved three years in suc-
cession by the American Medical Association — requires
a concentrated effort on the part of all of us. We
hope that your society will take up the challenge this
year, and will organize an all-out detection program
for Diabetes Week.
The American Diabetes Association has prepared
a series of practical, easy-to-use pamphlets on how to
organize and promote a Diabetes Detection Drive.
Copies of two of these pamphlets are herewith en-
closed. Suggestions on how to organize a Committee
on Diabetes in your society are given on page 4 of
the pamphlet, "Organizing a Successful Diabetes De-
tection Drive.”
A form on which you can let us know what action
your Medical Society takes on this matter is attached,
together with a self-addressed return envelope. Do not
hesitate to get in touch with us if you want any
additional information or literature.
Very cordially yours,
JOHN A. REED, M.D., Chairman
Committee on Diabetes Detection.
* * *
UNIVERSITY OF GEORGIA SCHOOL
OF MEDICINE
Augusta, Georgia
September 14, 1950
Dr. Edgar D. Shanks, Editor
The Journal of the Medical Association of Georgia,
Atlanta, Georgia
Dear Dr. Shanks:
The annual Obstetric Seminar will be held on
November 13-17, 1950, at the Medical College of
Georgia, Augusta, Georgia. This is under the auspices
of the Division of Maternal and Child Health of the
State Board of Health of Georgia, Florida and South
Carolina.
Speakers will include nineteen diplomates of the
American Board of Obstetricians and Gynecologists.
We would appreciate it if you would list this in your
meeting notices.
Sincerely yours,
RICHARD TORPIN, M.D.
Professor and Chairman, Department
of Obstetrics and Gynecology.
RESEARCH GRANTS MADE TO
EMORY PROFESSORS
About $35,000 in medical research grants were ear-
marked recently for Emory University, according to
the announcement by the federal security administra-
tor. The grants, made by the Public Health Service,
are part of $4,000,000 approved by the Surgeon Gen-
eral upon the recommendations of the National Advisory
Health Council.
Funds will go to 144 institutions in 39 states, with
Emory University receiving four of the six made in
Georgia.
The two largest Georgia grants go to Dr. John L.
Patterson, assistant professor of physiology, and Dr.
Albert Heyman, assistant professor of medicine, for
studies on diseases of the brain, and to Dr. Walter
H. Sheldon, chairman of the department of pathology,
and Heyman for studies on the Herxheimer reaction
in syphilis. Dr. Stephen W. Gray, associate professor
of anatomy, will conduct research in effect of high
gravitational environment on cell and tissue growth,
Dr. Paul H. Beeson, associate dean of the School of
Medicine, will do research in leptospiral meningitis.
DR. R. E. DYER COMES TO EMORY
The retirement of Assistant Surgeon General R. E.
Dyer, Director of the National Institutes of Health,
on October 1, w'as announced recently by Dr. Leonard
A. Scheele, Surgeon General of the Public Health
Service, Federal Security Agency.
In Atlanta, officials of Emory University announced
simultaneously that Dr. Dyer had accepted appointment
as director of research at the Robert Winship Clinic of
the Emory University Medical School.
Dr. Dyer has spent 34 years in the Public Health
Service. He has served since 1942 as director of the
National Institutes of Health, research branch of the
430
The Journal of the Medical Association of Georgia
service with permanent laboratories at Bethesda, Md.,
and field research projects in many other places in
this country and abroad.
OBITUARY
Dr. Bentley Childs Adams, aged 53. one of Thomas-
ton’s leading physicians and prominent citizens, died
August 28, 1950. Dr. Adams was born in Carsonville
district, Taylor County, the son of the late Mr. and
Mrs. Arch Adams and with his parents moved to
Thomaston when he was six years of age. He graduated
from Emory University School of Medicine, Atlanta,
in 1923, and he interned one year at Macon Hospital,
Macon. He spent his entire professional life minister-
ing to the sick of Thomaston and Upson County.
In 1924 lie became associated with Dr. R. L. Carter,
Thomaston. The two physicians opened a clinic and
at the time of Dr. Adams’ death they were operating
The Clinic, Thomaston, with Dr. T. A. Sappington
and Dr. A. A. Arrington. Dr. Adams was a member
of the Upson County Medical Society, the Medical
Association of Georgia and a fellow of the American
Medical Association. He was a member of the First
Baptist Church, and served as a deacon and treasurer
of the church. His community interests were numerous,
and besides his church work, he was a Mason and
a Shriner. Dr. Adams was a member and past presi-
dent of the Thomaston Kiwanis Club, and a director
of the Thomaston and Upson County Chamber of
Commerce. He served a term on the Thomaston Board
of Education. In addition to his work with young
people on the athletic field, he also worked with
Boy Scouts. He was a member of the .Flint River
Boy Scout Council and devoted much time and talent
to Scouting. He is survived by his wife; a daughter,
Mrs. Jim Woods, Atlanta; a son, Bentley Adams;
three sisters and three brothers. Funeral services
were held in the unfinished auditorium of the First
Baptist Church with the pastor, the Rev. Raymond
C. Moore officiating, and the Rev. Richard F. Simpson
and the Rev. J. M. Windham assisting. Burial was in
the Glenwood Cemetery, Thomaston.
* * *
Dr. Everette Iseman, aged 65, died at his home,
302 East Forty-sixth Street, Savannah, September 3,
1950. Dr. Iseman was a native of Spartanburg, S. C.,
the son of the late Simon Iseman and Ellen Levi
Iseman. He graduated from the University of Mary-
land School of Medicine and College of Physicians
and Surgeons, Baltimore, Md., in 1909, and interned
at the Hebrew Hospital, Baltimore. He lived in
Manning, S. C., before moving to Savannah. He was
a member of the Georgia Medical Society, the Medical
Association of Georgia and the American Medical
Association. A veteran of World War I, Dr. Iseman
was a member of Savannah Post No. 135, American
Legion. We quote from the editorial pages of the
Savannah Press, September 4, 1950:
“Many Savannahians in all walks of life lost not
only a physician but a friend when Dr. Everette Iseman
succumbed yesterday after an illness of several weeks.
He had been active in his profession here for 37
years, ministering to his patients without regard to
self up until the very hour that he was stricken. It
had been hoped that with rest he could recover his
strength, but the strain on his endurance through
the vears had been too much.
"No one ever needed Dr. Iseman's services without
being able to get him, regardless of the hour or
weather. A capable physician and surgeon, he com-
bined his knowledge with a personal interest in every
patient that won him a place of affectionate esteem
among the high placed and the humble. It was in-
dicative of the spot that Dr. Iseman held in the hearts
of those to whom he administered that when news
of his serious illness became known individual and
collective prayers were offered in many homes and
churches for his recovery.
“More than a generation had grown up under Dr.
Iseman and as a physician he had watched the cycle
of life in countless families. With them he had re-
joiced in times of happy events and he had employed
his skills to lighten their dark hours. Truly, there are
many to recall him not alone as doctor hut friend.”
He is survived by his wife, Mrs. Doris Smith Iseman;
one daughter, Mrs. Milton F. Eisenberg, both of Savan-
nah; two sisters and two grandchldren. Funeral services
were held at Mike Israel Synagogue, conducted by
Rabbi Solomon E. Starrels. Burial was in Bonaventure
Cemetery, Savannah.
PLAY SAFE WITH DRUGS
The indiscriminate use of drugs can be costly, not
only from an economic standpoint but in the value
of lives lost or damaged, the Educational Committee
of the Illinois State Medical Society cautions in a
Health Talk. With the unfortunate emphasis today on
sleep inducing agents called barbiturates, the antihista-
mines and the antibiotics as “cure alls”, it is no wonder
that the public is confused.
Properly handled under competent medical super-
vision, these drugs have a useful place in alleviating
pain and curing disease. Frequently, for example, it
is necessary to prescribe a sedative, but sleeping pills
and powders as a regular habit can be extremely harm-
ful. When the body and mind are functioning normally,
there is no need for drugs to make you sleep.
The antihistaminic drugs are a product of the
research laboratory which marks the advance of medi-
cine in the curative field. Handled carefully, these
drugs are producing good results in some conditions
related to allergy, but they are also causing severe
reactions in certain individuals. Histamine is a chemi-
cal normally present in the body which, in some
persons, is the factor involved in allergic conditions,
such as hives, hay fever and other sensitivities. Thus
the antihistaminic drug is a compound designed to
fight this chemical reaction in the body, which makes
some people more sensitive than others to certain
conditions.
Because so many antihistaminic drugs are now
marketed does not mean that they are safe or that
they are the answer to the mystery of the common
cold which is characterized by symptoms similar to
forms of allergy, such as itching and swelling of the
nasal membranes, tearing of the eyes, and the like.
Taken indiscriminately, the antihistaminic drugs can
kill. They can also be the means of causing death
and injury, since they produce side-effects in certain
persons that make them unsafe to drive a car. for
example. These side-effects include nausea, vomiting,
headaches, poor coordination and drowsiness.
Antibiotic drugs are another group which must be
handled carefully. Taking its name from anti meaning
against and bio meaning living tissue, this group then
fights organisms or bacteria either by destroying them
completely or decreasing their growth. There are
numerous antibiotic drugs, all of which work differ-
ently in various conditions. They too produce different
reactions necessitating the watchful supervision of
a physician.
Research is necessary to learn the cause and cure
of disease. Research brings knowledge and knowledge
is power — the power to save life and relieve pain. But
indiscriminate use of drugs will undo the good that
is being accomplished. Self-medication is not the
product of medical research, for it brings illness and
unhappiness instead.
Too much of one drug can produce toxicity or
poisoning in the chemical substances of the body, a
condition which results in drowsiness, a mental stupor,
October, 1950
431
a difficulty in walking and talking and noticeable
tremors of the tongue, lips and fingers.
Don’t listen to the flamboyant advertising on drugs.
Be suspicious of anything that is presented as a
“cure-all’’. Be cautious. You don’t know how one
taken blindly may affect you.
LINK FOOT ERUPTIONS TO SHOE
MATERIALS AND CONSTRUCTION
Rapid increase in foot eruptions has paralleled the
use of certain materials, particularly waterproof mate-
rials, in manufacturing footgear, two Evansville (Ind.)
dermatologists point out.
Writing in the July issue of Todays Health , pub-
lished by the American Medical Association, Drs. L.
Edward Gaul and G. B. Underwood say:
“Parents can learn something from instinctive actions
of their children. Instead of calling their toe itch
the fungus or athlete’s foot and promptly rubbing
in an irritating remedy, they should (like their chil-
dren) kick off their shoes.
“The financial setbacks of the shoe industry in
1919 sent fabricators scurrying for cheaper materials.
Time-proved leather was replaced by rubber and
adhesives, by bonded, laminated, coated and impreg-
nated fabrics and papers. Various plastics are now
replacing these. The result is that we have steadily
exposed our feet to a wide variety of chemicals.”
Foot eruptions are the third most common skin dis-
ease, the doctors find. One survey indicated that three
out of four people have foot eruptions. Careful
studies by dermatologists have shown fungus to be
the cause in approximately 50 per cent of cases.
“Certainly the rapid increase in foot eruptions
paralleled the use of cheaper materials in manufactur-
ing footgear, and particularly waterproof materials,”
the doctors say. “Tanners and processors have suc-
ceeded in destroying the natural porosity and absorbent
properties of leather. Various chemicals highly irritat-
ing to the skin are added. Zealous manufacturers seal
any porosity left in leather with moisture-resistant
adhesives and cements.
“To make sure that none of the sweat from the
sole can evaporate, beneath the insole is a bottom
filler that seals out wet weather. Anything on hand
that will not dissolve in water is used as filler. One
combination consists of asphalt and a mass of cemented
rubber, containing pieces of cork. These substances
ooze up through tack holes and cracks and make the
feet sweat, burn, itch and break out.
“Contact of an impervious material like rubber sheet-
ing, plastic or painted leather with the skin is soon
followed by an accumulation of moisture. This results
from unconscious sweating. In hot weather the sweat
increases. If the sweat cannot evaporate, the cooling
effect of evaporation is lost and the skin heats up.
“An annoying burning sensation results. The skin
swells, blood vessels dilate and the functions of the
skin as a protective covering for the body are quickly
lost. Then the chemical irritants in the shoes work
their havoc. The feet burn, smart, itch, become red-
dened and soon break out. The thin skin between
the toes is white and soggy, a warning that the shoes
do not allow the sweat to evaporate.
"Investigators emphasize that fungi grow and thrive
in moisture. Water-tight shoes provide ideal growth
and multiplying conditions. Future footgear should
take care of two basic needs: (1) rapid dissipation of
sweat from the feet; (2) dryness in wet weather.
Loose-fitting rubbers allow air movement around the
shoes. This protection should be removed as soon as
the wearer is in a dry place.
“Nature furnished us with a delicate alarm system
for detecting irritations of the skin. Its warnings
are itching, burning, stinging and swelling. If these
symptoms appear, suspect your shoes at once. More
severe warnings are redness, blisters and ‘weeping .
RESPIRATOR “BREATHES” FOR
POLIOMYELITIS VICTIMS
A respirator which enables victims of the bulbar
type of poliomyelitis to breathe almost in a natural
manner has been developed by a group of Boston
doctors.
In contrast to older forms of artificial respiration
by means of pressure, the new respirator operates
through electrical stimulation of a point on either of
the phrenic nerves, which run down each side of the
neck into the diaphragm.
Drs. Stanley J. Sarnoff, James V. Maloney, Jr., Benja-
min G. Ferris, Jr., and James L. Whittenberger. and
Charlotte Sarnoff, all of the Harvard School of Public
Health, describe the use of the respirator in the
August 19 Journal of the American Medical Associa-
tion.
Acute bulbar poliomyelitis is the form of the disease
in which the enlarged upper part of the spinal cord,
popularly called the “bulb . is affected. Since this
area contains vital centers that control respiration and
the heart, involvement can be severe enough to inter-
fere with breathing. It has become general practice
not to place a patient so affected in a tank respirator,
since this may increase the respiratory difficulty, the
doctors say.
“Supportive therapy, with painstaking attention ta
maintaining an unobstructed airway, has remained the
cardinal principle in the management of this form of
the disease,” the doctors point out. “Phrenic stimula-
tion has not been used previously in bulbar poliomye-
litis.
“Respiration was produced by applying a moistened,
cloth-covered electrode externally over the skin at the
site of the motor point of the phrenic nerve.”
The first patient to receive electrophrenic respiration
was a 9-year-old boy who was brought to the Children’s
Hospital in Julv, 1949. He was acutely ill and spon-
taneous respiration had become highly irregular.
“The patient’s residual paralyses gradually dis-
appeared almost completely,’ the doc'ors report. In
December 1949 he could swallow, had gained weight
almost to his presumer level and had recovered suf-
ficiently to engage successfully in his favorite sports,
ice skating and ice hockey.”
Successful use of the respirator on eight othel
patients is reported by the doctors. However, they
add:
“The usefulness of the electrophrenic respirator can-
not be considered as established in bulbar poliomyelitis
until additional experience has been obtained, but the
data are encouraging. It is obvious that one phrenic
nerve must be wholly or oartiallv uninvolved by disease
if effective electrophrenic respiration is to be per-
formed.
“The extraordinary extent and severity of central
nervous svstem derangement that can exist and still
be reversible if the critical demands of the respiratory
and circulatory systems are met has been demonstrated.
The electrophrenic respirator consistently and strikingly
diminished the restlessness and hypertension in one
patient and achieved similar results in others.”
The study was aided bv a grant from the National
Foundation for Infantile Paralysis, Inc.
RESENTMENT CAN CAUSE HIVES,
DOCTORS’ STUDY SHOWS
A close relationship between an attitude of resent-
ment and development of hives (commonly known as
nettle rash) is shown by a study made by two New
York doctors.
“Thirty unselected cases of chronic hives were
432
The Journal of the Medical Association of Georgia
investigated to determine the relationship between
stressful life situations and processes responsible for
the disease, l)rs. David T. Graham and Stewart Wolf
of Cornell University Medical College say in the
August 29 Journal of the American Medical Associa-
tion.
"Attacks were highly correlated with emotional dis-
turbances of a particular kind. Traumatic life situa-
tions responsible for lesions were almost exclusively
those in which the patient felt resentment because he
saw himself as the victim of unjust treatment about
which he could do nothing.
"In brief, these patients considered themselves
wronged or injured (usually by someone in a fairly
close family relationship), and they regarded the
situation as one which precluded any action on their
parts. They believed that they could neither retaliate
nor run away. In this setting, they became intensely
resentful.
"All the subjects were seen to flush when topics
of significant personal concern were brought up for
discussion. Five subjects had lesions while discussing
their problems.
“In general, as a group the patients had not only
failed to express hostility but tended not even to feel
it. They had for the most part adopted a rather
passive attitude toward punishment from parents or
other superiors. This was sometimes the result of
being exposed to authoritarian parents who tolerated
no expressions of aggression.
“One man apparently came to a decision that there
were more rewards in conforming to his father’s
wdshes than in rebelling. Another was brought up
by h;s mother and aunt to feel guilty about hostile
feelings or behavior and almost all tendencies to
action on his part had been frustrated by adults. In
at least two women the difficulty seemed to be prin-
cipally that they found hostility unacceptable in terms
of their standards of proper behavior.
“The failure to find ‘allergic” factors is of interest.
Many of the patients had already tried eliminating
from their diets various foods which they had sus-
pected of being responsible for their diseases. How-
ever. this group may not represent a truly random
sample of persons with chronic hives.
“All the evidence presented with respect to skin
changes indicates that the difficulty is an increased
tendency of (blood) vessels to dilation. The vessels
behave as they would have if the person actually had
been receiving blows.”
SOME OF THE MOST IMPORTANT
“FAMOUS FIRSTS”
IN THE HISTORY OF MAN'S HUMANITY TO
MAN IN THE UNITED STATES:
1727 — First Childrens Institution : founded by Ursu-
line Nuns in New Orleans to care for children orphaned
by Indian massacre.
1752 — First Hospital: Pennsylvania Hospital, Phila-
delphia. Cornerstone laid by Benjamin Franklin. Now
a Red Feather service.
1851 — First Group IT ork Agency: Boston YMCA,
December 29. Patterned after “Y” in Montreal. 644
T s are Red Feather services of local Community Chests
today.
1853 — First Foster Home service for children: The
Children s Aid Society of New York was the first to
place dependent or neglected children in “foster
homes, rather than in orphanges.
1854 — First Day Nursery: Following in the wake of
the French “creche” movement in Paris, a “Nursery
for Children of Poor Women” was established in New
Tork City in 1854. Now, many day nurseries are
supported through Community Chests.
1877 — First Visiting Nurse Association: New York
City. Visiting Nursing is now one of the most importani
of the Red Feather services.
1877 — First Family Service Society: Buffalo, N. Y.
Established to “do away with the whole indiscriminate
method of almsgiving” and to “organize the charitable
impulses and resources of the community in behalf
of families in need according to their need.”
1887 — First United Fund-Raising Campaign: The
“Associated Charities”, Denver, Colorado. Included 23
health and welfare services.
1909 — First Council of Social Agencies: Milwaukee,
Wis., and Pittsburgh. Pa. There are now 400 Councils
throughout the United States, often called now “Com-
munity Welfare Councils”.
1913 — First Community Chest: Cleveland, Ohio, es-
tablished the first united fund-raising campaign with
budgeting and social planning.
1945 — First Adoption of Red Feather As National
Symbol of the community Chests and Councils of
America.
There are now fifteen thousand Red Feather services,
supported by Community Chests, many of which are
direct descendants of these “Famous Firsts”.
Note: If you are interested in full details on any
of these leads, please write to Magazine Service.
Community Chests and Councils of America. 155 East
44th Street, New York 17, N. Y. (MU 7-8300).
NEW BOOKS
Operative Technic in Specialty Surgery. Edited by
Warren H. Cole, M.D., F.A.C.S., New York: Appleton-
Century-Crofts, Inc., 1949.
There are 21 contributors to this book which is
edited by Dr. Warren Cole, an outstanding surgeon.
The specialties include plastic surgery, thoracic surgery,
orthopedic surgery, neurosurgery, gynecology and male
urology. Many of the chapters include descriptions of
basic anatomy and physiology which is helpful to the
general surgeon.
The section on plastic surgery deals with w-ound
healing, skin grafting and definitive procedures most
commonly employed.
The section on thoracic surgery describes the technics
of thoracoplasty, pulmonary resection, diaphragmatic
hernia and cardiac surgery in detail.
The section on orthopedic surgery is well organized,
describing both closed and open methods for fracture
reduction. The section on neurosurgery covers trauma,
infection, brain tumors, spinal cord, cranial nerves and
peripheral nerve. The autonomic nervous system is also
covered.
The section in gynecological surgery describes pro-
cedures which have been useful to the authors eliminat-
ing discarded procedures.
This book will be a help to the resident surgeon
and the general surgeon doing some specialized pro-
cedures.
WILLIAM P. LEONARD, M.D.
* * *
The Pathogenesis and Pathology of Viral Diseases
edited by John G. Kidd, M.D., Department of Path-
ology, The New York Hospital — Cornell Medical Cen-
ter. New York Academy of Medicine, Section on
Microbiology, Symposium No. 3. 235 pages, 6x9 inches,
illustrated. New York, Columbia University Press,
1950. Price: 15.00.
This is the third of a series of important and dis-
tinguished volumes to come from the symposia held
by the Section on Microbiology on the New York
Academy of Medicine. The papers in this volume
contain the latest information in the relatively new
and growing field of virology. Being cellular parasites,
viruses are best studied in their relationship with cells.
This important phase of virology is covered thoroughly
in these papers. They contain data not duplicated in
any other single volume. Much of the information is
October, 1950
433
completely new, notably most of that on electron
microscopy of viruses. The subjects are presented by
twelve authorities, all of whom have worked long
in the field of virus diseases and have published
widely. The book is well illustrated with charts and
photomicrographs.
* * *
Williams Obstetrics by Nicholson J. Eastman, Pro-
fessor of Obstetrics in Johns Hopkins University School
of Medicine, and Obstetrician-in-Chief of the John
Hopkins Hospital. 10th edition, 1200 pages, 696 illustra-
tions. New York, Appleton-Century-Crofts, Inc., 1950,
Price: $12.50.
Over half of this new 10th edition, originally written
by J. Whitridge Williams and revised in its 7th, 8th,
and 9th editions by Henricus J. Slander, has been
completely rewritten by the present author in order
to provide the practicing physician and the student
with a complete and thoroughly modern text. Recog-
nizing the need for continued strong emphasis on sound
fundamentals, Dr. Eastman has strengthened those
sections and in addition he has built up and con-
siderably enlarged the sections on prenatal care, the
treatment of the complications of pregnancy, the
handling of the delivery, the details of operative pro-
cedures, and the uses of all the most modern, recog-
nized methods for the further necessary reduction of
maternal and infant mortality. Historical data and
theoretical considerations have been reduced to an
absolute minimum in order to give the practitioner
and student information of a more practical type.
* * *
'The Ethical Basis of Medical Practice, by Willard
L. Sperry, Dean of the Harvard Divinity School, with
a foreword by J. Howard Means, M.D.. Jackson Profes-
sor of Clinical Medicine, Harvard University Medical
School. Pp. 185. New York: Paul B. Hoeber, Inc.,
1950. Price $2.50.
This book is of special interest to both practitioners
and medical students. It grew out of a lecture given
to house officers at the Massachusetts General Hospital.
Dean Sperry is more concerned with defining and
clarfying the basic moral problems that confront the
physician than with providing a ready-made set of
answers. He considers such topics as the general rela-
tions of science and ethics, the basic distinction be-
tween a profession and a trade, the influence of speciali-
zation upon ethical standards, and the meaning of
“reverence for life” to the modern scientist. In two
well-balanced and thoughtful chapters the author
examines both the pros and cons of euthanasia.
Throughout the book, the reader — physician, pastor or
patient — will find clarity, penetrating vision, and a wise
absence of dogma.
* * *
A Textbook of X-Ray Diagnosis, edited by S. Coch-
rane Shanks, M.D., F.R.C.P., F.F.R., Director, X-Ray
Diagnostic Department, University College Hospital,
London ; and Peter Kerley, M.D., F.R.C.P., F.F.R.,
D.M.R.E., Director, X-ray Department, Westminster
Hospital; Radiologist, Royal Chest Hospital, London.
Volume IV (Bones, Joints and Soft Tissues), Second
Edition. 592 pages, 6x9 inches, with 533 illustrations.
Philadelphia and London, W. B. Saunders Company,
1950. Price $15.00.
This volume IV is one of four books in the new
(2nd) edition. The other three will be released in
the near future. This book covers adequately all com-
mon lesions of the bones, joints and soft tissues, with
the material subdivided into eleven parts as follows:
The Normal Bones and Joints; The General Pathology
of Bone; Congenital Deformities of Bones and Joints;
Traumatic Lesions of Bones and Joints; Inflammatory
Diseases of Bone and Joints; Osteochondiritis; Static
and Paralytic Lesions, the Intervertebral Discs, Ortho-
pedic Operations; Constitutional Diseases of Bones
and Joints; Tumors and Cysts; the Soft Tissues; and
Localization of Foreign Bodies. The x-rays are bril-
liantly reproduced; the accompanying text is clear,
concise, and highly informative. This volume is a
worthy successor to the famous volume of the First
Edition.
* * *
Techniques in British Surgery, edited by Rodney
Maingot, F.R.C.S. England, Surgeon. Royal Free Hos-
pital, London; Senior Surgeon, Southend General
Hospital. 733 pages, 6%"x9 with 473 Illustra-
tions. Philadelphia and London, W. B. Saunders Com-
pany, 1950. Price: $15.00.
Twenty-nine topflight British surgeons contributed
to this book detailed accounts of the operative technics
they have perfected — technics that are acknowledged to
be the most effective known in Great Britain at the
present time. While step-by-step procedure is empha-
sized and demonstrated in more than 1000 pictures on
473 figures, a well-balanced amount of attention is
paid to pre- and postoperative care, prevention and
treatment of complications, and general management
of the case. General and special surgeons, practitioners,
and many specialists will find this new volume a
real storehouse of thoughts, hints, helps — ideas that
can be applied in whole or in part to their own
practices.
* * *
Aseptic Treatment of Wounds, by Carl W. Walter,
M.D., Assistant Professor of Surgery, Peter Bent Brig-
ham Hospital, Director of Laboratory for Surgical Re-
search, Harvard Medical School. 372 pages, 255 figures
made up of 974 line drawings. New York, The Mac-
millan Company, 1948. Price: $9.00.
This book contains a complete summary of the
latest facts on methods of preventing postoperative
infection and sepsis — the methods by which the surgeon,
his assistants, and all the materials that enter into a
surgical procedure are rendered aseptic. Each chapter
contains a description of apparatus, equipment, and
instruments required for the particular method of
asepsis under discussion. There are instructions for
their use and maintenance. We recommend this book
to anyone connected in any way with surgical field,
such as physicians, surgeons, medical students and
nurses. The technic described expresses the surgical
philosophy of Elliott C. Cutler and Harvey Cushing.
The illustrations by Mildred Codding, well-known medi-
cal illustrator, provide minute dramatization of each
step involved in a technic.
* * *
Principles of Public Health Administration by John
J. Hanlon, M.S., M.D., M.P.H., Associate Professor of
Public Health Practice, School of Public Health,,
University of Michigan, and Chief Medical Officer and
Associate Chief of Party, Bolivia, The Institute of
Inter-American Affairs. 506 pages with 48 illustrations.
St. Louis, The C. V. Mosby Company, 1950.
Dr. Hanlon has divided his book into three main
parts: (1) An Introduction, containing chapters on the
philosophy, background and development, and socio-
economic justification of public health activities; (2)
Administrative Considerations in Public Health: and
(3) Pattern of Public Health Activities in the United
States. Wide use is made of excellent illustrative
charts and tables. This volume, the newest of its kind
published in the United States, is recommended to
all persons interested in public health work.
* * *
Friend of the People by Chalmers G. Davidson, Ph.D.,
Professor at Davidson College. Pp. 151. Columbia,
The Medical Association of South Carolina, 1950.
Price: $2.75.
This is the story of the life of Dr. Peter Fayssoux,
Charleston, South Carolina, the first president of the
434
The Journal of the Medical Association of Georgia
Medical Association of South Carolina. Dr. Fayssoux
was typical of his generation in many facets of his
interests — a Revolutionary patriot, an outstanding
“practitioner of physic,” a leader in local statecraft
and a Charleston personality of singular appeal. During
the Revolution he was Surgeon-General and Chief
Physician for the Southern hospital. He was also a
leader of the Anti-Federalists — the “States-righters”
of their day. Anyone interested in medical history will
enjoy this book.
* * *
Cerebral Palsy by John F. Pohl. M.D., Orthopedic
Surgeon, Michael Dowling School for Crippled Children,
Minneapolis, Minnesota; Diplomate. American Board
of Orthopedic Surgery: Member, American Academy
of Orthopedic Surgeons; Associate Member, American
Academy for Cerebral Palsy. 224 pages with 131
illustrations. Saint Paul. Bruce Publishing Company,
1950. Price: $5.00.
This text explains the diagnosis and treatment of
cerebral palsy with specific and special therapeutic
technics concisely described. Numerous illustrations
supplement the descriptive chapters and vividly demon-
strate each step to be taken in the treatment of all
types of cerebral palsy. Emphasis is placed on neuro-
muscular training. The technics presented in this
book have been proved successful during twelve years
of research and clinical study by Dr. Pohl. Recom-
mended to medical practitioners, therapists, and parents
of children with cerebral palsy.
* * *
On Hospitals, by S. S. Gold water, M.D., Formerly
Superintendent and Director, the Mount Sinai Hos-
pital. New York; Commissioner of Healfh of the City
of New York; Consultant in Hospital Organization
and Planning; Commissioner of Hospitals of the City
of New York. 384 pages, 6% x9y2 inches, illustrated.
New York, The Macmillan Company, 1947. Price:
$9.00.
This book contains a group of more than fifty articles
carefully selected from the voluminous writings of a
man whose life was devoted to public health, hospital
administration, and hospital planning. These articles,
culled from the many previously published papers and
addresses and much unpublished material left by Dr.
Goldwater, were compiled and edited by Mrs. Gold-
water and experts in the field. Dr. Goldwater was so
far in advance of his time that the practices w'hich
he advocated are just now beginning to come into
wide use. This book is the outcome of his carefully
thought-out philosophy and his wide practical experi-
ence. Presented in Dr. Goldwater's clearly reasoned
style, it offers the most authoritative information avail-
able on the planning and administration of hospitals.
It is pleasant to read, easy to understand. It is a
definite addition to medical literature. Recommended
for all who work in hospitals.
* * *
Up From the Ape, by Ernest Albert Hooton, Professor
of Anthropology at Harvard University and Curator of
Somatology at the Peabody Museum. 769 pages,
6% x 91/2 inches, containing 39 full-page half-tone
plates, 6 photomicrographs, 68 text drawings. Revised
edition. New York. The Macmillan Company, 1947.
Price: $7.00.
A completely new edition of the famous classic on
man’s evolution from the dawn of time to the present
day which incorporates masses of new facts discovered
since the first edition of this delightful classic in 1931.
In the six parts of this book, man is viewed from all
possible sides. First there is the question to whom
he is related in the animal kingdom; why he is a
mammal and a primate; and if this reasoning does
not convince you, there is the newest proof — blood
tells! Immensely interesting and informative. Don’t
miss it.
The Management of Obstetric Difficulties by Paul
Titus, M. D., Obstetrician and Gynecologist to the St.
Margaret Memorial Hospital, Pittsburgh; Consulting
Obstetrician and Gynecologist to the Shadyside Hospital,
Pittsburgh; Secretary of the American Board of Ob-
stetrics and Gynecology ; Member Reserve Consultants
Advisory Board, Bureau of Medicine and Surgery,
United States Navy (Captain, MC, USNR). 1046
pages, 7 x 10 inches, 446 illustrations and 9 color
plates. Fourth edition. St. Louis, The C. V. Mosby
Company, 1950. Price: $14.00.
This latest edition of Dr. Titus’ book incorporates
the changes made in obstetric practice in the post-war
period since the publication of the third edition in
1945. He states that drugs, especially penicillin, used
exclusively by the armed forces in World War II
have come into use in private practice in the last
few years and have greatly lowered the maternity mor-
tality. This and other changes are ably presented.
One of the finest features of this text are the beautiful
illustrations, numbering nearly a half-thousand, which
appear in every chapter. A “must” for every obstetrician
and gynecologist.
* * *
Doctor Come Quickly, by Frank J. Clancy, M.D.. a
practicing physician in Seattle, Washington. 248
pages, 6x8^2 inches. Seattle, Superior Publishing
Company, 1950. Price: $2.95.
An autobiography of a physician whose practice
brings him into contact with people in a relationship
which is at once intimate and detached. He prefers
to look on a doctor as a person dealing with people,
rather than as a remote “M.D.” dealing with “cases”.
The emphasis in this book is on his practice; i.e. his
patients. The book teems with reminiscences: of
bathtub gin and stomach pumps, girls who followed
the fleet and then passed blithely through the VD
clinic, patients more interested in laxatives than life,
etc. The author states: “My object has been to present
a real-life doctor to the reader, not a medicine man
who performs staggering deeds with long magnetic
fingers and a bowl of hot water.” Recommended to
all tired doctors who need a tonic to pep them up.
Thoroughly enjoyable.
* * *
“Let's Name the Baby." A new booklet of particular
interest to doctors and parents-to-be has just been pub-
lished under the title, “Let’s Name the Baby.” It
includes over 750 first names of boys and girls giving
the original meaning of each name, the language from
which the name is derived, etc. The booklet also
includes horoscopes based on the signs of the Zodiac
covering birth dates throughout the year and an
interesting foreword which tells how our first names
evolved over the years. Another feature lists the
birthstones of the various months.
The 32-page booklet with humorous illustrations is
offered to doctors at low prices in quantity lots — as
low as 9 cents each in lots of 1,000, and 12% cents
each in lots of 100. It is being distributed to patients
by many obstetricians and pediatricians. Individual
copies are priced at 25 cents each and are obtainable
from Juvenile Merchandising, 114 East 32nd Street,
New York 16, N. Y.
* * *
Immortal Magyar, by Frank G. Slaughter, M.D., one
of the country’s most popular writers of medical fiction.
211 pages, 5% by 8Y2 inches, illustrated. New York,
Henry Schuman. Inc., 1950. Price: $3.50.
A straight-forward, un-romanticized narrative bi-
ography of one of the greatest and most tragic medical
figures, Ignaz Philipp Semmelweis, who conquered
childbed fever. Semmelweis was a Hungarian physi-
cian whose unique contribution to medical science was
never fully recognized in his lifetime. He started his
(Continued on Page XVI)
The Journal of the Medical Association of Georgia
XV
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XVI
The Journal of the Medical Association of Georgia
(Continued from Page 434)
fight against puerperal fever in Vienna but was driven
out by political and personal persecution. He then con-
tinued his life-saving task in Hungarian hospitals,
only to meet with more opposition. Embittered and
angry, he continued his lonely struggle until his death
at the early age of forty-seven. This is an inspiring
story, told with warmth and insight by one of the
country’s favorite authors, of a man who launched a
new era in obstetrics, and of his great life-saving
discovery.
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THE JOURNAL
OF THE
Medical Associa tionof Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia. November, 1950 No. 11
MANAGEMENT OF TRAUMATIC RUP-
TURE AND STRICTURE OF THE
MEMBRANOUS URETHRA COMPLI-
CATING FRACTURE OF THE PELVIS
James H. Semans, M.D.
Atlanta
In a series of 780 patients with fractures
of the bony pelvis, 99 or 12.6 per cent, were
complicated by rupture of the membranous
urethra. This series was collected in a high-
ly industrialized community, where such
accidents are not rare.1
Diagnosis. The diagnosis of rupture of
the membranous urethra is considered as
soon as blood is seen at the external urinary
meatus. Rectal examination frequently
demonstrates an absence of the normal con-
tours of the prostate. This is usually pro-
duced by bleeding around the urethra. The
resulting hematoma masks the prostate. Not
infrequently the prostate has been rotated
anteriorly, because of complete separation
from its attachment to the membranous
urethra. Traction on the apex of the pros-
tate by the remaining intact structures moves
this portion of the gland anteriorly and
proximally, away from the examiner’s rec-
tal finger.
It is occasionally necessary to inject ra-
diopaque material into the urethra to con-
firm the diagnosis. If this is done, a 10
per cent solution of diodrast, skiodan or
neoiopax should be used. These solutions
produce no painful necrosis of tissue. Be-
ing readily absorbed, they do not remain as
Read before the Medical Association of Georgia in annual
session, Macon, April 20, 1950.
a foreign body. Sodium iodide, although
opaque to x-ray, is extremely irritating to
tissue and painful, when it has extravasated
through the point of rupture in the urethra.
The oily solutions are less desirable because
of their permanence.
The possibility of rupture of the urinary
bladder, complicating fracture of the bony
pelvis, must also be considered. This is
outside the scope of the present discussion.
Treatment. Because the patient is fre-
quently in shock, elevation of the foot of the
bed, blood transfusions and sedation are of
immediate necessity. Meanwhile, the pa-
tient is cautioned not to void, if he has not
already done so. Extravasation of urine
through the point of rupture irritates the
periurethral tissue. Next in order is supra-
pubic cystotomy.
Early repair of the ruptured urethra is
desirable. This can often be accomplished
through the perineum, after cystotomy, as
part of the same surgical procedure. If the
patient’s condition contraindicates perineal
surgery at the same sitting, the periurethral
space can be drained from above, through a
stab wound in each lower abdominal quad-
rant. This provides a path of exit for blood
surrounding the urethra, a site of potential
infection. Perineal repair at this time avoids
the disadvantage of dense scar tissue and
bony fixation of the narrow pelvic arch,
often encountered later.
The usual perineal inverted U incision
is made. With a sound in the urethra, the
operator’s finger is guided to the site of
rupture in the midline of the incision, an-
terior to the rectum and on the inner surface
of the transversus perinei muscle. If the
436
The Journal of the Medical Association of Georgia
Fig:. 1. Cystourethrogram showing: upward displacement of
the urinary bladder and lengthy stricture of the mem-
branous urethra, before operation. Note extravasated oily
radiopaque medium, still evident two years after injection.
apex of the prostate has been rotated up-
ward, a sound passed through the cystotomy
and prostatic urethra makes the gland acces-
sible in the perineal incision. The apex of
the prostate can then he grasped with for-
ceps and sutured to the urogenital dia-
phragm. A self-retaining balloon catheter,
passed into the urethra and guided through
the prostate into the bladder, acts as a splint.
Four radial sutures of chromic 1 catgut
makes the anastomosis secure. A Penrose
drain, left in the perineal incision for sev-
eral days, provides adequate dependent
drainage for the suture line. The catheter
should be left in place for at least 2 weeks.
Antibiotics should next be administered.
If the patient is able to take medication by
month, chloromycetin in dosage of 500 mg.
every 8 hours provides prophylaxis against
infection. For those patients who cannot
take medication orally, 300,000 units of
crysticillin and 1.0 Gm. of streptomycin
daily for 3 days, accomplish the same pur-
pose. Risk of toxicity is minimal during this
brief interval.
Management of a dense stricture, many
months after injury, is much more difficult.
Painful urethral dilatation, infected resi-
dual urine in the bladder and eventual renal
damage are indications for excision of the
stricture. The scar tissue can be totally or
subtotally removed, and the prostate anas-
tomosed to the external urinary sphincter.
If the pubic bones have not too much de-
formity after the fracture has healed, this
procedure can be carried out through the
perineum. However, as described below, a
transpubic route may be the surgeon’s only
choice.
CASE REPORT
Neither a perineal nor retropubic approach pro-
vided sufficient exposure to remove the stricture in
a patient who lias recently been treated. A 39 year
old colored man was pressed against a stone wall
by a truck on Feb. 16, 194-8. Emergency x-rays showed
fracture of both the superior and inferior pubic rami
on both sides. Another fracture line extended vertically
throughout the entire left wing of the sacrum. Injec-
tion through the penis of an oily radiopaque medium
demonstrated marked extravasation in the region of
the membranous urethra (fig. 1).
Suprapubic cystotomy was carried out within 24
hours. Management of the ruptured urethra was con-
servative, consisting of urethral dilation at regular
intervals. The patient had continual, marked difficulty
in voiding, except for periods of 5 to 7 days after
dilatation.
Surgical Procedures. Dr. Lawson Thornton immobi-
lized the saroiliac joints with a bone graft on Dec. 3,
1948. This was successful in correcting orthopedic
complaints resulting from instability in the region
of the fractured sacroiliac joint.
On May 31, 1948, an attempt at repair of the stric-
ture of the membranous urethra through a perineal
incision was made by me. The indications for opera-
tion w^ere recurrent chills and fever and persistent
infected residual urine. Narrowness of the pubic arch,
produced by bony fixation of the fragments of the
pubic rami, was so marked that satisfactory exposure
of the area of stricture could not be accomplished.
The cystourethrogram ( fig. 1 ) made before this
operation shows the upward displacement of the bladder,
and length of the stricture. The same shadows of
extravasated oily radiopaque medium are clearly
illustrated in x-rays made 2 years after the accident.
Since the patient continued to carry infected resi-
dual urine in amounts of 75 to 250 cc. and had recur-
rent chills and fever, it wras decided that some means
must be provided for removing the stricture. Since
the perineal route had not been feasible, and the
retropubic space too narrow for satisfactory exposure,
a transpubic approach was used.
Dr. Phillip Warner removed the symphysis pubis
and sufficient bony fragments on either side to provide
satisfactory exposure of the stricture. After this was
accomplished on March 15, 1950. it was possible to
excise, under direct vision. 9 Gm. of scar tissue
between the urogenital diaphragm and prostate. Care
was taken not to injure the anterior wall of the
rectum, by confining the excision to the anterior and
lateral walls of the strictured urethra. The floor of
the area was not disturbed. The apex of the prostate
was freed of scar tissue, until it was pliable and
could be mobilized to meet the urogenital diaphragm.
A finger in the rectum identified the site of the
external urinary sphincter. It was considered prefer-
able to leave a few millimeters of strictured urethra
in this area, in order to avoid the risk of damaging
the external urinary sphincter and producing incon-
tinence.
November, 1950
437
Extemol
Sphincter
PROGRAM
tATION
Fig. 2. Voiding cystourethrogram, showing tile bladder and prostate fixed to the urogenital diaphragm, after excision of
the strietured membranous urethra.
Four sutures of chromic 1 catgut were used to
anastomose the apex of the prostate to the urogenital
diaphragm around a balloon type of soft rubber cath-
eter. This was left in place as a splint for a period
of 3 weeks. The old cystotomy was re-established
and maintained for a period of 1 month.
The postoperative x-ray (fig. 2), made while the
patient was voiding a radiopaque fluid, shows the
new location of the prostate and bladder near the
urogenital diaphragm. The strietured area, seen in
the previous illustration, was much shorter. There was
no residual urine after this voiding. Dilatation, al-
though at greater intervals, had to be continued. After
four and one-half months the residual urine was 90
cc. Before operation it was 200 cc. The patient’s pubic
arch has proved stable enough to enable him to walk
after operation.
Millin' reports a similar patient, suc-
cessfully operated upon by Stobbaerts 5
years ago. This patient was a miner, who
was able to return to work after excision of
the symphysis and urethral stricture. Post-
operative photographs are convincing evi-
dence of the preservation of good muscular
function after removal of the symphysis.
Discussion and Summary
Repair of rupture of the membranous
urethra within the first few days after trau-
ma is strongly recommended. If the pubic
arch has not been excessively narrowed by
the displaced bony fragments, either the
perineal or retropubic approach is satis-
factory. The advantage of dependent peri-
neal drainage is apparent.
However, if these routes are not feasible,
a transpubic approach should be consid-
ered. The assistance of an orthopedic sur-
geon is valuable in providing immobiliza-
tion of the pelvic arch when indicated, and
also for removal of the symphysis pubis
without risk of damage to the urogenital
diaphragm and external urinary sphincter.
The indications for repair of long stand-
ing stricture of the membranous urethra
are: (1) infected residual urine and (2)
necessity for continued dilatation of the
strietured area for the remaining years of
the patient’s life.
REFERENCES
1. McCague, E. J., and Semans, J. H. : The Management
of Traumatic Rupture of the Urethra and Bladder Compli-
cating Fracture of the Pelvis, J. Urol. 52:36, 1944.
2. Millin, T. ; Retropubic Urinary Surgery, Baltimore,
Williams & Wilkins Company, 1947.
HEALTHGRAM
The final diagnosis in pulmonary tuberculosis rests
upon the demonstration of the tuburcle bacillus just
as that of carcinoma of the lungs depends upon
histologic proof. A reasonable certainly of predicted
diagnosis can be obtained in about four-fifths of the
cases with only the usual x-ray examination such as
posteroanterior, oblique or lateral films. Merrill C.
Sosman, M.D., New England J. Med., June 1, 1950.
438
The Journal of the Medical Association of Georgia
HORIZONS OF MODERN PLASTIC
SURGERY
John R. Lewis, Jr., M.D.
Atlanta
The origin of plastic surgery dates back
to 4000 B.C. Since that time there have been
only two periods of rapid advancement of
this specialty, once about 100 A.D. in the
day of Celsus and Galen, and again during
the 20th century when given an impetus by
two world wars.
Fig. 1. (a) Newborn baby with harelip deformity. (b)
Three weeks after repair of lip. Repair is carried out
under local anesthesia within the first few days of life.
In view of its recent modern history plas-
tic surgery has made rapid progress and
has become a full fledged branch of the tree
of modern surgery. However, its future
horizons beckon and give hint of further
progress.
One of the most essential of the plastic
surgical procedures is the correction of a
harelip. This procedure may he carried out
safely and simply during the first few days
of life and is usually performed under local
anesthesia. The technic which I prefer
brings the scar to the midline at the red
border so as to leave a symmetrical lip, and
one which leaves the least possible evidence
of the previous defect to embarrass the pa-
tient (fig. 1). This surgery should be car-
Read before the Medical Association of Georgia in annual
session. Macon, April 20, 1950.
lied out at the earliest possible moment, not
only because the baby responds well, but
because it lessens the heartache and embar-
rassment of the parents.
Another prominent congenital deformity
is ptosis of the eyelids. It may lead to dis-
use atrophy of the affected eye if neglected.
Correction is carried out by implanting a
fascia lata strip in the eyelid and attaching
it to the occipitofrontalis muscle behind the
eyebrow (fig. 2).
Fig. 2. (a) Congenital ptosis of upper eyelid. Loss of
vision may result from disuse atrophy of the eye. (b) Six
weeks after correction by plastic surgery'.
“Birthmarks” of other types are quite
frequent also and correction at the earliest
possible date is strongly advised. Dark
hairy moles can be quite deforming and
should he fully excised. If small these may
be closed primarily, but a larger lesion must
be replaced by a skin graft. Neglected
lesions should of course he removed at any
time during life and many of these larger
lesions may he excised with closure if the
operation is performed in stages.
Hemangiomas are frequently seen at
birth. The usual strawberry mark may re-
gress rapidly after birth and may need no
treatment. However, many of these lesions
remain and may even become extensive.
The smaller raised lesions may he injected
with sclerosing agents with some success.
However, large lesions usually do not fully
respond to injection and come to surgical
excision (fig. 3).
One of the most common operations per-
November, 1950
439
formed by the plastic surgeon is rhinoplasty.
This operation is performed oftentimes be-
cause of the hump nose. The hump is re-
moved and the nose is shortened and nar-
rowed in order to achieve a more pleasant
appearance (fig. 4). Frequently the appear-
ance of the whole face is changed by cor-
recting the appearance of the most promi-
nent member, the nose. This operation is
certainly not to be considered strictly cos-
metic as one is forced to admit after noting
the response of the personality and the
change in the general outlook of the patient
following an operation of this type. Many
operations on the nose are necessary be-
cause of trauma to the nose. The nose may
be deflected to one side or the other giving
the face an unpleasant appearance as well
as interfering to a great degree with breath-
ing through the nose. Surgery may be per-
formed under local anesthesia to correct not
only the breathing difficulty but also the
appearance of the nose, with only the loss of
one or two weeks from work. Local anes-
thesia is used and postoperative pain is
practically nil.
The so-called saddle nose or flat nose de-
formity may result from nasal operations
performed to relieve breathing difficulty
and as a result of trauma. Correction can
be carried out on these cases by inserting a
cartilage transplant either from the patients
own rib or using preserved cartilage (fig.
5).
Prominent ears are a great source of em-
barrassment and a feeling of great inferi-
ority to both children and adults (fig. 6).
Even little boys only 4 or 5 years old feel
their inferiority because of the teasing of
playmates who call them Jumbo and Ele-
Fig. 3. (a) Large raised hemangioma of back, (b) Four
weeks postoperatively. Large lesions such as this must be
excised.
Fig. 4. (a) Hump nose deformity of nose. (b) Six
weeks after correction by plastic surgery under local
anesthesia.
Fig. 5. (a) Saddle nose deformity of nose. This commonly
results from neglected injuries of the nose, (b)' The nose
has been corrected by a cartilage graft to the bridge under
local anesthesia.
Fig. 6. (a) Prominent protruding ears may cause severe
psychologic complexes, in children as well as adults, (b)
Correction has been carried out under local anesthesia.
440
The Journal ok the Medical Association of Georgia
pliant ears and other taunting names. These
can be corrected very easily under local
anesthesia leaving a small scar well hidden
behind the ear. Ears in children can be cor-
rected at the early age of 5 to 7 years be-
cause the ears grow very little after that age.
In cases of avulsion of the ears as well as
congenital deformities it is oftentimes nec-
essary to reconstruct the external ear.
One of the most common and most dis-
heartening facial disfigurements is the
scarring caused by acne and smallpox.
These acne pits and pock marks have been
borne with little hope of relief and with a
feeling of selfconsciousness and a severe
inferiority complex in most cases. During
the past three years I have had experience
with a new method of treating these de-
forming scars. It consists of abrading the
skin under local anesthesia, followed by a
fine mesh gauze dressing for about one
week. During this week the epithelium re-
generates and the resulting skin is much
smoother and more even (fig. 7). A similar
method is very effective in cases of trau-
matic tattooes in which grit and cinders have
been ground into the skin or bits of oil or
foreign material have been blown into the
skin in explosions. By abrading the facial
skin in stages this material is quickly re-
moved. Actual surgical tattooes are best
removed by removing the outer layers of
the skin with a dermatome.
Prognathism, or a very prominent lower
jaw and jutting chin is not an unusual de-
velopmental deformity. There have been
several operations designed to correct this
deformity, but the most effective operation
in my opinion is the resection of a segment
of the body of the mandihle on each side.
This results in a less prominent chin and
the teeth fall into satisfactory occlusion.
Automobile accidents lead by far all other
causes of injury to the face. The guest pas-
senger, the passenger riding beside the
driver in the front seat, is injured about four
Fig;. 7. (a) Severe sears of the face caused by acne and by
chickenpox. These are a severe handicap, (b) After smooth-
ing; of the skin under local anesthesia in three stages.
times as often as anyone else in the car.
These injuries should be properly evaluated
as soon as possible. All fractures of the
facial bones should be ascertained and re-
duced and all lacerations be meticulously
debrided, thoroughly cleansed and carefully
closed at the time of the accident. A crash
pad is of value in lessening injuries sus-
tained on the instrument panel.
Burn scars present a difficult problem.
Many times the resulting scars are very con-
tracted and allow very little stretch. The
scar if firm and keloidal should be excised
and replaced by a thick split-thickness skin
graft. Often Z-plastic procedures may be
performed in order to allow the proper
amount of mobility of the part. This is par-
ticularly useful across flexion creases. In
severe burns of the chest wall the breasts
may be bound down and large skin grafts
must lie applied underneath each breast in
order to free up the breasts and make the
patient more comfortable.
Skin involved by x-ray burns are poten-
tial areas of malignancy for x-ray irradia-
tion has a progressive affect. These areas
should be excised and replaced by thick
dermatome skin grafts. If the color does not
appear satisfactory a pink pigment may be
injected into the graft by tattooing in order
to give a more pleasant appearance.
Lesions of the nose resulting in large
defects of the nose may be repaired from
November, 1950
flaps from the face or, if large, from tube
flaps from the neck. The neck skin gives a
good color match with the facial skin.
Lesions of the eyelids may he excised and
replaced by full thickness grafts from be-
hind the ears with a good functional and
cosmetic result. Ulcerations in old burn
scars should be strongly suspected of ma-
lignancy. Wide excision with skin grafting
should be carried out. These lesions usually
prove to be squamous cell carcinoma.
Plastic surgery of the breast is carried
out not only for cosmetic purposes but for
purposes of comfort. Large pendulous
breasts are uncomfortable and pendulosity
in many cases may lead to chronic mastitis
due to the deficient drainage and venous
return from the pendulous breasts. Surgery
consists of reshaping the breasts and shift-
ing the nipples to a higher position. The
nipples retain their normal response to
stimulation and the normal sensation. Such
patients are much more comfortable fol-
lowing surgery.
On the other hand surgery for hypoplas-
tic breasts is carried out simply for pur-
poses of appearance and the attendant psy-
chologic complexes. The breasts may be
built up either with fat grafts or possibly
with a new plastic, polyethylene. The graft-
ed material is applied against the chest wall
and beneath all the fat and breast tissue
which is present so that any lesion occurring
in the breast would be easily palpable out-
side this material. These patients recover
rapidly following surgery.
Enlargements of the breast in the male
are embarrassing. In cases of gynecomastia
the patient develops a severe feeling of self
consciousness. The excessive breast and
fatty tissue is removed through an intra-
areolar incision with little or no scar re-
sulting.
In conclusion I would like to repeat that
refinements in the technics which were
worked out by the masters of the past and
441
have been improved with each succeeding
decade have carried this field into a more
honored place among the medical special-
ties. Plastic surgery has a twofold purpose:
improvement in appearance and improve-
ment in function. I think that no one would
deny that improvement in appearance and
in function accomplishes a great improve-
ment in the psychologic outlook of the pa-
tient and better prepares him for his social
contacts and business dealings, as well as
more nearly insures his personal happiness
which, after all, is most important of all.
THE TREATMENT OF FRACTURES OF
THE MIDDLE THIRD OF THE FACE
Frank F. Kanthak, M.D.
Atlanta
Fractures of the bones comprising the
middle third of the face present unusual
problems in treatment as compared with
those fractures of the lower third of the
face. This is so in part because of the close
anatomic and physiologic association of the
bony structures of the middle of the face
with the orbit, the base of the brain, the
paranasal sinuses and the cribriform plate.
In addition, the bones forming this portion
of the facial skeleton are largely thin “egg-
shell” type structures which do not lend
themselves to customary methods of reduc-
tion and fixation as may be utilized on other
osseous structures.
These injuries are frequently associated
with severe injury to the patient in so far as
his sensorium is concerned. They are fre-
quently associated with more or less mental
confusion and actual brain damage. For
these reasons, the patient may not receive
early adequate care in the replacement of
these fractures. Since these bones have a
tendency to heal rather rapidly, they may
heal in mal-position with conspicuous de-
Read before the Medical Association of Georgia in annual
session, Macon, April 20, 1950.
442
The Journal of the Medical Association of Georcia
formities which are very difficult to correct
at a later date. If the patient is seen early
it is possible to reduce these fractures more
often than not, with relatively little incon-
venience to the patient and with compara-
tively little danger. Actually, because of
the intimate relationships between these
fractures and the base of the brain, symp-
toms such as cerebrospinal leakage may stop
promptly after reduction of these fractures
because of the extrusion of spicules of bone
which have penetrated the dura. These fac-
tors in addition to the antibiotics, enable us
to reduce and treat these injuries earlier
with greater safety than was previously con-
sidered possible. The anesthesia of choice
here is endotracheal anesthesia; but, if con-
ditions warrant, the patient may be anes-
thetized with deep block anesthesia and
local infiltration anesthesia, and the opera-
tion proceeded with. I will discuss the treat-
ment of fractures of the maxilla a little more
completely later on.
In conjunction with fractures one fre-
quently sees rather extensive lacerations and
some soft tissue loss. Here the patient is
handled in the same way after he is stabil-
ized and is considered a satisfactory risk
for anesthesia. Under endotrachael anes-
thesia the wound is debrided, the soft tissues
are debrided, and loose fragments of bone
are removed, the intraoral apparatus is in-
stalled to treat the fractures of the jaws,
because our objectives are to restore the
occlusion of the teeth as well as to restore
the patient’s face to its former symmetry.
In a consecutive series of 26 cases of
fracture of the zygomatic bone these were
the symptoms that I noted : All of them had
swelling of the face, as you might expect,
because of the injury that they had en-
countered. In addition, after the swelling
had subsided, a large number of them had
depressions of the face. A number of them
had trismus or inability to open the mouth
widely, or pain in the jaw. If you will re-
member the anatomic arrangement, the
coronoid process of the mandible lies under-
neath the zygomatic arch, so that as a de-
pressed fracture of the zygomatic bone en-
sues it presses on the coronoid process of
the mandible. This prevents the mouth from
being opeend. Ecchymosis is readily under-
standable, and anesthesia of the infraorbital
area occurs because of the location of the
infraorbital nerve in connection with the
zygomatic bone, where it is readily trauma-
tized by. the fracture occurring in that por-
tion of the face. This anesthesia is tem-
porary.
A small number of these patients had
diplopia, due to a change in the tension of
the extraocular muscles when the optic globe
was lowered by the depressed fracture of
the zygomatic bone which forms the floor
and lateral wall of the orbit.
One of the patients had emphysema, be-
cause the zygomatic bone forms the outer
wall of the antrum, so in a depressed frac-
ture of the zygomatic bone it is inevitably
depressed into the maxillary sinus and there
is some rupture of the mucosa and the an-
trum is filled with blood.
The treatment of these fractures is rela-
tively simple. There have been many meth-
ods proposed. All of them are effective, and
the choice of which method one uses de-
pends on one’s personal preference, with
one exception and this is that if the fracture
of the zygomatic bone is comminuted and
broken into small pieces into the maxillary
sinus, one is wise in doing a Caldwell-Luc
type operation and cleaning out the frag-
ments of bone and the frayed tissue that en-
sues from that type of injury, otherwise the
elevation of the fracture may be accom-
plished by any of the means indicated here.
If one reduces these fractures relatively
soon after injury the serrated edges of the
bone are sufficiently sharp so that it will
retain its position by friction. If one waits
for ten days or more, reduction is frequently
November, 1950
443
difficult because fibrous healing occurs
which sometimes makes it impossible to ele-
vate the hone; secondly, if the hone is ele-
vated, it promptly falls hack to its previous
position because it has nothing to hold it in
the original position. It is necessary to sup-
ply some form of external support to the
bone to do that.
Skull cap traction has been used in
the past a great deal to treat fractures of
the maxilla as well as fractures of the zygo-
matic hone or of the nose, and I have yet to
see a patient who has been comfortable in
one.
Fractures of the maxilla can he diag-
nosed, in the absence of x-rays and other
things, by the change in the occlusion of
the teeth and by grasping the maxilla and
seeing if it can he moved.
Instead of treating this with a head cap,
direct wiring of the hone through the zygo-
matic process of the frontal bone is done,
passing a stainless steel wire under the
zygomatic arches, underneath the skin, and
bringing the wires out into the muco-buccal
fold. There they are wired to an arch bar
which supports the fractured maxilla against
the cranial vault. In this way all the appa-
ratus is retained inside the face.
In conclusion, these fractures bring up
unusual problems because of their anatomic
location. The reduction of these fractures
should be attempted as early as considered
consistent with the patient’s well being.
They have a tendency to heal rather rapidly
and to fix in position, and they are extremely
difficult to correct after fixation has oc-
curred. They can he reduced under local an-
esthetic if necessary, with endotracheal anes-
thesia being the method of choice, and direct
wiring of the bone, such as illustrated in the
last case provides a method of fixing the
maxillary fractures, which enables the pa-
tient to go through the period of healing
without the encumbrance of a skull cap
which is uncomfortable to him.
EARLY SIGNS AND SYMPTOMS
OF BRAIN TUMORS
Charles E. Dowman, M.D.
Atlanta
In medical school days my Professor
of Obstetrics referred us to a text which
listed the signs of pregnancy in three cate-
gories: presumptive, probable and positive.
If we are to be of help in progressive dis-
eases, particularly in neoplasms, we must
pay more attention to the patient’s early
complaints, with a fairly high index of
suspicion, else we will he able to do little
for them. The only cure we know for
cancer, or any other tumor, is to get it
out with a wide margin of normal tissue.
Recently, a fellow physician told me by
phone that his patient, referred to me by
an eye doctor, couldn’t have a brain tumor.
When I inquired why he felt that way,
he said it was true that she had had con-
vulsions for eight years and headache and
recently blindness, but that she had had no
diplopia and no vomiting. Gentlemen, this
doctor was sincere, honest, conscientious,
and trying to do the best for his patients.
If he has been allowed to carry the con-
cept that the diagnosis of brain tumor re-
quires all of these symptoms, then that is
the fault of those of us who do such work
and have not taken to him more accurate
graduate education. Hence this talk, direct-
ed mainly to the man who sees these people
early. It is obviously impossible for a neu-
rosurgeon to see every patient. Therefore,
we must let you know when to he suspicious
of brain tumor. As in pregnancy, the ear-
liest signs and symptoms are the presump-
tive ones.
Convulsions
Very small tumors, strategically located,
make their presence known early by con-
Read before the Medical Association of Georgia in annua]
session, Macon, April 20, 1950.
444
The Journal of the Medical Association of Georcia
vulsions. Certainly, anyone who has his
first convulsion after the age of 20 years,
deserves very careful neurologic and neuro-
surgical investigation. Dr. Hughlings Jack-
son of England, almost a century ago, de-
scribed the type of convulsion which begins
in one part of the body, then spreads to
involve other parts. Having observed these
patients before and after death, he gave us
our first theories of cortical localization.
These theories were later supported by the
results of stimulation from an induction
coil after this had been invented, carried
out by Frisch and Hitzig about 1885.
Actually, the problem of localization in the
brain is better understood if one remembers
the position of the image on the back of a
ground glass camera. Since the main por-
tion of the brain was developed along with
the use of an eye with a lens system, this
superstructure is arranged backwards and
upside down. Thus the leg centers lie high
on the brain and the face centers low, with
the arm center in between. The right side of
the brain controls the left side of the body
and vice versa. Thus tumors close to the
midline may produce convulsions starting
in the leg while those in the temporal lobes
and low frontal lobes, usually start in the
face.
The most alarming attacks are the cata-
plectic ones with sudden loss of conscious-
ness without warning which occur after a
larger tumor has begun to squeeze the brain
stem. Here life itself is at stake and unless
pressure is released, death will result.
Unfortunately, rarely does the physician
observe a convulsion. Therefore, we are
usually dependent on the observation of the
patient and of his family. It is much more
difficult to reconstruct what happened at the
time of a convulsion from asking others
than to observe one, but frequently, careful
questioning as to the positioning of the head,
eyes, arms and legs after one attack wdll give
more adequate information after the next
one.
Generalized convulsions may occur from
tumor and are more apt to do so with so-
called “silent area" localization, particu-
larly temporal and frontal. Subfrontal
tumors may have attacks preceded by unci-
nate warnings. This usually consists of a
bad odor and the odor is usually a familiar
one.
Temporal lobe tumors may produce only
somnolence. It is not without reason that
the Germans call this the Schlafenlappen or
sleep lobe.
Occipital tumor attacks may begin with
formed visual hallucinations or the patient
may show a fairly sweeping visual field loss
and be unaware of it until he runs into a
door jamb, or is surprised to see a car which
has come from his “blind side” right in
front of him.
Focal sensory attacks occur in parietal
lobe tumors, either a strange, crampy sensa-
tion or a focal numbness. On the dominant
side of the brain, one may see temporary
aphasias which may be in the naming
sphere (the so-called nominal aphasias), in
the motor or actual speech center, or in the
association center for vision or hearing.
Of course all of these paroxysmal handi-
caps can be completely and continually
present once a center has been invaded in-
stead of irritated, so it is usually better that
one find and treat such cases in the phase
of irritation rather than in the phase of
paralysis.
Headache
Unfortunately all early tumors do not
showr themselves with such insistent symp-
toms as convulsions. For the others we must
wait for the tumor to show itself in some
other way. Headache is one fairly regular
presumptive symptom of tumor. Usually,
there is little help to be gained from the
location of the headache, but stiff neck and
suboccipital headache do occur with cere-
November, 1950
415
bellar and foramen magnum tumors. In
colloid cysts of the third ventricle and some
of the tumors which intermittently block
the flow of the spinal fluid, we see headaches
that come on abruptly, frequently when the
patient is lying down, and disappear when
the patient stands or leans forward. The
ordinary increased pressure headache is
worse in the early morning, better after be-
ing up and about, and may be accompanied
by vomiting but does not have to be. The
headache may be steady or throbbing. Fre-
quently, it is described as “all over”. Bi-
frontal location occurs particularly in fron-
tal tumors. The headache of brain tumor is
frequently progressively worse as time goes
on. Any patient with headache which re-
quires narcotics stronger than codeine for
relief certainly merits neurosurgical study.
Cranial nerve complaints also suggest a
presumptive tumor diagnosis. Loss of smell,
partial visual field loss, double vision, pro-
trusion of one eye, facial pain or numbness,
hearing handicaps, vertigo, difficulty in talk-
ing or swallowing all give indication from
the history for one to investigate the prob-
lem further.
Vomiting does occur as a late sign of
brain tumor, and associated with headache
or double vision or both may be considered
as essentially a positive sign. It is this stage
that we hope our patient will not reach be-
fore we see him. When any third year medi-
cal student can arrive at a diagnosis of brain
tumor, the outlook for cure in such a case is
less than when the first symptom develops.
Signs
Now let us go into the more important
signs of brain tumors. Masses on the skull
are frequently a fairly positive sign and yet
they may be felt on the head for years be-
fore convulsions occur in superficially
placed meningiomas. A unilateral non-
pulsating exophthalmos is a frequent sign
of involvement of one wall of the orbit or
of the soft tissues in the orbit by a friendly
tumor. One meningioma I saw was biopsied
from within the mouth, having produced a
deep temporal mass.
An ophthalmoscope is a very important
gadget to be able to use in all fields of medi-
cine. In increased intracranial pressure,
where the veins are distended, the disc mar-
gins blurred, the optic cup filled, then frank
disc elevation, hemorrhages and exudates,
this instrument is of tremendous value. The
only way that one can become proficient
with it is to use it daily, looking into many
normal eyes in order to know the normal so
well that pathologic findings become very
striking by comparison.
Fields of vision can be done rapidly and
readily by confrontation methods with the
patient looking into the examiner’s eye, the
hand or finger being well out in the tem-
poral and nasal fields of vision, and the pa-
tient stating whether the hand or finger is
moving or still. Inasmuch as the visual path-
ways traverse the deep temporal and pari-
etal lobes as well as spreading out in the
occipital lobe, knowledge of handicap in
any of these three lobes may be gained early
by careful field tests.
Nystagmus occurs particularly in cere-
bellar and cerebellopontine lesions. Since
this also occurs in families, history here is
important. Since the auditory nerve is con-
cerned with balance as well, this sign usu-
ally occurs with tumors originating here.
Spasticity and increased reflexes on one
side are seen in hemisphere tumors early
and later in cerebellar handicaps. Foramen
magnum tumors notoriously produce bi-
lateral spasticity.
Hearing handicaps not explainable by
ear infections certainly make one want to
investigate such cases, particularly by con-
firmatory evidence of erosion of the internal
auditory canal in eighth nerve tumors,
which shows up readily on x-ray. In early
cases, these can sometimes be removed with-
out even sacrificing the facial nerve. When
The Journal of the Medical Association of Georgia
446
one has waited for years until increased
intracranial pressure is produced, the opera-
tive mortality is high and damages after
operation are more severe in survivors. 1 he
classical triad of tinnitus, vertigo and deaf-
ness bespeak an eighth nerve lesion. Spinal
puncture at times shows elevated protein and
at times, one must look at the nerve to be
sure a tumor is not being overlooked. Men-
iere’s syndrome can he caused by friendly
tumors. With hearing already lost and con-
siderable vertigo, the nerve can be cut with
benefit to the patient in the absence of
tumor. Unsteadiness of gait frequently also
bespeaks a cerebellar tumor. Polyuria,
polydipsia and polyphagia give early leads
to pituitary handicaps.
X-Ray of the skull is of value in demon-
strating calcified tumors, shifts of a calci-
fied pineal gland, and bony erosions. In
infants and children it also may demon-
strate separation of the sutures. While
spinal puncture can tell us that we have in-
creased intracranial pressure, an ophthal-
moscopic examination frequently tells us
this in a much safer fashion. It is usually
unwise to do a spinal puncture in the pres-
ence of choke or venous engorgement unless
the diagnosis of meningitis is strongly sus-
pected. Even then it is risky. Brain abscess,
a space-occupying mass, may likewise show
some meningeal signs, usually also with
papilledema. Stiff neck occurs with ten-
torial or foramen magnum herniations even
without meningitis.
To Summarize:
1. Headache of sufficient intensity to
require heavy medicine should he neuro-
surgically investigated.
2. Any convulsion or similar paroxys-
mal disorder beginning after the age of
twenty is a symptom of brain tumor until
proven otherwise.
3. The ophthalmoscope should be used
regularly by all physicians so that abnor-
malities will be more quickly recognized.
4. Bony skull masses very strongly sug-
gest underlying tumor.
5. Deafness without explanation on a
basis of infection should make one suspect
eighth nerve tumor.
THE RELIEF OF DISTRESSING PAIN
BY INTERRUPTING NERVE
PATHWAYS
Exum Walker, M.D.
Atlanta
The relief of pain is a prime responsi-
bility of the medical profession. The ideal
approach to this problem is to find and
remove the cause of the pain, and when this
can be done, it is the best solution. Too
often, however, either the cause cannot be
determined, or if apparent, it cannot be re-
moved. Whenever the pain is severe or
prolonged, it may constitute a perplexing
problem and tax the ingenuity of the physi-
cian. Continued pain is not only distressing
hut has a progressive effect on the person-
ality and behavior of the individual, and in
time this may so demoralize him that he
becomes incapable of carrying on his usual
obligations to his family and society.
It is well known that the relief of pain by
drugs over a long period of time not only
is unsatisfactory, but may add the complica-
tion of addiction to an already unhappy
state.
In recent years considerable study and
research has been carried out to gain a better
knowledge of the nature of pain and to learn
the anatomic pathways which convey pain
impulses. This knowledge along with the
rapid advances made in neurosurgical tech-
nics has made possible in most instances a
practical solution for the relief of major
pain.
Basically, pain may he thought of as the
Read before the Medical Association of Georgia in annual
session, Macon, April 20, 1950.
November, 1950
447
conscious experience of a distressing sen-
sation. The existence of pain depends on
the perception of painful impulses reaching
certain centers in the brain and the con-
scious reaction to the stimuli. The relief of
pain by neurosurgical methods has to do
with blocking out or destroying the integrity
of certain pain pathways or centers. By
utilizing these measures physical pain can
almost invariably be controlled, although
the patient must accept the physiologic loss
incident to the procedure. The doctor who
is experienced in the task of relieving pain
can evaluate the patient’s individual prob-
lem and judge what course or procedure
may be advisable.
Careful consideration should be given to
the emotional behavior of the patient as
well as to his occupation and his economic
and social status. It is necessary to judge
the patient’s problem as a whole and decide
if pain alone is the major factor. Too often
one finds that the patient has been subjected
to considerable stress other than pain and
that he may mislead his physician by er-
roneously believing that his unhappy state
of anxiety is due solely to pain. One must,
therefore, meticulously analyze and evalu-
ate the whole of the patient’s problem before
passing judgment on what is the best solu-
tion.
From a practical standpoint it may be
convenient to subdivide each patient’s prob-
lem into three etiologic components and to
evaluate and deal with each component sep-
arately.
First are the factors other than pain which
subject the patient to stress and result in
anxiety. These have to do with his individ-
ual lack of adjustment to his own life’s prob-
lems. If these factors are dominant and if
proper interpretation and therapy cannot
be given by the patient’s own physician,
then the aid of a psychiatrist should be
obtained. The management of this phase
will not be elaborated upon in this paper.
Then there is to be considered the nature
of the organic pathologic process and an
evaluation made of the amount of pain
which exists in terms of the quantity of pain
impulses which are initiated and transmit-
ted to the brain. This could be called the
perception of pain as distinct from the re-
action to pain. Or, more simply, one must
judge how much pain the patient is actually
having and what ends are advisable and
justified to control his pain. Whenever it is
impractical to control the pain by direct
treatment of the lesion itself, then attention
can be focused on the mechanism of the
pain and the anatomic pathways through
which the pain impulses are conveyed to the
receptive centers in the brain. Such an
approach is the major theme of this paper
and will be dealt with in more detail pres-
ently.
Finally there is to be considered the pa-
tient’s reaction to his pain, or simply what
it means to him. Proper attention to this
component of pain will avoid much con-
fusion and temper one’s judgment in treat-
ment.
The perception of pain may be abolished
by preventing the impulses from reaching
the thalamus or general sensory headquar-
ters. This may be accomplished by inter-
rupting the pain pathways at some level.
The reaction to pain can be favorably altered
by direct attack on the prefrontal regions of
the brain. Certain pain mechanisms may
be influenced by direct attack on the sym-
pathetic pathways which supply the affected
region.
Section of a peripheral nerve trunk does
not often afford any lasting relief arid, there-
fore, is seldom indicated. For regional pain
division of cranial or spinal posterior roots
often offers an effective and relatively sim-
ple means of abolishing pain. Pain involv-
ing more diffuse areas may require section
of some central pain pathways. The anterior
spinothalamic tract conveys pain and tern-
The Journal of the Medical Association of Georgia
448
perature impulses and is located superfi-
cially so that it may he selectively divided
in the spinal cord, medulla or mid-brain.
This permanently abolishes the senses of
pain and temperature perception below the
level on the opposite side and leaves the
ordinary sense of touch perception and
other functions intact. No serious disability
results and the patient can perform normal
activities. This procedure is useful when-
ever the pain is unilateral. Bilateral cor-
dotomy can be performed, but there is some
risk of bladder paralysis, so this complica-
tion must be considered as a possibility.
Bilateral cordotomy is principally used in
cases of intractable pain due to cancer. The
technic of cordotomy has been greatly sim-
plified so that it has come to be a relatively
minor procedure.
Various portions of the sympathetic nerv-
ous system may be removed to control pain
in a variety of conditions. Visceral pain
fibers are included in the sympathetic
chains, and an appropriate excision will
denervate most of the thoracic, abdominal
and pelvic viscera. Also many types of
vascular pain and pain due to nerve injuries
may be controlled by interrupting the sym-
pathetic nerve supply to the region involved.
Prefrontal lobotomy was initially per-
formed for certain types of psychiatric dis-
orders, but its use in the relief of pain has
been a recent innovation. This procedure
does not abolish the perception of pain but
affects the patient’s reaction to it. After bi-
lateral lobotomy the patient is no longer
concerned about his pain and will usually
not mention it or ask for relief. This opera-
tion leaves a definite personality defect and
should rarely be performed except as a final
resort. It has its greatest usefulness in the
relief of pain from cancer.
Unilateral lobotomy is less effective, but
has the advantage of leaving so little per-
sonality defect that it usually goes unde-
tected. This procedure has been very useful
in certain patients with multiple minor pains
associated with a poor adjustment to the
problems of life. Much research is under-
way at present on the localization of func-
tion in the prefrontal lobes of the brain. It
is hoped that in the near future we may be
able to abolish the reaction to pain so that
it is no longer a distressing sensation with-
out seriously altering other intellectual
functions.
Sciatic Pain is usually due to a lesion of
an intervertebral disc, although it may be
due to other causes such as a neoplasm or
injury to the spine or sciatic nerve. Severe
persistent pain can usually be controlled by
removal of the disc; however, in some in-
stances it may be necessary to divide a nerve
root or perform a cordotomy1 2 3.
Brachial Pain or Neuritis is most com-
monly due to an intervertebral disc lesion in
the cervical region. The clinical syndrome
and treatment are essentially analogous to
that of lumbar intervertebral disc lesions4.
Cer vico-0 ccipital Pain or so-called sub-
occipital neuralgia is probably due to some
irritative trauma of the upper cervical
nerves. This is a very common occurrence
and causes pain and headache which begins
in the suboccipital region and is often asso-
ciated with suboccipital tenderness and ag-
gravation of pain on motion. It can usually
be relieved by division of the second and
third cervical sensory nerve roots.
Trigeminal Neuralgia or tic douloureux
is characterized by transitory paroxysms
of severe pain in the face. The cause is sel-
dom apparent, but the pain can be abolished
with certainty by division of the posterior
root of the trigeminal nerve. In recent years
an improved operative approach has been
devised in which the pain can usually be
relieved, leaving most of the sensation in
the face intact with preservation of the cor-
neal reflex ' G.
The Pain of Angina Pectoris can be im-
mediately relieved by novocaine injection
November, 1950
419
in the region of the stellate ganglion. This
procedure is simple and its value is not
generally appreciated. Cardiac pain can be
permanently controlled by removing the
upper five sympathetic ganglia or by divid-
ing the analogous thoracic dorsal nerve
roots. The patient will still have distressing
symptoms of substernal oppression, short-
ness of breath and sometime pain in the jaw
if he over exerts, so the caution signal is not
destroyed. This procedure has been widely
used in certain areas of the country with
good results but has received scant atten-
tion in the South.
Abdominal Pain having its origin in the
viscera can be relieved by resection of the
thoracolumbar region of the sympathetic
chain along with the splanchnic nerves.
Renal Pain can be relieved by section of
the lower two thoracic and first lumbar
dorsal roots.
The Pain of Dysmenorrhea usually can
be largely relieved or abolished by resection
of the superior hypogastric plexus. The re-
section leaves no detectable loss of function
and denervates the pain fibers to the body
of the uterus and upper portion of the
cervix. It is a very practical and effective
procedure to control severe dysmenorrhea
and its value has not been generally appre-
ciated.
The Pain of Herpes or “shingles” can usu-
ally be immediately relieved by novocaine
injection of the sympathetic pathways to the
region. If this is done in the early stages of
the disease a single injection may dramati-
cally stop the pain permanently and avoid
the chronic painful phase. In chronic post
herpetic paiu a sympathectomy or dorsal
root section may help, but this is less cer-
tain.
The patients who suffer Intractable Pain
from Cancer can be saved from much suffer-
ing by judiciously selecting the appropriate
procedure. The results are far superior to
the time-worn custom of administering in-
creasing quantities of narcotic drugs. In
the earlier stages it is preferable to dimin-
ish or abolish the perception of pain by di-
viding pain pathways. Later, when the pa-
tient is entering the inevitable downhill
phase, a lobotomy is better. This will con-
trol the pain problem and at the same time
release the patient from the anxiety that
inevitably accompanies the realization that
he is not getting well. After lobotomy the
patient is happy, cheerful and does not com-
plain despite his downhill course.
BIBLIOGRAPHY
1. Walker, Exum: Intervertebral Disc Lesions, South
M. J. 38:832-834 (Dec.) 1945.
2. Walker, Exum: Pathology Causing the Sciatic Syn-
drome. South. Surgeon 9:820-826 (Nov.) 1940.
3. Walker, Exum: Sciatica — Its Cause and Treatment,
Dis. Nerv. System 1:38-42 (Feb.) 1940.
4. Walker, Exum: Branchial Neuritis Due to Cervical
Intervertebral Disc Lesions. J. M. A. Georgia 38:1-3 (Jan )
1949.
5. Walker, Exum: The Relief of Pain in Trigeminal
Neuralgia, J. M. A. Georgia 29:222-225 (April) 1940.
6. Walker, Exum: A Simplified Suboccipital Technic for
Trigeminal, Acoustic, or Glossopharyngeal Rhizotomy, J.
Neurol., Neurosurg. & Psychiat. (British) — 13:127-129 (May)
1950.
133 Doctors Building, Atlanta.
THE USE OF ANTABUSE IN THE
TREATMENT OF ALCOHOLISM
A Preliminary Report of 27 Cases *
James N. Brawner, Jr., M.D.
Albert F. Brawner, M.D.
Smyrna
In 1948 a new treatment for alcoholism
was first reported by Martensen-Larsen1 2 of
Denmark. This was based on the sensitiza-
tion of individuals to ethyl alcohol by tetra-
ethylthiuramdisulphide, a drug which has
been given the trade name “Antabuse”.
The use of this drug as a possible treat-
ment for alcoholism was suggested by Hald
and Jacobsen3. They and their co-work-
ers' 8 reported studies of its toxic and
pharmacologic properties. They found that
individuals who had taken 1 Gm. or more of
antabuse 12 to 24 hours before, were sensi-
*The Antabuse used in this study was generously furnished
by Ayerst, McKenna & Harrison, Ltd,, 22 East 40th Street,
New York City, N. Y.
Read before the Medical Association of Georgia in annual
session, Macon, April 20, 1950.
450
The Journal of the Medical Association of Georgia
tized to ethyl alcohol to the extent that a
small and otherwise innocuous amount of
any alcoholic beverage resulted in a prompt
and disagreeable reaction. This antabuse-
alcohol reaction consisted chiefly of a cir-
culatory, vasomotor and respiratory disturb-
ance characterized by intense redness of the
face, eyes, neck and chest; perspiration,
tachycardia and dyspnea; subjective sensa-
tions of smothering, uneasiness, marked pal-
pitation, a throbbing headache and in the
later stages frequent nausea and vomiting.
It was found that the antabuse-alcohol
reaction was caused by an abnormally high
concentration of acetaldehyde in the blood.
This occurred with a blood alcohol content
as low as 10-20 mg. per cent, a level which
produces no symptoms in persons not sensi-
tized by antabuse. The reason for this in-
crease of the blood acetaldehyde is not yet
known, but Hald and Jacobsen’ considered
it to be the result of a disturbance of the
alcohol oxidizing enzyme, dehydrogena-se.
The Scandinavian workers also found
that antabuse could be administered daily to
human subjects and animals for a long time
in moderate doses without appreciable toxic
effects so long as alcohol was not consumed.
It was found to be eliminated from the body
slowly and for this reason a person who had
been taking antabuse regularly would re-
main sensitized to alcohol for six to eight
days.
In Canada, Bell and Smith9 reported fa-
vorable results in 9 alcoholic patients treat-
ed with antabuse. Gelbman and Epstein10
found that out of 55 alcoholic patients treat-
ed 45 had not reverted to their old habits of
drinking. Antabuse was made available on
prescription in Canada in 1949. In regard
to this Ferguson11 commented editorially:
“The burden of responsibility which has
been thrown so suddenly on the general
practitioner is heavy and unfair”.
Four deaths have so far been mentioned,
two by Danish investigators12 in patients
with diabetes mellitus; one by Jacobsen and
Martensen-Larsen1' in which antabuse was
given to a 60 year old man while drinking
heavily, and one by Jones14 from Halifax,
Nova Scotia. The latter was the death of a
29 year old male which occurred 2 hours
and 25 minutes after a test drink with 30
cc. of rum. He had received 5.5 Gm. of
antabuse over the previous five days. Au-
topsy “left little doubt as to the cause of
death, namely an acute conjestive right-
sided heart failure, but gave little indication
as to why this cardiac failure should have
occurred”.
The first publication in the United States
was by Jacobsen and Martensen-Larsen11.
They gave an excellent review of the phar-
macologic properties of antabuse and re-
ported 99 alcoholic patients who had been
under treatment in Denmark for six months
or more. Of these 99 patients 52 were con-
sidered “socially recovered”, and 19 as
“much better". Glud12 recently reviewed
the studies of the Scandinavian workers and
made suggestions for the use of antabuse in
the United States.
From these early reports it appeared that
treatment of alcoholic patients with anta-
buse was promising, but all agreed that it
should be used cautiously and should al-
ways be combined with a general plan of
treatment including psychotherapy and all
other available measures.
Present Study
The purpose of this paper is to present
our experiences and results with antabuse in
27 alcoholic patients who began treatment
between July 1, 1949 and January 1, 1950,
and who were followed until March 15,
1950. In the short time elapsfed we realize
that no accurate appraisal can be made of
any treatment for alcoholism. From this
brief experience, however, some interesting
and instructive data concerning antabuse
have been recorded. Careful observations
have been made on 76 antabuse-alcohol re-
November, 1950
451
actions produced with different kinds and
amounts of alcoholic beverages. A prelim-
inary evaluation of antabuse in the treat-
ment of alcoholism is attempted from the
results obtained. Finally, a description of
the antabuse-alcohol reaction seems justi-
fied. Physicians everywhere are likely to
encounter a person who has been taking
antabuse and who has tried to drink; there-
fore knowledge of this reaction may prove
helpful.
Selection of Patients
All alcoholic patients who were admitted
after July 1, 1949 were informed of the
general nature and the availability of anta-
buse treatment. If interest was expressed in
it the requirements for treatment were ex-
plained in detail to the patient and a respon-
sible relative. They were informed particu-
larly that antabuse was not “a cure'” for
alcoholism; that its use was still in the
“clinical trial” stage and could be used
only under close supervision. They were
told that antabuse was intended as an added
means of maintaining abstinence from alco-
hol while an individual became better ad-
justed in life physically, emotionally, so-
cially, economically, spiritually, and until
alcohol was no longer needed for support or
escape.
Contraindications and Precautions
For the present time it has been suggested
by the distributors that antabuse not be
administered to patients with diabetes mel-
litus, myocardial failure or coronary dis-
ease, pregnancy, goiter, epilepsy, cirrho-
sis of liver, hepatitis, nephritis and in pa-
tients addicted to drugs as well as alco-
hol. Antabuse should not be given to
patients who are drinking, who have been
treated recently with paraldehyde, nor
should paraldehyde be administered to those
taking antabuse. Because of the definite
circulatory effect in the antabuse-alcohol
reaction any symptom or suggestion of car-
diovascular disease should be carefully
studied. Essential hypertension does not
seem to be a contraindication.
Study and Treatment of Patient Prior
to Antabuse Therapy
Patients were sobered and received sup-
portive measures of adequate nourishment,
vitamins, glucose, insulin and fluids. A de-
tailed history was obtained especially in
regard to the family background, environ-
mental factors, personality traits and ill-
nesses which may have had a bearing on the
alcoholic problem. Careful physical, neu-
rologic and psychiatric examinations were
made, keeping in mind the above contrain-
dications. The routine laboratory studies
consisted of a complete blood count, sedi-
mentation rate and urinalysis. Electrocar-
diograms, determinations of liver and renal
functions were made when indicated. A ma-
ture psychotherapeutic relationship was at-
tempted as soon as possible, stressing the
importance of this phase of treatment, of
regular consultations and follow-up visits
until and after antabuse therapy becomes no
longer necessary.
Plan of Treatment
If there were no contraindications and no
alcohol had been taken for at least seven
days the drug was begun. About 9:30 a.m.
each day the following dosage was given:
1st day — Antabuse 2.0 Gm. (4 tablets)
2nd day — Antabuse 1.5 Gm. (3 tablets)
3rd day — Antabuse 1.0 Gm. (2 tablets)
4th day — Antabuse 0.5 Gm. (1 tablet)
5th day and after 0.125 Gm. to 0.5 Gm. daily as
necessary.
Patients were advised to remain in the
hospital during the start of antabuse treat-
ment. Some of them completed their hos-
pital period of sobering and supportive
treatment, went home for a short stay and
then returned after seven days of abstinence
to start on antabuse.
On the fourth day of antabuse treatment
a test drink was given. This consisted at
first of 45 cc. of 86 proof (43 per cent alco-
hol by volume) blended whiskey for the
452
The Journal of the Medical Association of Georgia
average size person and 30 cc. for those who
were small or undernourished. Due to the
initial severe reactions, one of which was
alarming after 45 cc. of whiskey, we have
more recently been giving only 20 cc. to
30 cc. of whiskey. In most cases this was
enough to produce a definite and moderately
severe reaction. It was intended for the first
or second reaction with alcohol to be suffi-
ciently severe for the patient to know what
to expect when one becomes sensitized with
antabuse. During the reaction the patient
A\as impressed with the relation between
the amount of alcohol consumed and the de-
gree of discomfort. Some Avorkers admin-
istered the test drinks by allowing patients
to drink as much of their usual beverage as
desired. Because of potential dangers re-
sulting from an excess of alcohol it was
always our practice to administer a safe
amount at one time and to supplement this
with an additional amount if the reaction
failed to reach the desired intensity. This
was necessary in only a few instances.
All patients were required to remain over-
night folloAving the first test drink. Most of
them were discharged the fifth day at which
time they were informed about the daily
dose to be taken regularly thereafter. Ad-
justments in dosage were necessary because
of certain disturbing symptoms, all of which
were eventually controlled after a few Aveeks
of treatment.
The second visit was from 4 to 7 days
after the first alcohol test had been given.
At this time another test was scheduled with
smaller amounts of whiskey or Avith beer
or wine if these beverages had been used.
Some patients were given as many as five
test drinks on different occasions, but the
average Avas three per patient. During the
first month the patient was asked to return
each Aveek, but as time elapsed it became
more and more difficult to encourage visits
this often. After the third month of treat-
ment all patients were asked to return at
least every two or three months. Laboratory
studies on blood and urine Avere made at
frequent intervals.
The Antabuse- Alcohol Reaction
Immediately before the alcoholic bev-
erage was given record Avas made of any
effects which the patient may have experi-
enced from antabuse alone; the pulse and
respiration rates Avere counted, blood pres-
sure recorded and the oral and facial skin
temperatures Avere measured. The color of
the skin over the body, the vascularity of
the sclerae and the odor of the breath were
noted. The time was recorded at which the
kind and amount of beverage Avas taken.
The above observations were repeated every
five to ten minutes, all other objective and
subjective symptoms being observed and
recorded.
Within two to four minutes practically
all patients, regardless of the amount or
kind of alcoholic beverage consumed, ex-
perienced a feeling of warmth in the face
and showed a distinct redness in the skin
of the cheeks, forehead and neck. An imme-
diate rise of from two to five degrees in the
facial skin temperature was an indicator of
the degree of vasodilatation which had oc-
curred. Also in most patients we observed
a mild cough in the early minutes of the
reaction followed by a sense of smothering
and mild dyspnea which was typical of the
early respiratory effect. To these early cir-
culatory and respiratory symptoms are add-
ed the folloAving objective and subjective
changes listed in the order of their appear-
ance:
A. Objective Changes Noted:
1. Redness and flushing of face, neck
and chest.
2. Tachycardia; precordial and cervical
pulsations.
3. Cough; hyperpnea.
4. Injection of sclerae; edema of eyelids
and lips.
November, 1950
453
5. Strong odor of acetaldehyde on breath.
6. Drop in blood pressure.
7. Perspiration.
8. Tremors and other features of a severe
“morning after”.
9. Generalized vasodilatation.
10. Engorgement of veins and dilatation
of arterioles of retina.
11. Pallor; sudden slowing of pulse, vom-
iting.
12. Yawning, drowsiness, sleep.
13. Recovery and resumption of activities.
14. Aversion to more alcohol.
B. Subjective Changes Noted:
1. Feeling of heat in face and ears.
2. Sensation of smothering; substernal
pressure; tightness of throat.
3. Palpitation and pounding of heart.
4. Stinging of eyes; blurring of vision.
5. Feeling of apprehension and uneasi-
ness.
6. Nervousness similar to that of a bad
“hangover”.
7. Dizziness, weakness and faintness es-
pecially in the erect position.
8. Throbbing headache; roaring in ears.
9. Generalized discomfort and malaise.
10. Aching in legs; numbness in hands and
feet.
11. Nausea and at times vomiting.
12. Desire to sleep.
13. Upon awakening relaxed and re-
freshed.
14. Desire for food.
15. No desire for another drink during or
after reaction.
16. “Never before such an experience
from such a small drink”.
Vasomotor Symptoms: The vasodilata-
tion which occurred two to three minutes
after alcohol consumption first appeared
about the cheeks or ears, spread rapidly
over the entire face, then to the neck, chest
and upper extremities. In more severe re-
actions this was evident over the entire body
after about 40 minutes. There was increased
perspiration especially on the palms and the
soles. The sclerae became typically “blood
shot” and remained so until the reaction
subsided. Ophthalmoscopic examinations
showed dilatation of the arterioles and mod-
erate engorgement of the veins of the retina.
The increase in the skin temperature of the
cheek during the reaction served as an ac-
curate measure of the degree of facial vaso-
dilatation, but it was no indication of the
ultimate severity of the total reaction.
When this vasodilatation had been ex-
treme and especially when the patient sat
or stood erect, the marked flushing often
gave way to an extreme pallor not unlike
that seen in shock. At this time the pulse
volume became small and rate often slowed
rather suddenly from the previously accel-
erated rate. At times a bradycardia of 50 to
60 was observed. A rapid drop in blood
pressure always accompanied this syncope.
The recovery from this state was gradual
and was usually completed in from 1 to 2
hours. In two of the more severe reactions
oxygen, coramine and adrenalin were used.
Circulatory Symptoms: In addition to
the above peripheral changes, there was a
tachycardia often as high as 130 to 150 per
minute. The systolic and diastolic pressures
in most instances dropped. This drop was
rather extreme when the person had con-
sumed 30 cc. or more of whiskey or 360 cc.
of beer.
Respiratory Symptoms: The first effect
on the respiratory system was often an
asthma-like cough, followed by an increas-
ingly severe shortness of breath, a heavy
substernal pressure and constriction about
the throat. This resulted in fear, uneasiness
and discomfort until the peak of the reac-
tion had passed. Extreme dyspnea and hy-
perventilation were relieved by inhalation
of pure oxygen or carbogen, but this had
little effect in relieving the entire reaction.
454
The Journal of the Medical Association of Georgia
The work of Asmussen, Hald, Jacobsen and
Joergensen4 showed evidence of broncho-
dilatation with an increase in ventilation
and in the respiratory dead space.
Gastrointestinal Symptoms : \\ hen the re-
action was severe and especially when the
marked flushing gave way to pallor, nausea
and vomiting often occurred.
Neurologic Symptoms : The effect on the
nervous system during the antabuse- alcohol
reaction was manifested by nervousness,
tremors, dizziness, headaches and blurred
vision. In the later stages there was definite
drowsiness and desire to sleep. Several pa-
tients complained of transient numbness in
the extremities and of pain in the legs. No
convulsions occurred in this series, but one
typical generalized seizure has been ob-
served subsequently in a 34 year old male
30 minutes after receiving 20 cc. of 86
proof whiskey as his first test drink. Con-
vulsions have been reported previously1'1,
but have not occurred very often.
TABLE 1
Proportion of Male and Female
Alcoholic Patients Accepting Antabuse From
July I, 1949 to January 1, 1950
All Alcoholic
No. Patients
Per Cent
Patients
Accepting
Accepting
Admitted
Antabuse
Antabuse
Male
205
17
8.3
Female
24
10
41.6
Total
229
27
11.8
The severity of the antabuse-alcohol re-
action is described as follows (Table 2) :
1. An alarming reaction was character-
ized by flushing, marked dyspnea and tachy-
cardia; fall in blood pressure to an extreme
degree; almost imperceptible pulse; semi-
stupor, pallor and appearance of shock.
Supportive measures of adrenalin, cora-
mine, oxygen and intravenous fluids were
used. The duration was about 3 hours (fig.
1).
Fig. 1. Changes in temperature, respiration, pulse and blood pressure during an alarming antabuse-alcohol reaction pro-
duced by 45 cc. of 86 proof whiskey.
November, 1950
455
TABLE 2
Degree of Reaction in 76 Test-Drinks With
Various Amounts of If hiskey, Beer and Wine.
45
Amount Whiskey
(43% alcohol by
37.5 30 22.5
CC.
volume)
20 15
Amount Beer
oz.
12 8 6
Sherry
Wine
4 45 cc.
Alarming
Reaction
1
0
0
0
0
0
0
0
0
0
0
Severe
Reaction
4
2
10
6
0
0
3
0
2
0
1
Moderate
Reaction
1
0
9
1
1
1
1
1
5
0
0
Mild
Reaction
0
0
0
2
1
20
0
1
2
1
0
— —
Totals
6
2
19
9
2
21
4
2
9
1
1
2. A severe reaction consisted of gen-
eralized vasodilatation, marked tachycar-
dia, dyspnea, malaise, nausea and at times
vomiting; drop in blood pressure, weakness,
intense drowsiness and desire to sleep. Oxy-
gen was used to combat dyspnea. Duration
1^2 to 2 hours.
3. A moderate reaction was one showing
intense flushing of face, neck and upper
trunk; moderate tachycardia and dyspnea;
slight drop in blood pressure and a mild
degree of generalized discomfort. Duration
about one hour.
4. A mild reaction was characterized- by
a definite flushing of face, injection of eyes,
slight increase in pulse rate, but no appre-
ciable change in respirations and blood
pressure. Duration of from 30 minutes to
one hour.
Results
From July 1, 1949 to January 1, 1950
treatment with antabuse was accepted by 17
out of a total of 205 male alcoholic patients
admitted, and by 10 out of a total of 24
female alcoholic patients admitted (Table
1). On March 15, 1950 the condition of
these 27 patients, as far as alcohol is con-
cerned, was grouped as follows: (Table 3
and 4) :
Group A. There were 13 patients (10
male and 3 female) who were abstinent and
were making a satisfactory adjustment; only
2 had attempted to drink and in each case
this was a small amount for one day only.
Of these 13 patients 9 continued taking anta-
buse, and 4 had remained abstinent from 3
to 7 months after it was discontinued.
Group B. An additional 7 patients (3
TABLE 3
Summary of 27 Alcoholic Patients Starting Treatment With Antabuse July 1, 1949 to January 1, 1950
Years
Date
Final
Treatment
Resumed
Results to
Case
Sex/Age
Drink-
Antabuse
Daily
Stopped;
Relapsed
Antabuse
March 15, 1950
No.
ing
Started
Dose Gm.
*with advice
1
M/33
16
7/9
0.5
No
No
Abstinent
2
M/29
14
7/15
0.5
Yes
Yes
Yes
Much better
3
F/39
18
7/18
0.125
Yes*
Yes
No
Much better
4
F/35
16
8/3
0.25
Yes
Yes
Yes
Much better
5
M/41
20
8/5
0.25
No
No
Abstinent
6
M/42
15
8/9
0.25
Yes*
Yes
No
Unchanged
7
F/30
16
8/10
0.25
Yes
No
No
Abstinent
8
F/41
12
8/20
0.25
Yes*
Yes
Yes
Unchanged
9
F/38
13
8/20
0.375
Yes
Yes
No
Unchanged
10
M/35
12
8/27
0.25
Yes
1 day only
Yes
Abstinent
11
M/23
8
8/29
0.5
Yes
Yes
Yes
Much better
12
F/38
20
9/2
0.25
Yes
Yes
Yes
Much better
13
M/46
20
9/14
0.25
Yes
Yes
Yes
Much better
14
M/36
20
9/14
0.25
Yes
No
No
Abstinent
15
M/47
15
9/16
0.125
Yes
No
No'
Abstinent
16
F/47
28
9/20
0.5
Yes
Yes
Yes
Much better
17
M/48
14
9/20
0.125
Yes*
No
Yes
Abstinent
18
M/36
20
* 9/21
0.25
Yes
Yes
No
Unchanged
19
M/54
32
9/28
0.125
No
No
—
Abstinent
20
M/34
15
9/30
0.5
No
No
Abstinent
21
M/44
18
10/21
0.25
No
No
,
Abstinent
22
M/38
14
10/30
0.5
Yes
Yes
No
Unchanged
23
F/37
19
10/31
0.5
Yes
Yes
No
Unchanged
24
M/40
20
11/9
0.25
No
No
—
Abstinent
25
F/42
22
11/15
0.25
Yes
1 day only
No
Abstinent
26
F/35
5
12/13
0.5
Yes
No
No
Abstinent
27
M/40
20
12/20
0.125
Yes*
No
No
LInchanged
456
The Journal of the Medical Association of Georgia
male and 4 female) were considered “much
improved”. Each of these had had one or
two short relapses, but had resumed anta-
buse treatment; six required readmission
for control while one was able to stop drink-
ing at home. With one exception all seven
had discontinued antabuse against advice.
TABLE 4
Results in 27 Patients Followed to March 15, 1950
Abstinent
and adjust- Much better Unchanged
ing well
13 7 7
20
48 26 26
74^
99 Patients 52
Jacobsen, 71
Martensen-
Larsen (13)
Per cent 52.5
71.6
Group C. There were 7 patients (4 male
and 3 female) who discontinued treatment
with antabuse, two on our advice, and whose
condition in regard to alcohol is considered
“unchanged”. Four of these patients were
readmitted by us; one by another psychi-
atric hospital, and the fate of the other two
was not determined except to the extent
that they continued drinking.
29 28 (Somewhat
better and
unchanged)
19.1 28.4
Number
Patients
Per cent
TABLE 5
Side Effects of Antabuse Alone During and After
First Four Weeks of Treatment in 27 Patients
Number Patients
Symptom First 4 Weeks
No complaints 1
Drowsiness 21
Fatigue 9
Headache 6
Anorexia 3
Abdominal cramps 3
Depression 2
Hyperactivity 1
Nausea 1
Bad Taste 1
‘'Heartburn” 1
“Gas” 1
Inability to concentrate- 1
Dizziness 0
Dermatitis 0
“Antabuse Odor” to
Breath 5
Number Patients
After 4 Weeks
15
1
3
2
1
0
1
0
0
1
0
0
0
1
1
12
Side Effects of Antabuse : Table 5 shows
the various early and late effects of anta-
buse when the patient does not drink.
Drowsiness, fatigue and headaches were the
most common complaints during the first
four weeks of treatment, but after the main-
tenance dose was adjusted these symptoms
usually disappeared. The drowsiness and
sedative effect when not too severe were
considered helpful and desirable. At times
the daily dose was recommended to be taken
in the evening in order to avoid undue
drowsiness during the day and to obtain
benefit of the relaxation and rest at night.
The abnormal fatigue was often a dis-
turbing symptom, but also was transient and
could be controlled by reduction of the daily
dose to a slightly lower level. An unusual
odor to the breath was detected by others in
5 patients who had been taking antabuse for
less than 4 weeks and in 12 patients who
had been taking it for a longer time. This
odor seemed to us to be different from the
acetaldehyde odor noticed with alcohol. It
is referred to as the “antabuse odor”. The
“had taste” complained of by two patients
was associated with this “antabuse odor"
on their breath. It is our belief that anta-
buse when of sufficient concentration in the
body to produce sensitivity to alcohol, im-
parts a characteristic odor to the expired air
in a good many instances and when de-
tected will prove helpful as a means of
knowing that regular and adequate dosage
is being maintained by the individuals.
TABLE 6
Duration of Treatment ; Number of Relapses
and Resumption of Antabuse
Duration
Continuous
Interrupted
Interrupted
of
Treatment
Treatment
Treatment
Treatment
against advice
on advice
(Mo.)
1 or less
—
6
3
2
—
4
—
3
—
3
—
4
2
1
1
5
2
2
1
6
7
1
O
—
8
I
—
—
Total
6
16
5
Number
Relapsed
0
15
3
Number Resumed
Antabuse
—
7
2
November, 1950
457
No effect was observed on the cellular
elements of the blood or in the urinary
findings during follow-up examinations. As
a whole the side effects of antahuse alone
are minimal and subside in three or four
weeks and after adjustment of the daily
dosage.
Maintenance Dose: Of the 27 patients tak-
ing antahuse, sensitivity to alcohol was
maintained without appreciable side effects
in 7 patients with 0.5 Gm. daily; in one
patient with 0.375 Gm. daily; in 13 patients
with 0.25 Gm. daily and in 6 patients with
0.125 Gm. daily. When reduction in dosage
was made a subsequent test drink was ad-
vised and given in most instances. This was
to determine the sensitivity of a patient by
the appearance of a mild reaction when
about 15 cc. of 86 proof (43 per cent alco-
hol by volume) whiskey was consumed.
Duration of Treatment: It has not yet
been determined how long antahuse should
he continued. This must he decided between
the physician and patient when it is agreed
that a satisfactory adjustment is being made
and control without antahuse is possible
and desirable. On March 15, 1950 only six
patients (Cases 1, 5, 19, 20, 21, 24) contin-
ued taking antahuse without interruption for
periods of four to eight months (Table 6).
Sixteen patients stopped taking antahuse
at one time or another on their own accord.
The usual reason was that “it was no longer
needed or desired”. The time elapsed after
treatment started until it was stopped was
from three weeks to five months. Among
this group of 16 individuals 13 are known
to have relapsed. Two others drank small
amounts for 24 hours or less, resumed anta-
buse immediately and maintained control
thereafter. One female patient deliberately
stopped taking antahuse a week before an
anticipated New Year’s Eve party so this
could he duly celebrated. Hospital admis-
sion was necessary two weeks later, hut she
resumed antahuse as soon as possible and
has remained abstinent since then.
Complications Causing Termination of
Treatment: Five patients were advised by
us to discontinue antahuse. The first occa-
sion was following a severe reaction in a
41 year old female (Case 8, Fig. 1). For
her first test drink she was given 45 cc. of
86 proof whiskey and the alarming reaction
of collapse, apparent shock and impending
death was such that we preferred to suggest
that she not continue with treatment. A few
weeks later, however, she returned request-
ing antahuse again, hut without further test
drinks. To this we agreed, hut the holiday
temptation was irresistible for her. Antahuse
was discontinued and relapse occurred. She
has subsequently received treatment by us
and recently elsewhere.
The second instance (Case 6) was be-
cause of a small coronary thrombosis in a
42 year old male who had been taking
antahuse for 26 days. For 17 days preced-
ing his heart attack his daily dose had been
reduced to 0.125 Gm. due to complaints of
fatigue and inability to concentrate. An
electrocardiogram prior to the start of anta-
huse was reported “normal”, but afterwards
showed evidence of myocardial damage sug-
gestive of a small coronary occlusion. Anta-
huse treatment with us was not resumed by.
this patient. Shortly thereafter he relapsed
and is reported above as one whose condi-
tion is “unchanged ”. Recently, however, we
have learned that he has resumed antabuse
therapy elsewhere.
The drug was discontinued in a 39 year
old female (Case 3) who developed an
acneform rash over her face. She had taken
antabuse daily for four months. The rash
disappeared after treatment was stopped.
Relapse occurred 2l^> months later, re-
quired hospital treatment, and was followed
by no desire to resume antabuse. Gelbman
and Epstein10 reported the occurrence of
458
The Journal of the Medical Association of Georgia
rashes which were controlled with pyriben-
zamine and did not necessitate termination
of treatment.
A fourth patient (Case 17) was advised
to discontinue antabuse during a short hos-
pital stay for treatment of a reactive de-
pression. Upon discharge antabuse was re-
sumed. His depression resulted from ob-
vious conflicts in his environment and in
our opinion was not related to medication.
He has remained abstinent for over five
months despite unusually difficult problems
in his environment.
Antabuse was stopped when a 40 year
old male (Case 27) with schizoid tendencies
became psychotic after only 4 weeks treat-
ment. He had had previous attacks and had
accepted treatment w ith antabuse reluctant-
ly in order to satisfy an overly concerned
mother. His condition is considered “un-
changed” as related to alcohol.
Summary and Conclusions
1. The present status of the treatment of
alcoholic patients with antabuse is briefly
reviewed.
2. Among 229 alcoholic patients admit-
ted during a six month period, there were
only 27 patients (11.8 per cent) who ac-
cepted antabuse therapy.
3. To date there were 13 patients (48
per cent) treated with antabuse who were
abstinent and were making a satisfactory
adjustment; there were 7 patients (26 per
cent) considered “much better”, and 7 (26
per cent) who were not improved.
4. In this group of 27 patients there were
76 antabuse-alcohol reactions produced
with different kinds and amounts of alco-
holic beverages. The severity of the reaction
varied to some extent with different indi-
viduals who consumed the same volume of
alcohol, but generally it depended on the
total alcohol consumption.
5. In addition to the usual circulatory
and respiratory changes described in earlier
reports it was observed that a definite effect
on the blood pressure does occur. There was
a marked decrease in both systolic and dias-
tolic pressures when more than 20 cc. of
whiskey was consumed.
6. One alarming reaction was observed,
supporting more recent observations that po-
tential dangers are present and that anta-
buse should be used cautiously.
7. The most common side effect noticed
by patients taking antabuse was drowsiness.
When not too severe this proved helpful and
desirable. There was a disagreeable odor
detected on the breath of almost half the
patients taking antabuse, but otherwise the
side-effects were minor and transient.
8. The results of this study are encourag-
ing and compare favorably with those of
earlier reports.
9. Much more time is necessary before
an accurate appraisal of antabuse therapy
can be made. It should be combined with all
other measures for physical, emotional and
social rehabilitation of the alcoholic patient.
Antabuse can help the patient maintain so-
briety while these adjustments are being
made.
REFERENCES
1. Martensen-Larsen. O. : New Lines in Treatment of
Alcoholics, Ugesk, f. laeger. 110:1207 (Oct.) 1948; (Quoted
by Martensen-Larson ; reference 13).
2. Martensen-Larson, O. : Treatment of Alcoholism with
a Sensitizing Drug, Lancet 255:1004 (Dec. 25) 1948.
3. Hald, J. : Jacobsen, E., and Larsen, V. : The Sensi-
tizing Effect of Tetraethylthiuramdisulphide (Antabuse) to
Ethylalcohol, Acta pharmacol, et toxicol. 4:285, 1948.
4. Asmussen, E. ; Hald, J.: Jacobsen. E., and Jorgensen,
G. : Studies on the Effect of Tetraethylthiuramdisulphide
(Antabuse) and Alcohol on Respiration and Circulation in
Normal Human Subjects, Acta pharmacol. et toxicol. 4:297,
1948.
5. Hald, J. ; and Jacobsen, E. : The Formation of
Acetaldehyde in the Organism after Ingestion of Antabuse
(Tetraethylthiuramdisulphide) and Alcohol, Acta pharmacol.
et toxicol. 4:305, 1948.
6. Asmussen, E.; Hald, J., and Larsen. V.: The Pharm-
acological Action of Acetaldehyde on the Human Organism,
Acta pharmacol. et toxicol. 4:311, 1949.
7. Larsen, V. : The Effect on Experimental Animals of
Antabuse (Tetraethylthiuramdisulphide) in Combination with
Alcohol. Acta pharmacol. et toxicol. 4:321, 1948.
8. Hald, J. : and Jacobsen, E. : A Drug Sensitizing the
Organism to Ethyl Alcohol, Lancet 255:1001 (Dec. 25)
1948.
9. Bell. R. G., and Smith, H. W. : Preliminary Report on
Clinical Trials of Antabuse, Canad. M. A. J. 60:286, 1949.
10. Gelbman, F., and Epstein, N. B. : Initial Clinical
Experience with Antabuse, Canad. M. A. J. 60:549, 1949.
11. Ferguson, J. K. W. : Editorial, Canad. M. A. J. 60:295,
1949.
12. Glud, E. : The Treatment of Alcoholic Patients In
Denmark with “Antabuse” with Suggestions for its Trial
in the United States, Quart. J. Stud, on Alcohol 10:185
(Sept.) 1949.
13. Jacobsen, E., and Martensen-Larsen, O.: Treatment
of Alcoholism with Tetraethylthiuramdisulphide (Antabuse),
J. A. M. A. 139:918 (April 2) 1949.
November, 1950
459
14. Jones. R. O. : Death Following the Ingestion of
Alcohol in an Antabuse Treated Patient, Canad. Med. A. J.
60:609 (June) 1949.
ADDENDUM
Follow-up of these 27 patients to November 1, 1950
reveal that eight continue their abstinence, four of
whom are still taking antabuse. Six patients are con-
sidered much improved, but only two are taking anta-
buse. A total of 13 of the 27 patients have discon-
tinued antabuse, have returned to their regular habits
of drinking and are considered unchanged.
No serious difficulties have arisen in the continued
use of this drug.
Brawner’s Sanitarium, Smyrna, Georgia.
Note: The foregoing papers are a part of a sym-
posium. Discussion of them will follow completion of
the publication of the symposium, in the December,
1950. number of THE JOURNAL. — Ed.
DOCTORS AND THE PUBLIC
John E. Drewry
Athens
There is probably no name in medical history
held in higher esteem than that of the late Sir
William Osier, who practiced and taught at
Johns Hopkins in Baltimore and at Oxford Uni-
versity in England. He was the author of a book.
“Principles and Practice of Medicine”, which
was a basic text of thousands of contemporary
practitioners, and was himself the subject of
several important books, one of which, Dr. Har-
vey Cushing’s “The Life of Sir William Osier”,
published in 1925, won the Pulitzer prize. So
wise were Dr. Osier’s observations on such a
variety of subjects that only this fall — 31 years
after his death — a new book called “Osier Apho-
risms” has appeared, and undoubtedly it will
have a substantial sale. The teaching and per-
sonality of this man, according to Webster’s Bio-
graphical Dictionary, “strongly influenced medi-
cal progress”, and it is for this reason, among
others, that I turn to him for the text of my re-
marks on medical public relations.
The story is told (in “For Doctor’s Only” bv
Dr. Francis Leo Golden) that one day as Dr.
Osier was leaving the hospital, a patient called
out from a nearby bed, “Good morning, Doc.”
The great physician made no reply, but when he
reached a corridor, he turned to the interns who
were accompanying him and said:
“Bew are of the men who call you Doc. Rarely
do they pay their bills.”
This admonition, writh all its public relations
implications, is my text of the evening.
(Dean, Henry W. Grady School of Journalism, The
University of Georgia: Vice-President, Association of
Accredited Schools and Departments of Journalism: former-
ly President. American Association of Teachers of Journalism;
Author or Editor. “Concerning the Fourth Estate’’, “Post
Biographies of Famous Journalists’’, “More Post Biogra-
phies”, “Book Reviewing”, “Contemporary Journalism”,
etc.).
Address delivered at the statewide press conference of
the Medical Association of Georgia, Atlanta. October 2,
1950.
What does this statement mean? (“Beware
of the men who call you Doc. Rarely do they pay
their bills.”)
Are doctors primarily interested in their fees?
Do they place money above human relation-
ships?
Do they w ant the proper distance kept between
them and their patients? '
Are their ministrations, like their Latin pre-
scriptions, to be expressed in a language classical
and incomprehensible to the masses?
Above all, is the attitude of professional medi-
cine tow ard the public, and the agencies of public
relations, a little like that of big business of
yesterday: “The public be damned!”?
And is this attitude, as was the case with the
corporations, intensified by fear? In the case of
business — fear of government intervention ? In
the case of medicine — fear, again of government,
but in this instance known as socialized medi-
cine?
Fear, undoubtedly, is at the bottom of much
bad medical public relations. But it is more than
fear of socialized medicine. It is a fear much
more general and fundamental. It is the fear of
the unknown, and in the case of most doctors,
the unknown is public relations — its purposes and
technics. Coupled with this frightening ignor-
ance are a training, a tradition, and an ethical
concept w'hich eschew publicity. Doctors don’t
advertise and they are suspicious of those who
get into the public prints (no matter how dig-
nified the reference or reputable the publication) .
Dr. Osier had something of this point of view — -
although printer’s ink played a far greater part
in the establishment of his great reputation than
many doctor critics may realize. Wrote Dr. Osier:
“In the life of every successful physician there
comes the temptation to toy with the Delilah of
the press — daily and otherwise. There are times
when she can be courted with satisfaction, but
beware! Sooner or later she is sure to play the
harlot, and has left many a man shorn of his
strength, namely the confidence of his profes-
sional brethren.”
The doctor does not, of course, w'ant to be
shorn of his strength — of his professional repu-
tation. He is jealous of the esteem in which he
personally and his profession are held. He wants,
if he be the right kind of physician, to enhance
the standing of both. The prescription then, is
that of Holy Writ. “Heal thyself”. “Know ye
the truth and the truth shall make you free”. He
must analyze the fears that are at the root of
many of medicine’s public relations problems;
he must put into language those that have been
unverbalized; he must deal adequately with those
which merit attention; and he must free himself
of the paralvsis of what Roosevelt called the
greatest of all fears — fear of fear itself — the pro-
fessional equivalent of a child’s fear of the dark.
What then is the treatment? There is no gen-
460
The Journal of the Medical Association of Georgia
eral panacea, and the several phases of medicine
— general practitioner, specialist, hospitals, pub-
lic health, nurses — all have their special prob-
lems. But there are a few general principles
which may well serve as the basis of individual
or group action.
Do you know and are you concerned about
the answers to such questions as these:
What is it about doctors and medical practice
that the public does not like?
Which of these complaints have merit, and
what can doctors do about them?
What is the public?
Could it be that there is more than one public?
Are doctors, as such, aware of Capital and
Labor, of civic clubs and veterans’ organizations,
of Congress and the Senate, of the Church and
public education — and a host of similar groups,
all of which are potential friends or enemies?
In the answers to such questions as these lies
the beginning of wisdom in so far as good public
relations are concerned. As another one of your
speakers, Larry Rember of the American Medical
Association, has so well put it, “Medical public
relations is a continuous process by which the
medical profession endeavors to obtain the con-
fidence and good will of the public — inwardly
by self-analysis and correction to the end that
the best interests of the people will be served;
outwardly by all means of expression so that the
people will understand and appreciate that their
welfare is the profession’s guiding principle.”
Did you notice that phrase — “by self-analysis
and correction”? What are some of the areas in
which doctors may well do some professional
soul-searching? You know these, of course, better
than I, a layman, would. But I have read some
things that are not too complimentary to you
about fees; about kick-backs in the sale of spec-
tacles, drugs, and through referrals; about keep-
ing patients waiting in your outer offices much
too long; about treating the ailment rather than
the person; about discourteous brush-offs of
newspaper men whose missions are perfectly
legitimate; about unkind references to Reader’s
Digest, Time, and other publications which are
making a serious and intelligent effort to work
with and for the medical profession in the attain-
ment of better health for more of the people;
about a high and mighty and holier-than-thou
attitude toward those whom you are pledged to
serve and toward those social agencies, such as
the press and radio, which should and would
like to be your allies.
Many are the times that I have told our jour-
nalism students that the newspaper is for society
what the doctor is for the individual, and that
this is the age of preventive rather than curative
medicine. The press is concerned with the ills
of society, just as you are with the ailments of
the individual — or stated in the language of
preventive medicine, the press would promote
the health of the body politic just as you would
see that the individual remains well. This means
that the agencies of communication are poten-
tially your friends. But you must know these
agencies, and the men and women through whom
they function, if you are to enjoy this friendship
and its benefits.
It is not without significance that propaganda
— which is just another word for public rela-
tions— is of religious origin. The word derives
from the College of Propaganda which was in-
stituted by Pope l rban \ III (1623-441 during
the 17th century to educate priests. Propaganda
or publicity is, therefore, a phase or form of
education. And its greatest development has
been during the present century. There are some
fairly obvious and altogether logical reasons for
this, among which are:
1. The complexity of modern civilization
makes it impossible for any newspaper anywhere
to cover all sources of news. This applies equally
to the great metropolitan journal with its many
reporters and to the small weekly with one man
doubling in brass as reporter, editor, advertising
and circulation manager, linotype operator,
make-up, and press man. It applies also to press
services, such as the A.P., U.P., and I.N.S., and
to the magazines. Much worthwhile news, there-
fore, must be provided the press through public
relations offices if it is ever to be published.
2. Specialized subjects — and certainly medi-
cine is one of these — need to be treated by those
who understand them. A few of the better-heeled
newspapers and magazines are able to employ
science and medical writers, but the rank and
file of publications can do a better job of inter-
preting medicine to the public if the stories are
processed for readability and truth by a public
relations man or woman who has the point of
view of both the doctor and the press or radio.
3. Institutions and professions supported by
and/ or serving the public — and these would cer-
tainly include hospitals, doctors, dentists, et al —
have an obligation to keep their constituences
informed about how they are functioning — their
problems, difficulties, and achievements.
4. From the doctor’s standpoint — and this
may be regarded as the selfish point of view,
albeit enlightened selfishness — proper publicity
is a lever for the kind of support which medicine,
like all professions and social agencies, constantly
needs. We have often heard that an offensive war
is more easily and more successfully fought than
a defensive one. Good publicity — continuous
publicity — may be regarded as that offensive
which will keep doctors on the victorious side in
its many battles — be they against disease and
death or the forces of socialized medicine.
5. An important reason for public relations
development — one which doctors and others who
are publicity shy are likely to forget — is that the
newspaper, radio, and magazine, as important
November, 1950
161
social agencies, cannot ignore medical, scientific,
and educational news. In terms of the onward
march of civilization, it is the most important of
all news. It is the main skein in the fabric of
national and world progress. In the fulfillment
of this obligation, journalists are entitled to the
intelligent support of the medical world.
6. Possibly the strongest argument for active,
aggressive medical public relations — and again
this is from the standpoint of medicine, selfish,
but enlightened — is the fact that publicity is a
safeguard against misrepresentation. One reason
that so many persons are sympathetic to social-
ized medicine may be that that side has been
quick to appreciate the truth of this particular
argument for propaganda and to put it to prac-
tical use.
Which brings us back to that word propa-
ganda— indeed a tricky term. Some cynic has
said that whether propaganda is good or bad
depends on whether it is ours or that of the other
fellow. Certainly the word means one thing for
one group, and something entirely different for
another. For many, it has an evil connotation.
For them, it is something sinister, evil, under-
cover, perhaps dangerous. For others ( and we, I
hope, belong to this group ) it is a muchly abused
word of honorable origin and great potential.
It is a necessary part of our 20th century mores.
It is ours to use wisely through many media.
The agencies of propaganda are many, and
each has its special use. Newspapers and radio
readily come to mind. So do magazines and
pamphlets. But had you thought of schools and
textbooks, popular best-sellers and college
courses, the church and the movies, as tools of
propaganda? Where have people learned so
much about socialized medicine? Not in news-
paper and magazines alone. Do you know what
is being said on this subject in high schools, in
university courses in the social sciences, in ladies’
reading circles, and in civic clubs and on lodge
night? The range, scope, and possibilities of
public relations, my friends, are indeed far-
reaching. Good propaganda is quantitative as
well as qualitative, extensive and intensive. Are
you making the most of your opportunities and
obligations?
Medicine is one of the oldest of the profes-
sions, but one of the youngest to see the need of
organized publicity. I was interested to read that
it was only last year that the Medical Association
of Georgia inaugurated a public relations pro-
gram— thus becoming the 22nd such society to
employ a full-time public relations director and
the 32nd to set up a budget specifically for public
relations activities. The church ministry, another
old profession, is a newcomer to the public rela-
tions field. But much progress is being made.
Some of the theological seminaries are adding
courses in public relations to their curricula.
Possibly medical schools should do likewise. I
had a student tell me recently that he was plan-
ning to be an undertaker and that he thought
journalism would be a good pre-mortician’s
course. We now have a combination journalism-
law course. Medicine, the ministry, and the law
are, of course, the classical trilogy among the
professions. Two have taken formal cognizance
of the place of journalism or public relations as
a part of their educational preparation of novi-
tiates. The third, your profession, seems to be
toying with the idea. It may not be a bad one.
In conclusion, may I point quickly to some of
the good things by way of medical public rela-
tions which I think merit commendation:
1. Some of our best books are by doctor-
authors. We Georgians are familiar, of course,
with Dr. Frank K. Boland’s “The First Anesthet-
ic, The Story of Crawford Long”, and the tre-
mendous amount of time and energy which Dr.
Boland has exerted in behalf of Dr. Long’s claim
to fame as the first to use ether as an anesthesia.
Incidentally, this is a good example of medical
public relations at its best. We also remember
the great biographies or autobiographies of Hugh
Young, Harvey Cushing, the Mayo brothers,
and other towering giants of medicine. Perhaps
you doctors know, but I doubt whether the public
does, that some of our best fiction writers have a
medical background. To cite but three among
contemporary best-sellers, there are Somerset
Maugham, A. J. Cronin, and Frank Slaughter. If
we turned back the pages of history, there would
be Oliver Wendell Holmes and others of equal
stature. Have you ever wondered why some of
our best literature is medical in origin? (In the
book trade, it is said that books by or about
doctors, books about Lincoln, and books about
dogs always sell well). The answer may be in
the fact that physicians know life with its ail-
ments, problems, difficulties, achievements, and
moments of happiness as no other professional
group can. They know life and death and all that
comes between. In the language of Robert Peter
Tristram Coffin in his memorable poem, “Country
Doctor” —
"‘Through rain, through sleet, through ice, through snow.
He went where only God could go . . .
He left an old man in the dark
And blew up a tiny spark
In a young man two feet long
To carry on the dead man’s song . . .
He went to the country’s ends,
Not for fees, but for friends.
Came like an angel fierce and fast.
He saw men first and saw them last . . .
Our farms so lonely and spaced far
Could never have grown the nation we are
But for this man, come sun, come snow,
Who went where God alone could go.”
2. Our better magazines are devoting more
(Continued on Page 466)
402
The Journal of the Medical Association of Georgia
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E.. Atlanta. Ga.
November, 1950
MYSTERIOUS VIRUS DISEASE IN MEDICAU
SPOTLIGHT
An especially mysterious virus condition is be-
ginning to take the spotlight in the medical pro-
fessions never-ending battle against disease. It
is a condition known originally as glandular
fever, more recently rechristened infectious mon-
onucleosis, Dr. William Bolton of Chicago point-
ed out in the October issue of Today’s Health , a
publication of the American Medical Association.
Dr. Bolton, associate editor of the magazine,
said there are “plenty of reasons why this dis-
order should command attention. The actual
cause is believed to be a virus but is not exactly
known; the way the disease spreads also is
unknown.
“Its symptoms are so bizarre and -confusing
that accurate identification is extremely difficult,
said Dr. Bolton. “No entirely satisfactory treat-
ment has yet been developed.”
The disease is not new. It has been known
since 1889, causing among other disorders a
swelling of lymph glands, especially in the neck.
It originally was considered a disease chiefly of
children, but. like polio, it has “graduated” to
other ages.
“The principal signs in the average patient are
moderate fever, sore throat, cough, headache and
swollen glands,” said Dr. Bolton. “You could
have those in the start of German measles, in the
complications of an ordinary cold (with which it
is frequently confused), in a mild form of influ-
enza and a host of other disorders.
“Perhaps even more disturbing than the diffi-
culty of diagnosis is the erratic manner in which
infectious mononucleosis travels among the popu-
lation. First, it is believed that many persons
have it without identification ever being made.
This would be possible with mild forms of infec-
tion, when the victim feels no worse than he
would with a severe cold.
“Unsuspected, the virus could be passed on to
a dozen friends. But to complete the confusion,
not all of those friends would necessarily develop
the disease. Some of them might have had it
earlier, without knowing it. Others may have a
natural resistance to its effects.”
He pointed out its “spotty” nature — “it may
develop as a small-scale epidemic in a group of
children, yet attack only one child in a family of
three or four.” It may appear in one section of a
town and leap abruptly to some far-removed area.
“There is no rhyme or reason to its wander-
ings, no common medium such as water or food
supplies, unsuspected human carriers who har-
bor the virus without showing infection, or ani-
mal carriers,” he said. “It is limited to no special
region or season and does not occur as a result
of any changes in individual activity or body
function.”
Two accurate methods of identifying the di-
sease are available, he said. The first is to inspect
the white blood cells under a microscope; the
second to determine whether the patient's blood
serum causes a bunching of red cells taken from
a sheep.
During the active course of the disease there
is usually no extreme peril to life but the pa-
tient may feel worn out and unable to carry on
sustained activity for weeks.
Penicillin, chloromycetin, aureomycin and hu-
man blood serum have been used in treatment
and helpful results have been reported.
“Of course not everyone who feels w7eak and
worn out after an illness can assume that he has
had infectious mononucleosis,” said Dr. Bolton.
“But physicians are finding more and more fre-
quently that infectious mononucleosis is the final
picture after they have fitted together the pieces
of this jigsaw-puzzle disease.”
DIABETIC DOCTORS PROVE ONE CAN
LIVE LONG AND REMAIN ACTIVE
A diabetic person can take hope from the per-
sonal experiences of physicians suffering from
the same disease. Diabetic doctors — and these
are estimated at about one out of every 40 — have
proved that by adherence to a proper regime they
can conduct their normal activities and look
forward to a life expectancy almost as long as
that of the average physician.
This optimistic outlook was presented by Dr.
Robert F. Bradley of Boston in an article in
the October 7 Journal of the American Medical
Association. Dr. Bradley, associated with the
George F. Baker Clinic of the New England
Deaconess Hospital, made a study of the records
of 475 daibetic physicians consulting the Joslin
group between 1898 and 1947.
(The Joslin group is headed by Dr. Elliott P.
Joslin, clinical professor of medicine emeritus
at the Harvard School of Medicine, Boston, and
one of the world’s outstanding specialists in
diabetes ) .
From this study, Dr. Bradley concluded that
the average diabetic physician will live almost
as long as the average physician and will slightly
outlive his nonmedical contemporary. He also
concluded that it is worth while for a diabetic
person to enter medical school if (1) he shows
none of the degenerative complications of dia-
betes; (2) he demonstrates his ability and will-
ingness to control his diabetes, and (3) his dura-
November, 1950
465
tion of diabetes to time of entrance is less than
15 years. Under the same conditions, a medical
school need have no hesitation in receiving such
a student, he said.
“Once embarked in the study of medicine, the
physician in whom diabetes develops need not
give up his chosen profession, he added. '“He
should adhere to the hygienic practices that will
keep him in the best physical and mental condi-
tion, in order to prevent renal complications and
postpone as long as possible the lethal effects of
cardiovascular disease.'
Dr. Bradley cited the results of medical ad-
vance. In the era before treatment with insulin
(1898-1922 ), the average age at death of diabetic
physicians was 56.9 years. In 1948, it was 67.3
years. The duration of diabetes in fatal cases
rose from 8.5 years in the pre-insulin period to 15
years in 1948.
Diabetic coma, which at one time accounted
for 35.3 per cent of all deaths in stricken physi-
cians, has practically disappeared as a cause of
death. Infections and gangrene, likewise, have
almost disappeared as a cause of death.
He gave a number of examples of continued
activity although diabetes has been of long stand-
ing. A 68-year-old physician who has had the
disease for 41 years carries on a limited practice.
A 61-year-old doctor who has had diabetes for
35 years reported he was conducting an active
practice. His insulin dosage has been approxi-
mately 70 units daily since he first began taking
it in 1922.
CALLS FAMILY DOCTOR GUIDE IN OLD
AGE
With the problems of aging increased as a
result of the ever-lengthening life span of man,
the family doctor is in a position to guide older
patients “into the green pastures of old age,” in
the opinion of a Kansas City (Mo.) surgeon.
Writing in the October 21 Journal of the Amer-
ican Medical Association, Dr. Milton Buford
Casebolt said the role of the general practitioner
is “that of family counselor, skilled in the han-
dling of emergencies in the home and a kindly
guide to lead his patients to the achievements of
ripe, mature old age.”
Dr. Casebolt served as chairman of the Section
on General Practice at the annual meeting of
the American Medical Association in San Fran-
cisco last June.
“More persons are reaching old age than ever
before,” he pointed out. “In the last 50 years a
generation has been added to the life span. Prior
to 1900 life expectancy was about 40 years; in
1950 the expectancy figures are approaching 70
years.
“Diseases of the aged offer a challenge to the
general practitioner. He must know more about
the disorders of old age and the corrective meas-
ures to cushion the aging process in the human
body.
“The process of guidance of persons into ripe
old age involves rational living, mental maturing
and the acceptance of anatomic and pathologic
changes in the human body.
“The physician must learn more about the
elderly patient who comes to his door. He must
offer constructive medicine to the aged. A num-
ber of avenues are available in the approach to
the problem.
“They are: (1) continued research in the di-
seases and disorders of the person over 50; (2)
education of the geriatric patient; (3) environ-
ment control, and (4) individual guidance.
“The medical aspects involve: (1) periodic
health inventory; (2) individual guidance by the
family physician; (3) correction of nutritional
and glandular deficiencies, and (4) transition
from active, aggressive middle age to a more
quiet and serene old age, an aspect that must be
well understood by the doctor and the patient.
The family physician must furnish the technic
and be the traffic manager or director.”
He pointed out that the family doctor finds
himself many times in the field of mental and
nervous disorders. He sees the patient in the
beginning of psychotic changes — “the personality
deviations at this stage.”
“Fully one third of the persons who come to
my attention are suffering from anxiety com-
plexes, worry, apprehension and fear,” he said.
“There are three approaches to the problem.
“First, there is no happy solution. Resignation
to the inevitable must be instilled in the mind
of the sick person. Here the physician must
call for courage and lean heavily on the field of
religion.
“Second, the situation involves others than the
person who is ill. By conferring with interested
parties adjustments can be made to solve the
problem.
“Third, this group of facts involves the indi-
vidual for whom, by alteration of his or her men-
tal attitudes, values can be created on which the
patient can build a new emotional bridge over
which to cross the chasm of despair and confu-
sion into the sunshine of cheerfulness, hope and
faith.”
DOCTOR BLAMES EYES FOR 25 PER CENT
OF HEADACHES
Eyes are a cause of headache in 25 per cent of
patients, a Detroit ophthalmologist reported in
the October 14 Journal of the American Medical
Association.
“More patients consult medical clinics because
of headaches than for any other single complaint,
and for the same reason they most frequently
consult an oculist,” said Dr. Albert D. Ruede-
mann, professor of ophthalmology at Wayne
LJniversity School of Medicine.
“There is probably more medicine sold for
461
The Journal of the Medical Association of Georgia
headaches than for any other condition. Some of
the large drug concerns build up tremendous
fortunes by relieving the ordinary headache.
‘'It is the great social excuse for avoiding dis-
agreeable engagements. While it is easy to label
the patient neurasthenic (given to nervous pros-
tration I or hysterical or just nervous, the head-
ache may be the forerunner of a serious intra-
cranial disease.
He said most eyes are overused, either from
too much use or from use under poor working
conditions.
He listed as possible victims of faulty eye
functioning: The girl with a nervous breakdown,
the child who is inattentive, the person in busi-
ness who has a headache at noon which is re-
lieved by lunch and then has a recurrence about
3 or 4 o’clock, the clock watcher, the student who
cannot concentrate and the convalescent patient
who reads in bed and has a headache.
“They may require medical exercises, surgical
treatment, glasses or all three,” Dr. Ruedemann
said.
“Nearsighted persons do not have headache
or head pain unless the nearsightedness is un-
equal or severe or unless they are abusing their
eyes. Nearsightedness in combination with a
muscle error may cause trouble.
“Farsighted persons are apt to have frontal
headaches which are moderate to severe and are
present almost daily in the afternoon or evening.
Farsightedness sometimes is definitely associated
with certain types of work. The diagnosis is easy
to make and the treatment is a pair of glasses
used therapeutically and not as an aid to vision.
“If there is an inequality in the amount of error
in the two eyes the pain may be severer over one
eye and more common as a cause of headache.
“Neck pain is more frequently due to ocular
muscle imbalance than to anything else. The neck
muscles function primarily to move the head so
that the eyes will be in a position to see.”
Dr. Ruedemann suggested that every child
before entering the first grade should have his
eyes tested so that he can be protected against
abusing inadequate or deficient eyes.
HAVE A COLD? KEEP IT TO YOURSELF,
ADVISES DOCTOR
Keep that cold to yourself by staying away
from other people, advises Dr. Donald A. Duke-
low of Chicago, consultant in health and fitness
for the Bureau of Health Education, American
Medical Association.
Dr. Dukelow, writing in the October issue of
Todays Health, a publication of the A.M.A.,
pointed out that with the approach of the season
of rapid temperature changes, frequent wet feet
or wet clothes and increased exposure to infec-
tion in closed rooms, there is an increased risk
of colds.
“Most of us take a cold in our stride and go
about our work just the same,” he said. “Maybe
we growl a bit and feel rather nasty, but we
think we can get by and it will soon wear off.
“What’s wrong with this picture? In the first
place, anyone who goes to the office or sends a
youngster to school with a fresh cold is a public
nuisance. He needlessly exposes countless people
to the infectious disease that causes the loss of
more man-hours than any other.
“A few of those who get his cold may develop
pneumonia or have an allergy or chronic sinusi-
tis flare-up. As far as he himself is concerned, a
cold may be only a cold; yet many others will
develop complications or catch a superimposed
infection if he doesn’t reduce his contact with
them. With efficiency at a low level during an
acute cold, the benefits from working are far
overbalanced by the risk incurred.
"From all points of view — public health, per-
sonal health and your own public relations with
your associates — the important factors in the care
of a cold are to stay home, be quiet, make your-
self as comfortable as possible and keep your cold
to yourself. Nobody else wants it. And nobody
wants you when you have a cold.”
NUTRITION IS ASSOCIATED
WITH WELL-BEING OF BABIES
Nutrition research has been a factor in child
health and a contributor to the increase in life
expectancy, according to Dr. Philip C. Jeans, professor
of pediatrics in the College of Medicine, State Univer-
sity of Iowa, Iowa City, and member of the American
Medical Association’s Council on Foods and Nutrition.
(A baby bom in 1900 had an expected life span of
49.2 years; one born today has an expectancy of about
68 years. )
Writing in the September American Journal of
Diseases of Children, a publication of the American
Medical Association, Dr. Jeans pointed out that nutri-
tion knowledge is increasing at an accelerated rate
and that “we cannot even guess what tomorrow will
bring.”
He stressed particularly the application of nutrition
research to pediatrics, which deals with prevention and
treatment of diseases of children.
“Our knowledge includes a better understanding of
the functions of minerals, vitamins, and amino acids
and an increased knowledge of the relation of food
to health,"’ he said.
“Other discoveries are imminent. For example, gen-
eral availability of fat emulsions for use in parenteral
(other than by mouth) feeding is just around the
corner.”
He said that one long-term trend of nutrition re-
search on pediatric practice has been a more rapid
growth of infants and children. He added:
“Body length is significantly greater now than it
was 30 years ago, and it has become necessary to
change our concept of normal growth. Rickets, scurvy
and nutritional anemia, once so common, are now
almost rare. Babies with marasmus (progressive wast-
ing in emaciation) formerly were common in our
hospital wards, but now they are exceptionally rare.
The mortality rate among prematurely born babies
has been significantly reduced.
“These and other improvements are attributable to
changed concepts as to what constitutes an adequate
Novembek, 1950
165
diet for infants and children.
“One can list many contrasts in the past 50 years.
Vitamin C was unknown 35 years ago, and the feeding
of orange juice to babies was not routine until some
years later. A similar statement may be made for
vitamin D.
"We now recognize that iron and iron-containing
foods are necessary additions to the diet in early
infancy and that the thiamine intake of young bahies
is borderline until thiamine-containing foods are added.
Bahies are now fed much more abundantly than
formerly.
“Another factor that affects the health and welfare
of babies is the diet of the mothers during pregnancy.
It has been found that good nutrition of the mother
makes childbearing less hazardous for both the mother
and the baby.”
He added that poor maternal diet is associated with
complications of pregnancy and with illnesses of bahies
in early life.
TULAREMIA
Now that the hunting season is approaching, the
Educational Committee of the Illinois State Medical
Society, in a Health Talk, cautions the public, hunters
and housewives particularly, to be alert to the dangers
of tularemia or rabbit fever.
The infection is found in small wild animals, such
as rabbits, hares, field mice, o’possums, squirrels,
coyotes and skunks. It is acquired by man either by
direct contact with sick animals or by bites of insects
which have fed on them.
Tularemia takes its name from Tulare County in
California where the causative germs, Bacterium tular-
ense, was first identified in ground squirrels.
Hunters, trappers, butchers or housewives who skin
and clean infected rabbits acquire the disease through
some abrasion or even through apparently unbroken
skin. Eating improperly cooked infected meat or
drinking contaminated water may also be channels
of infection.
The incubation period is from three to five days.
Headache, chills and fever are the first manifestations.
Weakness, loss of weight, prostration, backache, joint
pains and drenching sweats mark the acute stage,
which lasts two or three weeks, after which the fever
drops gradually. The fever is always high, 104 to
105 degrees. Because of the debilitating effect of the
disease, convalescence usually takes two to three
months.
If the infection occurs through a cut or abrasion,
an ulcer develops at the site, and the lymphatic glands
in the area become swollen. In other instances, the
glands may swell without the appearance of an ulcer.
Some cases resemble typhoid fever or pneumonia. If
the infection occurs about the eyes, the conjunctiva,
the delicate membrane that lines the eyelids, is likely
to show ulcers. If infected meat is eaten, ulcers may
development in the mouth or the pharynx.
Tularemia can he prevented by following a few
simple precautions, particularly in the dressing of
game, especially wild rabbits. Hunters and housewives
should use rubber gloves. By nature, rabbits are frisky.
Actually then hunters should avoid shooting rabbits that
are inactive or appear ill. Rabbits found dead should
not be handled and all rabbits whose internal organs
are marked by small white spots should be destroyed.
Especially important is the thorough cooking of the
meat of wild rabbits.
In the preparation for cooking, the hands, after
touching the fur or raw meat, should be kept away
from the face, mouth and eyes, and all fur, refuse
and contaminated paper should be burned. The rubber
gloves should be sterilized in boiling water and the
hands washed thoroughly with soap and hot water. A
disinfectant, such as alcohol, applied to the hands
after cleansing, is valuable.
All persons should take special precautions against
the bites of ticks and fleas, hut particularly when
working in infected areas.
Anyone manifesting the symptoms of tularemia
should go to bed immediately and call a doctor,
because of the seriousness of the disease. It must be
remembered that one out of every twenty cases proves
fatal. If one recovers from an attack, however, a
permanent immunity is established.
Under the supervision of a physician, streptomycin
has been found beneficial in tularemia, particularly
in minimizing the suffering and the weakening fever.
ATHEROSCLEROSIS
Public Health Service grants totaling $230,773 for
research in four non-federal institutions on atheros-
clerosis— a form of hardening of the arteries which
leads to heart attacks — were announced recently by the
Federal Security Administrator.
The grants were made by the National Heart Insti-
tute following recommendations of the National Advis-
ory Heart Council and approved by Surgeon General
Leonard A. Scheele of the Public Health Service.
“Atherosclerosis is a major disease of our times,”
Dr. Leonard A. Scheele, Surgeon General, said in
commenting upon the grants. “Its consequences are
responsible for over 40 per cent of the three-quarters
of a million deaths in the Unitel States each year from
cardiovascular diseases, and it causes much suffering
and disability.
“It is a major threat not only to older persons but
also to many in the prime of life -because it is not
an accompaniment merely of old age but can affect
younger age groups.
“The intensified research effort against atherosclerosis
represented by these grants will permit the exploration
of promising new research leads and is aimd at pro-
viding definitive answers as to their possibilities. The
studies have potentialities for the development of
tests, simple and non-hazardous, for early case-finding
in atherosclerosis as well as for the eventual develop-
ment of preventitve or curative treatments.”
RARE TYPE OF CANCER
MAY FOLLOW NAIL INJURY
A rare type of cancer arising in the finger or toe
nails is reported by a Peoria (111.) doctor in the
September 2 Journal of the American Medical Asso-
ciation.
Appearance of a sore between the cuticle and the
nail is a distinguishing characteristic of this cancer.
Dr. Lyle W. Russell says. Symptoms such as swelling
and moderate pain easily may lead to delayed recogni-
tion of the tumor and confusion with other conditions,
he points out.
The cancer may appear as a small, yellowish crater
which fails to heal and if neglected may invade the
bone, according to Dr. Russell. Amputation of the
finger or toe is the recommended treatment and the
outlook for cure usually is good unless spread of the
cancer to another part of the body has occurred
prior to the surgery.
Injury appears to be a possible inciting cause in
the formation of this type of cancer, Dr. Russell says.
In 11 of 20 cases reported, a deep puncture wound
between the nail and nail bed or other injury to
this area preceded the diagnosis of cancer by six
months to 18 years.
The Medical Association of Georgia will hold its
1951 annual session in Augusta. The dates are
April 17, 18, 19 and 20. Bon Air Hotel will be
headquarters, with Partridge Inn participating.
Please make your reservations now.
466
The Journal of the Medical Association of Georgia
DOCTORS AND THE PUBLIC
(Continued from Page 461) ,
space to vour field. Time , I think, does a good
job with its section on medicine. Readers Digest
— in spite of some doctors’ cryptic and critical
comments — has carried many excellent articles
and has a point of view which is admirable. Look
magazine, with its illustrated feature on the Amer-
ican Medical Association, and its current article
by Margaret Mead on psychoanalysis, has shown
enterprise and discrimination in its approach to
health subjects. Atlantic Monthly, Life, Saturday
Evening Post, and Ladies Home Journal come to
mind, and in the case of the last mentioned, the
work of Edward Bok in the realization of pure
food and drug laws is indeed a milestone of
great importance.
3. All over the country, those newspapers
which are financially able to do so are adding
reporters and special writers to handle hospitals,
medicine, science, and related subjects. Our own
Atlanta Journal and Constitution have pioneered
in this form of journalistic progress and have
won sectional and national praise for their
achievements in this realm.
4. Radio, through local and network programs,
is giving more time and better talent to' programs
that relate to medicine and health. I remember
that a Peabody winner in 1942 was “Our Hidden
Enemy — Venereal Disease ’, Radio Station
KOAC, Corvallis, Oregon, prepared by Dr.
Charles Baker for the University of Kentucky.
5. Television, right here in Atlanta, has dem-
onstrated its usefulness in revealing operation
technics. I was privileged, as were some of
you, to see those marvelous demonstrations at
the Municipal Auditorium, and both the poten-
tialities and actualities of those telecasts were
impressive and far-reaching indeed.
There is much more than could be said about
what medicine has already accomplished by way
of good public relations, and also about what is
yet to be done. Possible I have said enough for
you to carry both themes forward in your own
thinking. To close. I turn again to Sir William
Osier — for whom 1 have great admiration, how-
ever much I may disagree with his statement
which I used as the text for these remarks. Sir
William once said:
“Always note and record the unusual . . . com-
municate or publish . . . anything that is striking
or new.’’
Did you note the key words in that injunction?
The unusual . . . communicate . . . publish . . .
striking . . . new.
How like the classical definition of news which
is in every primer of journalism!
If a dog bites a man, it is not news, but if a
man bites a dog, news it is.
The unusual . . . the striking . . . the new.
Perhaps medicine and journalism are not so
far apart after all. Certaiidy both are concerned
with human and social betterment. And. certain-
ly, a working alliance between the two is possible
without in any way jeopardizing the Hippocratic
oath. Dr. Osier admonished: “Remember how
much you do not know . Public relations is a
new field. There is much yet to be learned. But
progress is being made, and medicine in general,
and you of the Medical Association of Georgia,
in particular, are to be congratulated on what you
are accomplishing in this vital area.
MEDICAL EDUCATOR PRAISES PRESS;
CALLS FOR COOPERATION OF DOCTORS
The reporting of medical news in general is of a
high order and physicians are called upon to cooperate
wholeheartedly with the press, within the limits of
propriety, in an article in the September 30 Journal
of the American Medical Association.
Particular praise was given to ‘‘eminent, experienced
science writers in the newspaper and magazine field”
by Dr. Russell S. Boles of Philadelphia, educator and
specialist in internal medicine, who prepared the article.
“These men and women are an honor to their profes-
sion and deserve the utmost cooperation of members of
the medical profession in providing suitable medical
news to the public,” Dr. Boles said. "They are not
to be confused with the writer who frequently con-
tributes news more for its Sensationalism than for its
scientific value.
"The ethical science writer has no desire to report
medical news that may later prove a boomerang. He
judges the value of news by considering its source,
and through long experience he learns to recognize
reliable sources. He also learns to sense the publicity
seeker, whether an individual or an institution.”
He lauded the National Ascociation of Science
Writers for "its commendable efforts in promoting and
writing of medical science news,” saying: “Each mem-
ber of this association is proud of his reputation and
endeavors to enhance it in the eyes of the medical
profession.”
“Today, the physician may feel safe in the con-
fidence of the reporter and can feel assured that inter-
views and releases will be reported accurately; also
that care will be taken to include reference to any
qualifications or limitations he has expressed concerning
his investigations,” he added.
Dr. Boles cautioned both the medical profession
and the press to go slowr in publicizing the preliminary
results of scientific experiments which are being con-
ducted in all fields of medicine. He pointed out that
it is proper for a physician to report to his colleagues
by appropriate means that some new treatment or
method of diagnosis has appeared to be successful and
merits further investigation. He added, however, that
other researchers may discover it may be harmful
or even endanger life.
“Disillusionment follows in its wake, with the
result that the premature publicity provides nothing
but disappointment to, and a loss of confidence by,
the anxious reader,” he said.
“One who has had considerable experience in research
is slow to publish the results of his work. The true
scientist demands absolutely accurate and well con-
trolled experiments on a reasonably large scale and
over a long period of time before he draws any con-
clusions. The enthusiast, while honest, is apt to be im-
patient and jump to conclusions, and it is from him that
much unsound medical news emanates.”
News of the proper character, he said, demonstrates
to the public the remarkable accomplishments in the
field of medicine under a system of free enterprise
and opportunity, and provides an increasing sense of
security concerning health.
November, 1950
467
MEDICAL PUBLIC RELATIONS CONFERENCE
Terming the county “the key area in which the main
public relations job of the medical profession must
be done,” Dr. George F. Lull, Secretary and General
Manager of the American Medical Association, today
unveiled plans for the Third Annual Medical Public
Relations Conference.
The 1950 Conference is set for December 3 and 4
in Cleveland — just prior to the Clinical Session of
the American Medical Association. It will concen-
trate on county society programs aimed at increasing
community goodwill toward the medical profession.
In attendance at the two-day session will be some
300 M.D. chairmen of state and county medical society
public relations committees, society executive secre-
taries and public relations directors, officers of the
American Medical Association Woman’s Auxiliary and
key representatives of allied health organizations.
The program schedule calls for four work sessions,
two noon sessions and an evening session. All activities
will be at the Hotel Statler.
The opening work session on Sunday, December 3,
will take up the important “groundwork for a suc-
cessful public relations program.” On the docket will
be discussions on organizing public relations commit-
tees, financing the program, technics for finding out
what public relations work is needed, program plan-
ning and ways to build support among society members.
Work sessions on Monday, December 4, will include
a timely summary of “county societies and the legisla-
tive scene,” a series of brief reports on specific worth-
while county public relations activities, and an open
forum period during which conferees will divide into
three groups to swap ideas with representatives from
similar-sized communities.
Appearing at the “legislative” session will be Dr.
Dwight H. Murray, A.M.A. Trustee and Chairman of
the Committee on Legislation and Dr. Joseph S. Law-
rence, Director of A.M.A. Washington office.
The “activities with a purpose,” session will show
how county public relations projects have improved
community feelings towards doctors. Among the pro-
jects to be discussed are “community-minded doctors,”
“a doctor for every family,” “working with other pro-
fessions,” and “the doctor and civilian defense,” and
“let the doctor speak.”
On Monday afternoon three discussion groups will
be formed to take up medical public relations problems
in small communities, medium-sized communities and
metropolitan areas. Each group will attempt to work
out basic ideas that will be useful to other county
societies embarking on public relations campaigns.
Sunday noon, Dr. John W. Cline, president-elect of
the American Medical Association, will keynote the
conference with an address on “Serve Your Nation
Through Better Public Relations.” Speaker at the
Monday noon session will be R. W. Mills, secretary
of the Fond du Lac, Wisconsin, Association of Com-
merce. His topic is: “The American Way of Life.”
Mid-point of the idea-packed Public Relations Con-
ference will be the annual conference dinner Sunday
evening. Sharing the speaker’s platform will be A.M.A.
President, Dr. Elmer L. Henderson, and a nationally
prominent man outside the medical field. In addition,
the program will feature Cartoonist Marvin Bradley,
one of the creators of the comic strip, “Rex Morgan,
M.D.”
As a supplement to the regular conference sessions,
two special visual aid demonstrations have been sched-
uled. One will be a screening of the new Louis de
Rochemont film, “M.D. — the U. S. Doctor.” The other
will be a demonstration of a television package show
being produced by the Bureau of Health Education for
use by state and county societies.
The Medical Association of Georgia will hold its
next annual session at the Bon Air Hotel, Augusta,
April 17-20, 1951.
IMPORTANT NOTICE
The Committee on Constitution and By-Laws of the
Medical Association of Georgia will hold a meeting
at the Hotel Dempsey, Macon, Georgia on January 10,
1951 at two o’clock in the afternoon. Members of
the Association are cordially invited to present their
views to the committee either in person or by letter.
ALLEN H. BUNCE, Atlanta, Chairman
C. H. RICHARDSON, SR., Macon
MARION C. PRUITT, Atlanta
W. F. REAVIS, Waycross
JOHN A. DUNAWAY, Atlanta, Attorney
for the Association
A. M. PHILLIPS, Macon, President
EDGAR D. SHANKS, Atlanta, Secty-Treas.
NEWS ITEMS
Avera recently honored its founder, Dr. Alexander
Avera, with the dedication of a monument. Dr. Avera
was born in Jefferson County, Georgia, October 3,
1830. He graduated from Medical College of the
State of. South Carolina, Charleston, in 1858 and fin-
ished Oglethorpe College at Savannah in 1850. He organ-
ized a company of soldiers and enlisted in the Confeder-
ate Army and served in the War Between the States with
honor. At the close of the war, he returned to Jefferson
County and gave land for the entire site of the town
of Avera. He served as postmaster and station agent.
* * *
The Baldwin County Medical Society, Milledgeville,
held its monthly meeting August 7, at which time
Dr. Dawson Allen, of Allen’s Invalid Home, Milledge-
ville, gave a very interesting discussion on “The
Treatment of Alcoholism with Reference to Antabuse”.
The September meeting was held with a very inter-
esting talk on “Bronchiogenic Carcinoma ”, with par-
ticular reference to the x-ray findings and differential
diagnosis presented by Dr. Stephen W. Brown, Augusta.
Members of the Baldwin County Medical Society
were hosts at the Milledgeville Country Club, October
3, when they entertained with the annual ladies’ night
party in honor of their wives. Dr. Charles B. Fulghum,
Milledgeville, served as master of ceremonies. Taking
part on the program were members of the Milledgeville
State Hospital medical staff who are natives of other
countries. Dr. Robert D. Waller, secretary.
* * *
Dr. Robert L. Bennett, Warm Springs, director of
physical medicine at the Warm Springs Foundation,
has been named president-elect of the American Con-
gress of Physical Medicine.
* * *
The Berry Clinic, 1010 West Peachtree Street, N. W.,
Atlanta, announces the association of Dr. William Brad-
ley Martin. Practice limtied to cardiovascular diseases.
* * *
The Phoebe Putney Memorial Hospital, Albany, is
playing an important role in the state’s fight against
polio, according to Dr. Tully T. Blalock, Atlanta, mem-
ber of the Medical Advisory Board of the Georgia
Chapter of the National Foundation for Infantile
Paralysis. The medical program serving these patients
has been made possible by the Georgia Chapter of
the National Foundation for Infantile Paralysis, financed
exclusively by the March of Dimes.
* * /»
Dr. Frank Kells Boland, Atlanta surgeon and author,
was recently guest speaker in Jefferson at a day’s cele-
bration sponsored by Jackson County chapters of the
United Daughters of the Confederacy, to give due
recognition to Dr. Crawford W. Long, the man who
discovered ether. An autograph party was held in
the High School Library. Dr. Boland reviewed his
book, “The First Anesthetic, the Story of Crawford
Long” which gives proof of Dr. Long’s discovery of
anesthesia. Dr. Boland was honored at luncheon. In
The Journal of the Medical Association of Georgia
468
the afternoon the Commerce chapter of the UDC
sponsored a program and again presented Dr. Boland.
A display of pictures related to the life of Crawford
Long were exhibited.
Dr. Boland was also recently honored at a luncheon
given by the Woman’s Auxiliary to the Floyd County
Medical Society, Rome.
* * *
Dr. Nathaniel J. Brec.kir. New York City, faculty
member of the New York University College of Medi-
cine. gave a series of lecture-seminars at the Veterans
Administration Hospital (Lenwood), Augusta, during
the week of October 2. Dr. Breckir came to the hos-
pital as a part of this training program. His subject
was “Group Psychotherapy”
* * *
Dr. James W. Chambers, LaGrange, will head a
group of LaGrange doctors who will serve the people
of Harris County at the Hamilton Clinic, Hamilton,
each Monday. Wednesday and Friday.
* * *
Dr. Harley Cluxton, Jr., Savannah, has accepted the
position as director of medical research for the Armour
Laboratories in Chicago. He received his medical de-
gree from the Johns Hopkins Universtiy School of
Medicine, Baltimore, Md., in 1941. Following the
completion of his internship at the Baltimore City
Hospital, he entered the Mayo Clinic, Rochester, Minn.,
as a fellow' in internal medicine in 1942 and remained
there until 1944 at which time he entered the Armed
Services. Following the completion of his medical
field service course at Carlisle, Pa„ he was stationed
at the Army and Navy General Hospital, Hot Springs,
Ark. Major Cluxton received the Unit Citation award
and also the Army Commendation ribbon for meri-
torious service. After completing his tour of duty
in the Army in July, 1947, he went back to the Mayo
Clinic where he remained until he returned to Savan-
nah in February, 1949, to open his office for the
practice of internal medicine in association with his
twin brother, Dr. Hayes Cluxton.
* * *
The Georgia Department of Public Health, Atlanta,
announces that more than 20 foreign doctors studied
Georgia's health work in connection with the depart-
ment during the past summer. Venereal disease con-
trol and the hospital program received most of the
foreign physicians' attention. The physicians were
representatives from Central and South America, Ger-
many, China, Norway and South Africa.
* * *
Dr. William J. Dieckmann, Chicago, professor and
obstetrician in chief at the Llniversity of Chicago,
The School of Medicine and the Chicago Lying-In
Hospital, delivered the second annual E. C. Davis
memorial lecture before the Fulton County Medical
Society at the Academy of Medicine, Atlanta. October
5. The lecture honored Dr. Edward Campbell Davis,
one of the founders of what is now Crawford W.
Long Memorial Hospital, who died in 1931.
* * *
Dr. B. V. Elmore, Rome, Floyd County Health
Commissioner, has been officially commissioned as
registrar of vital statistics for entire Floyd County,
according to an announcement front the Georgia
Department of Public Health Director, Dr. T. F.
Sellers, Atlanta.
* * *
Dr. John B. Fitts, Atlanta, announces the associa-
tion of Dr. Spence McClelland, 902 Medical Arts
Building, Atlanta, in the practice of gastroenterology
and internal medicine.
* * *
Dr. W. Devereaux Jarratt, Macon, has enrolled at
Northwestern University Medical School, Chicago, for
a three-year course in ophthalmology. Dr. Jarratt is
a native of Macon, and graduated from Medical College
of Georgia, Augusta, and served in the U. S. Army for
four years, being discharged with the rank of lieutenant
colonel.
* * *
Dr. Frank F. Kanthak, Atlanta, recently addressed
the Central District Dental Society in Macon. Dr.
Kanthak is a member of the faculty of the Emory
Liniversity School of Dentistry and School of Medicine
and is associated with Dr. William G. Hamm in
plastic and reconstructive surgery. In addition to his
teaching duties, he is a consultant in plastic surgery
at the VA Hospital, Chamblee, and at the Olivet
General Hospital, Augusta.
* * *
Dr. Robert C. Major, Augusta, professor of thoracic
surgery for the Medical College of Georgia, has been
called to active duty with the U. S. Army, at Denver,
Colo. He is- known throughout the nation for his
work in thoracic surgery and will hold the rank of
lieutenant colonel in the Army.
* * *
Dr. John M. Martin, Augusta, has been appointed
by the Eederal Bureau of Prisons as physician for
federal prisoners who might be inmates of the Rich-
mond County jail.
* * *
Dr. Walter Martin, Augusta, who has been with
the Richmond County Public Health Department for
the past year, has opened an office in Thomson for
the practice of general medicine. Dr. Martin is a
native of Shellman, and graduated from the University
of Georgia Medical School, Augusta, in 1941. He
served in the European theatre with the U. S. Army
during World War 11 and was discharged with the
rank of captain.
* * *
Dr. J. H. Milford, Hartwell, announces the opening
of the Milford Clinic in a modem brick building on
East Franklin Street, Hartwell. The clinic contains
two examining rooms, two reception rooms — for
white and colored — a laboratory and office, and is
well arranged and modern in every respect.
* * *
Dr. W. E. Hamm, Atlanta, recently addressed the
the Summerville-Trion Rotary Club. Dr. Hamm used
a series of slides showing the before and after effects
of plastic surgery. He discussed plastic surgery in
cases of war injuries.
* * *
Dr. R. R. McCollum, Jr., Kingsland, entertained
the members of the Ware County Medical Society and
their wives at the Crooked River Club, October 4. The
sea food supper was a banquet long to be remembered.
Dr. W. A. Hendry, Blackshear, president of the
society, presided over the brief business session when
reports were made by Dr. Leo Smith, Waycross, secre-
tary. Doctors and their wives attending the annual
event were: Dr. and Mrs. Braswell Collins, Dr. and
Mrs. H. T. Adkins, Dr. and Mrs. Floyd Davis, Dr. and
Mrs. W. M. Flanagan, Dr. and Mrs. T. J. Ferrell,
Dr. and Mrs. Joseph R. Gay, Dr. and Mrs. A. M.
Knight, Jr., Dr. and Mrs. Clayton Massey, Dr. B. H.
Minchew, Dr. and Mrs. Harold Muecke, Dr. and Mrs.
W. L. Pomerov, Dr. and Mrs. Lovick W. Pierce, Dr.
and Mrs. W. F. Reavis, Dr. and Mrs. Ansley Seaman,
Dr. Leo Smith, Dr. and Mrs. M. D. Clayton, Jr., Mrs.
W. C. Hafford, all of Waycross, Dr. W. A. Hendry,
Dr. Katherine Hendry, both of Blackshear, and Dr.
and Mrs. I\. C. McCollum. Jr., Kingsland.
* * *
Dr. Robert C. McGahee, Augusta, was guest speaker
at a recent meeting of the Woman’s Auxiliary to the
Richmond County Medical Society at the Bon Air
Hotel, Augusta. Dr. McGahee’s subject was “Medical
Ethics”. He emphasized the part played by the
physician’s wife.
* * *
Dr. Harold W. Muecke, Waycross pediatrician, re-
cently presented a paper, “The Pediatric Approach to
November, 1950
469
Patients anrl Parents” before the Ware County Medical
Society.
* * *
The Medical College of Georgia, Augusta, recently
conducted a seminar on cytology and the early diag-
nosis of cancer. Dr. H. E. Nieburgs, director of the
department of clinical cytology of the Medical College
led two hours of discussion. He was followed by Mrs.
Ruth M. Graham, Vincent Memorial Hospital, Boston,
and Dr. H. J. Wespi, chief of obstetrics and gynecology,
Canton Hospital, Aarau, Switzerland.
Other lecturers who appeared on the program were:
Dr. Ingrid Stergus, Rome, Battey State Hospital, and
Lt. Col. Joe M. Blumberg, Walter Reed Hospital,
Washington, D. C. ; Dr. S. W. Brown, Dr. J. K. Cline,
chief of the cancer research department of the Univer-
sity of Alabama and Dr. John E. Dunn, of the U. S.
Public Health Service, Bethesda, Md.
* * *
Dr. William Rawlings, Sandersville physician and
surgeon, is doing postgraduate work in surgery at the
University of Pennsylvania School of Medicine, Phila-
delphia, for a period of eight months. He will con-
tinue his practice in Sandersville following completion
of his graduate studies.
* * *
The Richmond County Medical Society, Augusta,
at its recent monthly meeting, heard three doctors
from the Veterans Administration. The program was
a symposium on “Convulsive Diseases”. Dr. Julian
Kaufman, chief of the medical service discussed “Medi-
cal Aspects of These Diseases.” Dr. Henry Schneider-
man, chief of the neurologic service, spoke on
“Neurologic Aspects and Treatments.” Dr. Clarence
E. Jump, chief of the continued treatment service,
discussed “Psychiatric Aspects.”
* * *
Dr. Henry E. Steadman, Hapeville, recently returned
from a tour of South America. He traveled by steamer
to Buenos Aires, Argentina; stopped at Port of Spain,
Trinidad; Rio de Janeiro, Santos, Sao Paulo, Brazil;
and Montevideo, Uruguay. The return trip, via Pan
American Airways, was over the Andes to Santiago,
Chile; Lima, Peru; Panama and Miami.
Dr. Steadman gave a paper on a surgical seminar
conducted by the College of International College of
Surgeons in connection with the Seventh Biennial
Assembly held at Buenos Aires, Argentina. The paper
“Endometrioma of Sigmoid Producing Obstruction”
appeared in the September issue of the Journal of
International College of Surgeons. An abstract in
the form of “Summary and Conclusion” of the original
paper is given as follows;
“A case of sigmoid obstruction due to endometrial
tissue, in the absence of generative organ or other
ectopic endometrial tissue transplants, is presented.
“Differential diagnosis of endometriosis and carcinoma
of the sigmoid are given.
“The coexistence of carcinoma and endometriosis
must be considered a possibility.
“In cases of complete obstruction of sigmoid, surgical
intervention to deflate the distended bowel is of first
importance.
“Diagnosis especially in the absence of multiple
endometrial ‘transplants’ depends on the microscopic
findings.
“Generally speaking, a single endometrioma of the
lower bowel with obstruction should be resected. This
is e pecially true in cases relatively free of generative
organ pathology in which the patients desire to have
children.”
* * *
Dr. M. A. Strickland, Atlanta, announces the opening
of his offices at 106 North East Point Street, East
Point, for general practice and surgery. He holds a
Bachelor of Science degree from the University of
Georgia, Masters and Doctor of Philosophy from New
York University and Medical degree from Emory
University School of Medicine, Atlanta. Dr. Strickland
served an internship at Misericordia Hospital in New
York City and for one year, he was at the U. S.
Marine Hospital at Staten Island, New York. For a
short time, he was resident at Lawson VA Hospital,
Chamblee.
* * *
Dr. W. Edward Storey, Columbus, attended the
second annual meeting of the Georgia Heart Associa-
tion recently held in Atlanta.
* * *
Dr. T. 0. Vinson, Decatur, commissioner of health
for DeKalb County, was guest speaker at a recent
dinner meeting of the Lithonia Exchange Club. During
his term as health officer for DeKalb, Dr. Vinson
has accomplished much to improve the health standards
of the residents of this industrial area.
* * *
The annual scientific meeting of the Georgia Urologi-
cal Association and the Georgia Chapter of the
American College of Surgeons including the Trauma
and Cancer Committees will be held at the Hotel
General Oglethorpe, Savannah, December 1. Appearing
on the program will be Dr. Henry Cave, New York
City, president American College of Surgeons; Dr.
Alfred Blalock, Baltimore, professor of surgery of
Johns Hopkins University School of Medicine; Dr.
Frederick E. B. Foley, Minneapolis, clinical associate
professor of urology, University of Minnesota Medical
School; and Dr. Carl Badgely, Ann Arbor, professor
of orthopedic surgery at the LIniversity of Michigan
Medical School. All members of the Medical Associa-
tion are invited to attend. There will be a small
registration fee which will cover the cost of lunch,
cocktails and dinner. Dr. Reese C. Coleman, Jr.,
Atlanta, secretary.
He * *
Dr. Virgil P. Sydenstricker, Augusta, recently re-
turned from Geneva, Switzerland; London, England,
and Dublin, Ireland. His visit abroad was for the
purpose of attending conferences of the world health
organization, of which Dr. Sydenstricker is a consult-
ant. The subjects discussed at these conferences were
related to nutrition in industry, subjects on which Dr.
Sydenstricker is internationally recognized as an
authority.
* * *
Dr. John Venable, Griffin, director of the Spalding
County Health Department, announces the expansion
of the department’s clinic services. Many of the services
which have been offered only once a week, are now
being offered three times a week.
* * *
The Georgia Association of Local Public Health
Physicians was recently organized in Macon. Officers
were elected, a constitution and by-laws were adopted.
Dr. VI. E. Winchester, Brunswick, was elected presi-
dent. Dr. C. A. Henderson, Savannah, was named
vice-president and Dr. D. M. Wolfe, Albany, was elected
secretary-treasurer. There are 21 public health physi-
cians throughout the state who are eligible for mem-
bership in the association, whose purpose is to de-
termine policies of the group and to consider any
policy of any public or private agency dealing with
any matter pertaining to human health in any city,
county, district, or the state. The executive committee
is composed of the three above named officers and
Dr. R. Frank Cary, Macon; Dr. J. D. Stillwell, Thomas-
ville; Dr. T. 0. Vinson, Decatur; and Dr. Abe J.
Davis, Augusta. Dr. T. 0. Vinson, Decatur, was named
chairman of a committee on local public health work,
and with him will serve: Dr. D. M. Wolfe, Albany;
Dr. Ernest Thompson, Monroe; Dr. J. H. Venable,
Griffin; and Dr. J. D. Stillwell, Thomasville. Com-
mittee on Tuberculosis: Dr. C. A. TLenderson. Savannah,
chairman; Dr. H. T. Adkins, Waycross; Dr. W. J.
470
The Journal of the Medical Association of Georgia
Peeples, Columbus, and Dr. Abe J. Davis, Augusta.
Plans call for the association to meet once a year,
or as often as the executive committee deems it neces-
sary. Any assistant public health officer connected
with a local health department is eligible for mem-
bership. but no county will be allowed to have more
than two votes.
* * *
The Fulton County Medical Society held its semi-
monthly meeting at the Academy of Medicine, Atlanta,
October 19. Dr. Carter Davis was moderator. Scien-
tific program: “A Newr Concept in the Treatment of
Hirschsprung’s Disease”, Dr. Charles E. Holloway;
‘"Transthoracic Nephrectomy for Kidney Tumors”, Dr.
Harold P. McDonald.
* * *
The Georgia Medical Society held its regular meet-
ing at 612 Drayton Street, Savannah, October 10. “Kid-
ney Function in Disease”, with motion pictures, was
presented by Dr. Peter Scardino. Dr. Sam Young-
blood, Jr., secretary.
* * *
The Second District Medical Society held its fall
meeting, October 12, at Radium Springs, Albany.
The meeting was opened by the president. Dr. Robert
M. Joiner, Moultrie. The minutes of the previous
meeting were read and approved.
Dr. A. M. Phillips, Macon, president of the Medical
Association of Georgia was introduced. He made a
short talk and introduced Dr. Stephen T. Brown,
Atlanta, chairman of the Public Relations Committee
of the Medical Association of Georgia. Dr. Brown
made a talk concerning the importance of Public
Relations and stressed the importance of the individual
doctor's part in the Public Relations program.
Dr. M. W. Williams, Camilla, announced a General
Practice Seminar to be held at the Mitchell County
Hospital, November 1, 1950.
Dr. C. K. Wall, Thomasville, moved that the
Second District Medical Society meetings be held
the first Thursday of April and October in order to
avoid conflicts with the Florida Second District Medical
Society and the State Medical meeting; this motion
being seconded by Dr. Howard Cheshire, Thomasville,
and carried unanimously.
A committee was appointed to select a meeting
place for the April meeting and to appoint doctors
to present the program.
Scientific program: Dr. Robert Greenblatt, Augusta,
of the Department of Endocrinology of the Medical
College of Georgia discussed “Experience with ACTH
and Cortisone in Various Endocrine and Non-Endocrine
Conditions' . His discussion was divided into two
portions. The first part was on the “Physiology of
the Adrenal and the second part was case histories
in which ACTH and Cortisone had been used. The
discussion of Dr. Greenblatt’s paper was opened by
Dr. Henry Poer of Atlanta. Dr. George Dillinger of
Thomasville read a most enlightening paper, "The
Problem of Gout . Dr. Mack Sutton of Albany pre-
sented a “Kodachrome Clinic — Pediatric Cases”. His
slides and discussion of the cases were outstanding.
“Cervical Smear as a Routine Office Procedure” was
the title of the paper read by Dr. Charles Bellville
of Bainbridge. Dr. Bellville stressed the importance
of this procedure in order to detect early cancer of
the cervix.
Following the scientific program the committee an-
nounced that the next meeting would be held on the
first Thursday in April, 1951 at Moultrie. Dr. Walter
Thwaite of Quitman was selected to present a paper
on Medicine. Dr. John W. McLeod, Jr., of Moultrie
was selected to present a paper on Surgery and Dr.
Mervin Wine of Thomasville to present a paper on
Allergy.
Adjournment. The members of the Dougherty County
Medical Society entertained the members and visitors
of the Second District Medical Society with a social
hour and buffet supper. Frank A. Little, M.D., secre-
tary.
* * *
Dr. Tbomas A. McGoldrick, Jr., Savannah, held
clinics and gave a lecture at the Veterans Administra-
tion Hospital, Dublin, August 30, as a feature of the
hospital’s postgraduate program for its medical staff.
The subject of his address was “The Inherent Instability
of the Spleen.” Members of the Laurens County Medi-
cal Society were invited guests for the occasion.
* * *
Dr. Peter L. Scardino. Savannah, held a clinic and
lectured on “The Management of Renal and Ureteral
Calculi” at the Veterans Administration Hospital, Dublin,
October 25. His presentation was one of the regularly
scheduled features of the postgraduate teaching pro-
gram provided by the Veterans Administration for
the medical staff of the Dublin Hospital.
Tbe members of the Laurens County Medical Society
were invited guests for the occasion.
OBITUARY
Dr. James Henry McDuffie, Jr., aged 62, leading
Columbus physician, died September 27, 1950, at City
Hospital, Columbus. Dr. McDuffie was born in Keyser,
N. C., a son of the late Dr. J. H. McDuffie, Sr. and
Sarah Helen Page McDuffie. He graduated from the
University of Pennsylvania School of Medicine, Phila-
delphia, Pa., in 1916. He served his internship at
the Lenox Hill Hospital and the Lying-In Hospital
in New York City. During his two years service in
the Medical Corps of the Army during World War I,
he was in command of an Army hospital in southern
France. He had been a practicing physician in
Columbus since the close of World War I. During his
practice in Columbus, Dr. McDuffie worked untiringly
for the advancement of medicine, and was a leader
in the movement to secure the necessary funds to
build the new wing to the City Hospital, where he
served for several years as chief of staff. When the
Blue Cross insurance plan was broached for Columbus
he took a leading role in its successful establishment.
He was a member of the Muscogee County Medical
Society, having served it as president. He was recently
presented a life membership in the society in recognition
of his long membership in and service to the group.
He was also a member of the Medical Association of
Georgia, and a fellow of the American Medical Asso-
ciation. Survivors include his wife, Mrs. Lucile Peacock
McDuffie; a son, James H. McDuffie, III, Morrison,
111.; three daughters, Mrs. William Sylvan, New York
City; Mrs. B. H. Hardaway, 111, and Mrs. Lee Red-
mond, both of Columbus; a sister, a brother, and six
grandchildren. Funeral services were held at the
First Presbyterian Church, with Dr. John E. Richards,
pastor, officiating. Burial was in the Parkhill Cemetery,
Columbus.
NEW BOOKS
The First Anesthetic, The Story of Crawford Long :
Frank Kells Boland, M.D.. Atlanta, Professor of Clinical
Surgery, Emory University School of Medicine, and
President, Crawford W. Long Memorial Association.
Athens, Georgia: The University of Georgia Press,
1950.
This documentary narrative is an attempt to prove
the priority of the use of ether for surgical anesthesia
by Dr. Crawford W. Long.
No book, nor any statement for that matter, can
be entirely separated from tbe character of the author
and to one who knows how conscientiously the author
has worked on his manuscript, sifting out chaff and
diligently winnowing the true from the false, this
little book takes on the character of a testament
on the discovery of ether as an anesthetic agent.
It is difficult to present documentary evidence in
November, 1950
471
an interesting manner hut “The First Anesthetic”
accomplishes this feat. The book can be read in
one and one-half hours and should be read by every
one who is interested in the history of medicine or
who wishes to have a knowledge of one of the
greatest controversies that has ever occurred in medical
history. It is a must for every doctor.
The author, who is well known to me, has made
careful and conscientious study of Crawford Long’s
documentary evidence and has included in his book
photostatic copies of letters and other testimonials
presented in proof of his claim to be the first discoverer
and user of ether as a surgical anesthetic.
After reviewing the evidence presented, the reader
can not escape the belief that Crawford Long was the
first to use ether for surgical anesthesia and that he
used it after deliberately planning its use and calculat-
ing its effect.
JOHN W. TURNER, M.D.
* * *
Pathologic Physiology: Mechanisms of Disease:
Edited by William A. Sodeman, M.D., F.A.C.P. The
Wm. Henderson Professor of the Prevention of Tropical
and Semi-Tropical Diseases, Tulane University of
Louisiana School of Medicine; Senior \isiting Physi-
cian, Charity Hospital of Louisiana; Consultant in
Medicine, U. S. Marine Hospital at New Orleans.
808 pages with 146 figures and 30 tables. Philadelphia
and London. W. B. Saunders Company, 1950. Price
$11.50.
With the able assistance of numerous contribuotrs,
all of whom are distinguished in their fields of en-
deavor, Dr. Sodeman has produced a most creditable
book. Its size is right; its material is right. It should
be an addition to any physician’s library.
* ' * *
Thoracic Surgery, by Richard H. Sweet, M.D.,
Associate Clinical Professor Surgery, Harvard Univer-
sity Medical School, Illustrations by: Jorge Rodriguez
Arroyo, M.D., Assistant in Surgical Therapeutics,
University of Mexico Medical School. 345 pages with
155 illustrations. Philadelphia and London: W. B.
Saunders Company, 1950. Price $10.00.
In recent years thoracic surgery has become almost
commonplace in the large medical centers, but perhaps
is not so well appreciated and practiced in the small
medical centers. This book is rich in material and
will be found most useful in all medical centers.
* * *
The Pathology of Internal Diseases. By William
Boyd, M.D.. Dipl. Psych., M.R.C.P. (Edin.), F.R.C.P.
(Lond.), F.R.C.S. (Canada), LL.D. (Sask.), D.Sc.
(Man.), M.D. (Oslo), F.R.S. (Canada), Professor of
Pathology and Bacteriology in the University of Toronto,
Toronto. Cloth. Pp. 866. Fifth edition, thoroughly
revised, with 391 illustrations and eleven colored plates.
Lea & Febiger, Philadelphia, 1950.
Dr. Boyd, long a distinguished pathologist, has again
produced a book which should be most helpful to
those seeking more knowledge regarding the pathology
of internal diseases.
* * *
Eyes and Industry: Formerly Industrial Ophthal-
mology. By Hedwig S. Kuhn, M.D., Industrial Ophthal-
mologist, Hammond, Indiana. Second edition. Cloth.
$8.50. Pp. 378, with 151 text illustrations, including
three color plates. The C. V. Mosby Company, St.
Louis, 1950.
American industry being what it is, and renewed
efforts being made to protect at all times the workers’
eyes, this book will be found useful in the prophylaxis
and treatment of many patients with eye troubles.
NEW BOOK PRESENTS THE DOCTOR’S
CASE AGAINST SOCIALIZED MEDICINE
Out of the welter of information on the nation’s
health, Dr. W. W. Bauer of Chicago, director of the
American Medical Association’s Bureau of Health
Education, has produced an authoritative and highly
readable presentation of the doctor’s case against
compulsory health insurance.
SANTA CLAUS, M.D., merits careful consideration
by every citizen, for the future of medical care in
the United States affects everyone and every aspect
of living. In simple language and often highly amusing
style, this recently published book presents expert
testimony needed for a decision for or against com-
pulsory health insurance that under a democratic
government can be made only by the voters.
By detailing the American Medical Association’s
12-point program for improving the nation’s health,
Dr. Bauer explains what 140.000 or more doctors are
doing and planning to do in serving the country’s
health needs. The book presents medical evidence to
dispute claims by advocates of compulsory health
insurance that Americans are in bad health, that they
cannot afford medical care and that there are not
enough doctors. It reviews the ways of paying for
medical service. It shows in terms of the community
what the medical profession is doing to provide more
good doctors, not just more doctors. It explains the
full value of what doctors plan and exactly why they
feel compulsory health insurance would upset their
plans, and, more important, their relations with and
services to patients.
Dr. Bauer is well qualified for the job of author-
advisor on both the scientific and socio-economic aspects
of health questions. In his long experience as a
practicing physician and health education expert he
has demonstrated the rare quality of medical show-
manship— the ability to take the complex data of
the medical profession and make it dramatic and
meaningful to the lay reader without sacrificing accur-
acy. His writing consistently has shown the “human
touch” of humor and grasp of subjects both from
the point of view of the doctor and that of the patient.
Director of health education for the A.M.A. since
1932, Dr. Bauer also has been editor of its magazine,
Today’s Health (formerly Hygeia ), since 1949, after
serving 15 years as associate editor. Among his suc-
cessful books are Health, Hygiene and Hooey, Ameri-
cans Live Longer, Health Questions Answered, and
Stop Annoying Your Children. In 1947 he was awarded
the Elizabeth Severance Prentiss Medal by the Cleve-
land Health Museum for outstanding achievements in
health education. He served the United States Military
Government in Germany as a consultant in public
health problems in 1949.
Santa Claus, M*D. By W. W. Bauer, M.D. 266 pp.
Indianapolis: The Bobbs-Merrill Company, Inc. $2.75.
WHEN IT’S EPILEPSY
Epilepsy is a common disease, but, because of its
characteristic nature of developing into convulsions,
individuals afflicted with the condition are apt to be
shunned by general society. This is unfortunate, since
the disease affects persons in all walks of life and in
all intellectual and economic levels, according to the
Educational Committee of the Illinois State Medical
Society in a Health Talk.
There is probably more misunderstanding, more
incorrect beliefs, more fear and more unjustified dis-
crimination associated with this disease and the
people who suffer from it than any other illness. This
is particularly unfortunate because in 80 to 85 per
cent of the cases it is possible with proper treatment
to abolish or control the spells from which these patients
suffer, permitting them to lead normal and active
lives. In fact there are many persons with epilepsy
who are married, have families, hold important business
positions and are engaged in various professions.
The word epilepsy means seizure. Occurring in two
forms, one type of seizure, Grand Mai, occurs as a
result of an irritation of the brain. From the brain
a nervous discharge spreads down from the brain
through the spinal cord and then out through the
172
The Journal of the Medical Association of Georgia
nerves to the muscles to stiffen and twitch.
The second type of seziure, known as Petit Mai
or minor spell, is often so mild that it may pass un-
noticed hy people outside the family. The individual
suddenly stops what he is doing and becomes un-
aware of what is going on about him.
Although the generalized convulsive seizures or
major spells seldom cease permanently without treaty
ment, the minor spells or Petit Mai are most common
and most frequent during childhood, tend to dimin-
ish as the patient grows older and may even cease
as he becomes an adult.
In epilepsy, each case must he treated individually.
There are many different forms of treatment and
they must he fitted to the particular case. What is
suitable for one is often unsuccessful in another. And
again proper treatment does not depend solely on the
prescription of the proper medication by the physician,
but thorough cooperation by the patient is essential.
It is rather common for patients to go for a year
or so after beginning treatment without a single
attack and then suffer from one or a series of seizures.
This occurs because the patient has either decided
himself that he is well or has been inconsistent in
applying the treatment the physician has indicated.
The consumption of alcoholic beverages will also
cause attacks in patients whose seizures have other-
wise been controlled. And then it is easier to control
the spells if proper and adequate treatment is begun
early. Very often it is difficult to obtain satisfactory
relief for a patient who has had spells for several
years without proper control.
Grand Mai or Petit Mai are what might be termed
ordinary epilepsy. There are other epileptie seizures
which if noted for the first time in adult life may
be traced to some other condition, involving insuf-
ficient amount of sugar in the blood, insufficient supply
of blood to the brain because of heart disease and
so on.
Most cases can be managed adequately by the
family physician. Where special tests are needed, it
is the family physician who should be consulted.
CORTISONE SIDE EFFECTS REDUCED
BY SMALLER DOSAGES, REPORT SHOWS
The development of a dosage of cortisone acetate to
maintain improvement in cases of rheumatoid arthritis
with a minimum occurrence of undesirable side effects
is reported in the September 30 journal of the Ameri-
can Medical Association.
Cortisone is not a cure for the disease, but its
administration reverses crippling results. Its continued
use is necessary in order to prevent the return of the
pain and deformities which mark rheumatoid arthritis.
The problem of physicians using the drug has been
to prevent complications in side effects.
A report on the treatment of 42 patients is made
by Dr. Edward W. Boland and Dr. Nathan E. Headley
of Los Angeles. Based on preliminary studies, they said
it appears that some severe cases and most less severe
cases may be kept under adequate clinical control for
long periods, and with relative safety, with smaller
maintenance doses ranging from 32 to 65 mg. a day
provided larger doses to suppress the disease are used
initially.
‘‘Comparatively few unfavorable reactions have de-
veloped when these small doses have been used con-
tinuously for as long as six months,” they reported.
“So far all adverse effects have been temporary, dis-
appearing on hormone withdrawal or lowering of
the dosage.”
However, they added:
“Only time and further experience will determine
the full therapeutic possibilities of cortisone for rheuma-
toid arthritis. Explorations of its potentialities as a
treatment agent are greatly influenced by one fact:
The hormone suppresses rheumatic activity but does
not cure the underlying disease. Thus, it appears that
if antirheumatic effects are to be sustained, cortisone
must be given continuously.
"The question as to whether the hormone can be
administered safely and effectively for extended periods
of many months or years will not he answered posi-
tively until there has accumulated greater clinical ex-
perience in relation to dosage and methods of admini-
stration, greater knowledge regarding its physiologic
activities and more information as to the consequences
of its prolonged or repeated use.”
WATCH THAT WHEEZE
Asthma is a broad term meaning any condition in
which wheezing occurs but bronchial asthma is almost
certainly an allergic condition, the Educational Com-
mittee of the Illinois State Medical Society observes
in a Health Talk.
In bronchial asthma the symptoms are wheezing,
shortness of breath and cough. As in any form of
allergy, the sufferer has usually inhaled or eaten certain
substances which are harmless to the majority of
persons, but which produce great distress in those
individuals sensitive or allergic to them.
In many persons, it is difficult to lie down during
an attack; they resort to all procedures, such as
sitting up all night long in a chair or leaning forward
on a table to help them breathe more easily.
The wheezing associated with bronchial asthma varies
with different patients. Sometimes the wheeze is
very quiet and can he heard only with a stethoscope.
Sometimes it is so loud that the sound can be heard
clear across the room and even in the next room.
The wheezing occurs when the victim attempts to
get the air out of the lungs. In a person with a chronic
bronchial asthma, an x-ray film of the chest will show
that the diaphragm is pushed down from its normal
position and the ribs will have a straight character
instead of the normal curved formation. This change
develops because the sufferer is using all the muscles
he has to push out the air which has become trapped
in the breathing apparatus of the chest. Very often
this action produces another condition w'hich is called
emphysema.
Bronchial asthma is also characterized hy the history
of other allergic conditions, either in the patient or
the patient’s family, indicating heredity to be a factor
in at least sixty per cent of the cases. That is why
children of allergic parents should be watched very
carefully from the day of birth. Each new food should
be given one at a time to learn whether the baby
tolerates it.
A skin test is the usual method of establishing the
culprit causing bronchial asthma. The skin is scratched
with fine lines, ordinarily a number of rows are made.
The site may he either the forearm or the back, while
in children it may be either the chest or the abdomen.
Only the outer layer of the skin is scratched and no
blood is drawn. Materials, both in liquid and solid
form, are then applied to the scratches. If positive, a
sort of hive formation will result. Then, if necessary,
an injection procedure may be used to obtain more
information.
Persons inclined to wheeze, be short of breath and
cough should be suspicious of asthma. If a diagnosis
has been definitely established, they should avoid any-
thing that causes an attack, such as certain face
powders, cats, dogs, horses and certain food. Dust
should be avoided. In house cleaning a good vacuum
cleaner with attachments should be used, and sweeping
and dusting should be avoided. Whisk brooms only
shift the dust from one place to another.
Best results in asthma occur when the cause is
found and then avoided. If the cause cannot be entirely
avoided, the patient can be given injections of an
extract of the offending substance to help him build
up a resistance to it.
THE JOURNAL
OF THE
Medical Associa tion of Georgia
PUBLISHED MONTHLY under direction of the Council
Vol. XXXIX Atlanta, Georgia, December, 1950 No. 12
HYPNOSIS IN THERAPY
Richard M. Nelson, M.D.
and
Corbett H. Thigpen, M.D.
Augusta
There is available to physicians today a
valuable therapeutic technic. Few reputa-
ble physicians regardless of their personal
views, dare use it for fear of being asso-
ciated with quackery or charlatanism. Aside
from the necessity for considering public
opinion, many physicians view hypnothera-
py with a sincere feeling of distrust and
even hostility.
It may be worthwhile to look more deep-
ly into the cause of this rather prevalent
attitude. It should be remembered that few
medical schools include hypnotic technics
in their curricula and that opportunities for
graduate training in hypnotherapy are al-
most non-existent. Most physicians as well
as laymen have observed hypnotic sugges-
tion chiefly on the stage or in the hands of
charlatans where the spectacular, sensa-
tional, and often bewildering aspects of the
hypnotic state are used to overawe and
mystify the subject as well as the audience.
Explanations and understanding of the
whole procedure are carefully avoided,
while, in the actual induction of hypnosis,
every attempt is made to exclude critical
thinking and to create a childlike belief in
the magical powers of the hypnotist. On
the sui face, this whole therapy, as it is pre-
sented on the stage and described in sensa-
sJ*fad ™fore the Medical Association ol Georgia in anmn
session, Macon, April 20, 1950.
tional reports of the lay press, seems irra-
tional and unscientific. The well intended
but mistaken use of hypnosis by inexperi-
enced and untrained experimenters, and
“psychological healers*’ has further con-
fused opinion. This is because symptom
removal, per se, is usually temporary. The
deeper underlying causes of symptoms must
be dealt with before satisfactory relief is
obtainable13.
Recently, workers have demonstrated the
value of hypnotic technics in the treatment
of hysteria, anxiety, acute combat reactions,
amnesias and fugue states1"6121315. It
has also been successfully used as an anes-
thetic in selected obstetric, gynecologic and
dental cases, and in controlling such symp-
toms as insomnia, excessive smoking, enu-
resis, premature ejaculation, speech dis-
order, etc." s n 1 '. In many organic diseases
hypnosis can be helpful in relieving the
associated fear and worry and in securing
greater cooperation in the therapeutic re-
gime. This is true particularly when a ma-
jor change in habits of life is indicated,
as in peptic ulcer, hypertension, angina.
etc.11 19.
Experience has shown that practically all
normal persons can be hypnotized, the only
prerequisite being that the patient’s motiva-
tions to go into the hypnotic state be stronger
than his fears of the process4 . Hence the
value of a preliminary discussion with the
patient in which his misconceptions and
fears of hypnotic therapy are clarified and
dissipated; i.e., there is no true loss of con-
sciousness and hence no danger of “not wak-
ing up ; the patient’s going into the hyp-
notic state does not indicate a “weak will”
474
The Journal of the Medical Association of Georgia
or “weak mind"; lie will lie able to veto any
suggestion that is strongly distasteful to
him; and he will discuss his deepest “se-
crets” only if he desires to do so. On the
other hand, the patient is being trained in
the use of unconscious, and ordinarily in-
voluntary. mental forces that all normal per-
sons possess but which few can control. In
many cases it will he particularly expedient
to eliminate any mention of the word “hyp-
nosis”, because of the unfortunate connota-
tions of superstition and black magic which
the term elicits.
Similarly, any person of average intelli-
gence can learn to he a hypnotist. Any tech-
nic with which the therapist is thoroughly
familiar and which obtains adequate coop-
eration from the patient may he considered
a good technic. The physician should learn
to he flexible, however, and to adapt his
technic to the personality needs of his pa-
tient and he able to vary from a strongly
authoritative, domineering approach to
coaxing or persuasion; or even to guiding
on a basis of complete equality". The hyp-
notic phenomena may he presented purely
as “magic” or as creative productions of
“unconscious forces” which the patient is
learning to control.
The nature of the hypnotic state has been
the subject of endless speculation and con-
troversy and, as yet, a theory that adequate-
ly explains all the phenomena of hypnosis
has not been proposed1'. It has been dem-
onstrated that hypnosis is not sleep, that the
patient is in a state of increased “suggesti-
bility” and that while in this state an in-
creased "control of sensory and emotional
response of the patient to outside stimuli is
obtainable.
We attempt in authoritative methods of
inducing hypnosis, gradually to eliminate
more and more sensorimotor relationships
with the world until the hypnotist becomes
the patients dominant link with reality10. As
you will see in the description of this tech-
nic our purpose is to have the patient relin-
quish all, or almost all, external contacts
except auditory; to eliminate gradually the
sensory mechanisms one by one until this
purpose is accomplished.
Hypnosis when induced by authoritative
method seems to he a process of regression.
The state which exists is one resembling
sleep in which one or two channels of con-
tact with the outer world are maintained.
The thoughts of the hypnotist, who is using
this method, in a way, become the nucleus
of the thoughts of the patient. The desires
of the hypnotist become the patient’s desires
and gradually there is, one might say, a
dissolution of the ego boundaries. This pro-
cess has been well described by Kubie and
Margolin. They state, “It is this dissolution
of ego boundaries that gives the hypnotist
his apparent ‘power’; because his ‘com-
mands’ do not operate as something reach-
ing the subject from the outside, demanding
submissiveness. To the subject, they are his
own thoughts and goals, a part of himself1'".”
In some ways, ordinary sleep is similar to
such a hypnosis, but in other ways it differs
greatly. As we go to sleep we gradually
reduce our sensorimotor communications.
First, of course, we cut out the lights so that
we can be in comparative darkness, thus
eliminating the visual stimulation. We lie
quietly at rest allowing tired muscles to
relax and relieve muscular tension, elim-
inating another channel. Our bedrooms are
usually rather quiet where we may hear only
the repetitious ticking of the clock, or per-
haps the chirping of crickets. Thereby, the
auditory channel is considerably narrowed.
We lie in bed, usually with our thoughts of
the day and plans for the future. Gradual-
ly, these thoughts wane as we drop into a
semi-sleep or hypnagogic state. This, too,
gradually slips away and we are asleep.
All hypnosis differs from sleep in many
December, 1950
475
fundamental respects. Sleep is an ordinary
physiologic process, whereas hypnosis, par-
ticularly when the usual authoritative meth-
od is used, is induced or promoted by means
of a second party. Further, in sleep the
ordinary person is not under the influence
of another person, whereas in hypnosis the
subject may be strongly influenced by the
hypnotist. A person who is asleep can be
easily awakened by external stimulus.
Whereas a person under the usual type of
hypnosis, as a rule, can be stimulated and
awakened only by, the hypnotist himself.
This is, however, not true if the hypnosis
has been induced by the non-authoritative
method in which the patient plays an active
part. A hypnotized subject can carry out all
the activities normally associated with the
wakened state. Physiologically, Estabrook
has shown by means of the psychogalva-
nometer that there is a very definite drop in
electrical skin resistance in sleep, whereas
the resistance in hypnosis is the same as in
the unhypnotized state4.
In all methods of inducing hypnosis, it is
helpful to create relative immobilization of
the patient by the use of a monotonous stim-
ulus, low and rhythmical in nature. Monot-
ony plays a factor in creating a sensory
adaptation by providing a stimulus of con-
stant intensity which tends to lull the sub-
ject to sleep. It has been our experience that
rhythm of suggestion, plus a smooth, even,
clear voice- is conducive to putting a patient
into the hypnotic state. It is interesting to
note the difference in the patient during
the induction stage and during the authori-
tatively induced hypnotic state. In the in-
duction, there is a marked narrowing of
the ego boundaries of the subject by reduc-
tion of the sensorimotor channels. The only
sensorimotor channel open is that between
the subject and the hypnotist. In the transi-
tion into the fully developed hypnotic state
there is a partial expansion of the ego
boundaries into which the hypnotist has been
interjected and the subject is again able to
assume more reactions of the ordinary
awakened state1’.
There are almost as many methods of
inducing hypnosis as there are hypnotists
and, as mentioned previously, any technic
which obtains adequate cooperation from
the patient may be considered a good tech-
nic' 14. The hypnotist should adapt his meth-
ods to suit the personality and psychic needs
of the patient. Hypnotic induction technics
have been classified into two general types1":
1. The Authoritative: This is the type gen-
erally seen on the stage. Here the patient
remains passive and in a sense becomes
strongly dependent on the therapist; and
2. The Non- Authoritative or indirect
technics, in which the patient assumes a
varying amount of responsibility for his in-
duction and for the production of hypnotic
phenomena.
Technic of an Authoritative Induction
Method
The subject is asked to stand with his feet
close together. He is then told to look at
the hypnotist, straight in the eye and to
allow his body to relax as much as possible.
He is requested next to clasp his hands
together tightly. The hypnotist then places
his hands on either side of the subject’s
head, the palms being allowed to extend out
beyond the eyes, thus serving as “blinkers”.
(This is done in order to constrict the visual
field of the subject.) The hypnotist then
stares at the bridge of the subject’s nose and
tells him several times to squeeze his hands
more tightly together. The hypnotist then
begins to gently draw the patient’s head very
slightly backward and forward. He then
says to the patient, “you are gradually be-
ginning to sway backward and forward.
Keep looking straight into my eye. Back-
ward and forward — backward and forward.
You are swaying more and more (the hyp-
notist draws the head back and forth more
176
The Journal of the Medical Association of Georgia
strongly to create this swaying.) The tighter
your hands become, the drowsier you will
become. You are beginning to feel very
tired now, very drowsy, very sleepy, squeeze
your hands together and relax the rest of
your body; do as I say do. A ou are now7
very drowsy, very sleepy; you are swaying,
swaying, swaying, very tired, very drowsy,
very sleepy. Your hands are tightly inter-
locked. The tighter your hands become, the
sleepier you become. You are getting very,
very sleepy now. Your eyelids are begin-
ning to close. Your eyelids are beginning
to fall. Close your eyes; close your eyes.
\ou are very tired now, very sleepy, very
sleepy, very tired. The tighter I press upon
your head with my hands, the sleepier you
will become. You are now extremely
sleepy, extremely drowsy; your hands are
pressing tightly together, tighter, tighter.
You are very sleepy; do as I tell you to do.
Go to sleep; go deeply to sleep. Your hands
are now pressing very tightly together and it
is impossible for you to open them. It is
now impossible for you to open them. Your
eyelids are sticking tighter and tighter to-
gether, tighter and tighter together. Yrou
cannot open your eyes. You are extremely
tired. You are extremely sleepy. Go to
sleep — deeper to sleep — very much deeper
to sleep. Now', you are deeply asleep. You
will do all that I tell you to do. You hear no
sounds except the sound of my voice. You
w ill do all that I tell you to do.”
Discussion
The choice of this technic depends upon
the personality of the subject and his intel-
lectual capacity. The tone of voice used in
this technic is most important. The appear-
ance, manner and voice of the hypnotist are
also very important. He may use a coaxing
or demanding induction or one in which the
subject is made to feel on an equal footing.
These melodramatic maneuvers work ex-
tremely well on certain types of patient.
Notice that they are designed to immobilize
the subject and to create monotony. Fur-
ther, the subject is also fastening his sen-
sory modalities to one field of sensation and
gradually withdrawing attention from all
others. Other patients resist all authorita-
tive approaches, apparently feeling a seri-
ous loss of dignity or self-control may be
involved. Many people may be frightened
by the implications of black magic they find
in the situation.
Technics of the IS on- Authoritative Induction
Method
One of the authors (R.M.N.) has devel-
oped a modification of Erickson’s hand levi-
tation technic which places a much more
definite responsibility for the induction pro-
cess, as wrell as the production of hypnotic
phenomena upon the patient himself1 1\
In this technic, the patient may be seated
in a chair, or, preferably, should lie on a
bed. It is explained that his symptoms may
well be caused by unconscious emotional
forces which he can learn to understand
and to control. Suggestions are generally
as follows:
“You have a very important job to do —
I'm going to give you word-pictures of sen-
sations in your arm which I want you to
translate into sensation pictures by using
your imagination. Make these sensations
just as vivid and as real as you possibly can.
“Now, shut your eyes so that you can
concentrate more deeply. I want you to lift
your right hand up a few inches with the
palm upwards. That's right! Now stiffen
all the muscles in your forearm and hand.
Make them tight. Good! Picture an invis-
ible force pushing against the back of your
arm. Let yourself feel waves of force that
sweep up against the back of your elbow,
that rise up to your fingers like waves
sweeping in from an imaginary ocean. Each
wave pushing more strongly. The feeling of
pressure growing more intense. A feeling
of expectancy mounting, that soon — any
second now, your hand will move without
December, 1950
177
conscious effort toward your face . . . will
begin to move in a series of little jerks to-
ward your face. Any second now it will
move . . . There, it moved! And now the
pressure builds up again, the tension mount-
ing higher and higher — and, . . . there it
moved again. A pleasant sensation of move-
ment without conscious effort. It will con-
tinue to move like that until it touches your
face. When it reaches your face, it will he
the signal that you have reached a very deep
state of relaxation. It's moving more rapid-
ly now. Already it has passed the half-way
mark and soon it will touch your face. No
matter how tired you may become, don’t let
yourself stop until your hand reaches your
face. Then you can relax. Soon it will
touch — it’s almost there now — any second
it will touch your face and you will he very
deeply relaxed. Now! It touches and you
can let go and relax completely. That’s
fine! I’m going to move your arm down
to your side now without disturbing you.
You’ve done very well and the next time we
try this, you will he able to relax even more
quickly and more deeply because you know
how to do it now.”
The patient is then asked to picture a
hundred pound sack of cement resting on
top of his arm and to imagine that the arm
is becoming too heavy to lift because of the
heavy weight pressing it down. He is told
that, by the time the therapist counts from
one to three, it will he too heavy to lift.
After unsuccessful attempts to lift the arm,
the subject is allowed to remove the catalep-
sy by counting to three mentally.
In like manner, catalepsy of the eyelids
is induced by placing imaginary glue on the
eyelids and asking the patient to recall
similar sensations when his eyelids were
stuck shut during childhood inflammations.
Similarly catalepsy of the mouth is pro-
duced by having the patient picture his
mouth being stuck shut by very sticky taffy
candy; and anesthesia may be induced in a
hand by asking the patient to imagine that
a pressure around his wrist has shut off sen-
sations from his hand and that it is going to
sleep in the same manner that his foot may
have gone to sleep in the past so that eventu-
ally it becomes completely without sensa-
tion or anesthetized.
Discussion
It will be noted that the patient has been
guided into progressively deeper and deeper
hypnosis by inducing catalepsy in larger
and larger muscle groups and, finally, sen-
sory changes. In this process he is shown
the strength of the “unconscious” forces of
his “mind” and gains confidence in his
ability to use them.
With this technic, it was possible to in-
duce therapeutic levels of hypnosis in 46
of a current series of 48 unselected patients.
However it is not well adapted to the pa-
tient who has a pathologically poor opinion
of himself and his abilities. Here, an au-
thoritative technic may give better results
until the patient achieves a more optimistic
viewpoint.
Korzybski has pointed out that the words
used in describing an “event” are neces-
sarily abstractions of far more detailed sen-
sory impressions. It is possible for a per-
son to “realize” very much more about the
pain involved in a friend’s toothache if he
has himself experienced such a pain. In
effect, he recalls his painful experience,
“relives” it in miniature, and then can
evaluate his friend’s toothache in terms of
his own experience. The process is even
better illustrated by the difficulty of describ-
ing a color such as red to a color-blind
person. Having never experienced the sen-
sory impression that we term red , this hypo-
thetical person can recall color only in
terms of past experience in which the sen-
sation of “red” is lacking. He can have no
extensional understanding of this word.
It may be helpful to further classify hyp-
nosis into Intensional and Extensional types
1.78
The Journal of the Medical Association of Georgia
according to the formulation of the sugges-
tions used.
Intensional suggestions have often been
employed with authoritative hypnotic tech-
nics. To a lesser degree they also have been
used with the non-authoritative technics. A
therapist, for example, may attempt to in-
duce hypnotic phenomena through such
suggestions as these:
“As I count to three, your eyes will shut
more and more tightly and when I reach
three, it will be impossible to open them.”
“As I stroke your arm it will gradually
become less and less sensitive and finally,
on the count of three, will be completely
anesthetic.”
The degree of success obtained with such
suggestions will depend on the patient’s
ability to convert them into more concrete
or extensional experiences, to recall such
experiences, and to project them in accord-
ance with the therapists’ suggestions. That
many patients are able to do this success-
fully, is attested by numerous reports in
the literature. However many failures, es-
pecially in inducing anesthesia, may be ex-
plained by the patient’s inability to convert
a generalized or intensional suggestions into
specific extensional experience3.
In contrast, extensional suggestions are so
worded as to recall past experiences of the
patient more on a sensory than on a verbal
level. The patient can then re-experience
and utilize in enormously greater detail than
could ever be achieved by “verbal” means
alone. Examples of extensional suggestions
are given above in the detailed account of a
non-authoritative technic.
The almost universal use of suggestions
detailing the sensations that frequently pre-
cede sleep (as a means of inducing hyp-
nosis) indicates an “unconscious recogni-
tion” of the value of using the past experi-
ences of the patients to reinforce and
strengthen purely “verbal” suggestion.
REPORT OF CASES
Case 1. (M.B.B.) A 23 year old quadroon was
brought to the emergency room after being picked up
by the police when she was found wandering around
the streets of the city in a dazed state. The patient
would obey (to some degree) direct orders in her
waking state. She was put under hypnosis by the authori-
tative induction technic. After the hypnotic trance
was obtained, the hypnotist talked to the patient very
gently and softly for fifteen or twenty minutes, re-
assuring her and telling her it was his desire to help
her, no matter how difficult a problem it might be.
Then by direct questioning it was found wdiy the
patient was in such an emotional stupor. She had been
living with a married man for the past eight years.
By him she had three children. Over the past year
he had threatened again and again to desert her and
the children, thus leaving them to their own devices.
Two hours before she was brought to the emergency
room, he became very positive in his statements. She
felt that her problem was insoluble and there was no
possibility of extricating herself. The problem was
attacked directly by calling the man to the hospital
for an interview. A number of hours of psychotherapy
brought about a reconciliation and a change in attitude
on the man's part. The patient has had no trouble
whatsoever for the past five years following this episode.
Case 2. Mr. “B”, a 54 year old professional
speaker, came to therapy with a complaint of
cramping and drawing spells in which his extremities
would lock in tetanic positions until he was given an
injection of calcium gluconate or barbiturate. These
symptoms had been present for more than 30 years
following an attack of acute gastro-enteritis accompanied
by nausea and vomiting. He has had several episodes
of altered consciousness — during one of which, some
25 years ago, he attempted suicide.
By use of the non-authoritative induction technic
just described, the patient readily reached a state of
light hypnosis — showing a lively interest and curiosity
as each new phenomenon appeared. Some three sessions
were spent in training him in going into a hypnosis
of medium depth. On the third session the patient was
thrown into one of his typical “drawing” spells by
appropriate suggestions and then told that he could
relax himself completely by concentrating on his left
hand and imagining that invisible forces were pushing
it toward his face. The hand, slowly, and with apparent
effort, moved up to his face and he relaxed w'ith a
sigh of relief.
The next day another attack was induced and this
time the patient relaxed himself by the use of self-
hypnosis. He then returned to his home, some distance
away, and returned at regular intervals for continued
therapy. At subsequent sessions he reported that his
now infrequent “spells” were easily controlled by use
of his self-hypnocis and that he also had learned to
control his insomnia.
After a month’s therapy, the patient was taken into
a slightly deeper state of hypnosis in which he recalled
in vivid detail his suicidal attempt some 25 years
previously. When asked why he had not been able
to give these details previously he said, “I just
wouldn't let myself think about it.”
In the next few months the patient continued to
recall and abreact to numerous traumatic events of
his childhood and showed growing insight and maturity
of viewpoint. He has now been asymptomatic for
approximately six months and states that he feels
better than he has in years.
It may well be objected that this therapy consisted
largely of “symptom removal” and that we are being
inconsistent in criticizing others for using hypnosis
simply for that purpose. However we feel as the
patient has become proficient in self-hypnosis, we have,
to a considerable degree, strengthened his defenses
against anxiety to a point at which his symptoms are
December, 1950
479
no longer troublesome and have given him the courage
to look more deeply into his personality structure.
Case 3. (C.R.S.) A colored woman, 43 years of
age, had been admitted to the hospital with a tentative
diagnosis of cerebral hemorrhage. One week before
admission she had developed a hemiplegia over the
entire right side of her body. More careful examination
revealed all deep and superficial reflexes to be intact
despite the apparent paralysis and anesthesia on the
right side. Diagnosis of conversion mechanism was
made and the patient was put into the hypnotic state
by use of the authoritative method. During the next
several hours, by the inducing some degree of regres-
sion. the patient was able to reveal her problem. Her
only son bad been in the Army for two years. During
that time she had not heard one word from him and
had no idea where he was. She had become extremely
concerned about this, but was able to meet the problem
fairly well until her husband became quite seriously
ill and was unable to provide for the rest of the family.
The patient had nobly risen to the occasion endeavoring
to support the family by taking in washing. After a
few weeks, it became obvious to all of them that they
could not survive with her meager earnings. The patient
then developed her symptoms. It is interesting to note
that for a week after the diagnosis of conversion
mechanism was made, psychotherapy had been used
in an attempt to uncover her problem but to no avail.
A solution of this patient’s problem was rather easy.
The Red Cross was called upon and they located the
patient's son. He wired his mother money and a
loving message. Within five minutes after receipt of
this telegram, all traces of the patient’s paralysis and
anesthesia had totally vanished. The son continued to
write once a month thereafter until he was discharged
from service. Five years have elapsed since this
patient was first seen and there have been no recurrent
symptoms.
Summary and Conclusions
The prevalent feeling of distrust and hos-
tility towards the use of hypnotherapy is, to
a considerable degree, due to its unfortu-
nate association in the public’s mind with
the melodramatic performances of the stage
hypnotist.
Two sharply contrasting technics of in-
ducing hypnosis are described in detail: An
authoritative technic similar to those gen-
erally seen on the stage, which is best
adapted to the unsophisticated, dependent
type of personality; and a non-authoritative
technic which is better adapted to those pa-
tients who are more analytically-minded or
who resist authoritative methds through fear
of loss of dignity or self control. The latter
method is felt to have a wider range of use-
fulness as it can be successfully employed
in more than 95 per cent of unselected
patients.
It is felt that hypnotic suggestions are
necessarily interpreted by the patient in
terms of his past experience. Hence sug-
gestions are far more effective if worded so
as to recall previous experiences more on a
sensory than a purely verbal level. The pa-
tient can then “re-experience” and utilize
them in enormously greater detail than
could ever be achieved by “verbal” means
alone.
Hypnosis remains a very valuable aid in
therapy but should not be thought of as sup-
planting other methods of treatment. It is
best employed to re-inforce, and add speed
and directness to psychotherapy in which
the goal is restoration of a previous level of
functional equilibrium rather than an ex-
haustive reintegration of the personality
structure.
BIBLIOGRAPHY
I. Erickson. M. H.: Am. J. Psychiat. 101:668, 1944.
2.. Erickson. M. H. : M. Clin. North America 28:639, 1944.
3. Erickson, M. H. : M. Clin. North America 32:571, 1948.
4. Estabrooks, G. H.: Hypnotism, Dutton 1946.
5. Fisher, Chas. : Psychoanalyt. Quart. 14:437, 1945.
6. Kartchner, and Karner: Am. J. Psychiat. 103:630, 1946.
7. Korzybski, A. : Science and Sanity, Science Press,
ed. 2, 1941.
8. Kroger, W. S., and Freed, S. C. : Am. J. Obst. &
Gynec. 46:817, 1943.
9. Kroger, W. S., and Lee, S. T.: Am. J. Obst. & Gynec.
46:655, 1943.
10. Kubie, and Margolin: Am. J. Psychiat. 100:611, 1945.
II. Lewis, N.D.C. : M. Clin. North America 28:565, 1944.
12. Lindner, R. : Psychoanalyt. Rev. 32:325, 1945.
13. Lorand, S. : J. Nerv. & Ment. Dis. 94:64, 1941.
14. Van Pelt, S. J. : Brit. J. Med. Hypnotism 1:19. 1949.
15. Wolberg, L. R. : Medical Hypnosis, Gfune & Stratton,
1948, vol. 1.
SUDDEN DEATH IN PSYCHIATRIC
PRACTICE
Joseph D. McElroy, M.D.
Atlanta
Sudden death is defined as death occur-
ring unexpectedly in an individual who is
apparently in good physical health or who
is not known to be seriously ill. Suicide is
too large a subject to be included beyond
stating that any severely depressed indi-
vidual may attempt self destruction. Emo-
tional shock is too controversial a subject
to be dealt with here. Epilepsy, per se, is
rarely responsible for death and in status
Read before the Medical Association of Georgia in annual
session, Macon, April 20, 1950.
iso
The Journal of the Medical Association of Georgia
epilepticus exhaustion may be considered
the lethal factor.
Subdural hemorrhage in senile people
and those predisposed by chronic alcohol-
ism, paresis and arteriosclerosis may pro-
gress to fatal coma without premonitory
symptoms. Cerebral edema, particularly
common in alcoholics, may be rapidly pro-
gressive. There have been many diagnoses
of hysteria, catatonia, etc., which have been
changed to diagnoses of meningitis, enceph-
alomyelitis and brain tumor after post
mortem examination. In recent years it has
become more evident that fatal undiagnosed
adrenal and pancreatic tumors may be re-
sponsible for unusual behavior disorders.
Sudden death from physiologic exhaustion
is not uncommon in hypomania and cata-
tonic excitement.
Menmnger von Lerchenthal1, in an article,
“Death from Psychic Causes,” says: “It is
well known that there are sudden deaths in
psychoses in which pathological anatomic
examination discloses no adecpiate cause to
which death can be attributed”. This he
attributes to a hypersensitivity in the vagus
cerebral centers. Almost any text book of
anthropology bears reference to death
through suggestion of aborigines convinced
that they were under some powerful hex.
One wonders if the time worn old phrase
“scared to death” is entirely illogical!
Statistics relative to mortality rates in
convulsive therapies vary so widely as to
cast doubt on their reliability. Will, Rehfeldt
and Neumann' reviewed the literature deal-
ing with complications associated with elec-
troshock therapy. Thirty-three deaths were
noted in American and English literature.
“Of these 26 may be said to be related
to the electric shock, details of two are
unknown and five are only questionably
related to the treatment. There were no
deaths that could be attributed definitely to
changes in the central nervous system pro-
duced by the passage of the electric current
and demonstrated by post mortem examina-
tion". More references throughout the lit-
erature may he found to deaths attributable
to metrazol and considerably more to insulin
shock.
It is generally recognized that many neu-
rotic individuals demonstrate anxiety, hy-
pochondriasis or depression to the presence
of organic disease and that there are in-
stances in which mental symptoms may pre-
cede detection of signs of organic brain
disease. Brock and Wiesel . reported four
cases of individuals, diagnosed as psychotic,
in view of negative neurologic findings who
were given electro-shock and later found to
have tumor of the cerebrum.
Brain tumor as a factor complicating
psychiatric diagnosis has been explored by
many including McIntyre4, but unique fea-
tures of a recent experience seem to warrant
reporting of the following case.
A forty year old white male presented
himself to his physician in June 1949, with
complaint of headaches following attacks
of severe streptococcic throat and prostatitis
in December 1948. The headaches had been
growing progressively worse and for the
previous two months had been accompanied
by frequent transient dizziness, apparently
made worse by the taking of large amounts
of empirin. In the process of examination
by a neurologist, additional historical de-
tails were noted: general health good until
two years previously; “colitis," manifested
by intermittent attacks of nausea and diar-
rhea for two years, and loss of weight from
the usual 123 pounds to 112 pounds. Neu-
rologic examination was negative except for
fine horizontal nystagmus, barely percep-
tible vertical nystagmus, slightly unsteady
gait, and apparent marked tenderness to
deep pressure over the posterior cervical
muscles. The impression was that there was
no definite objective evidence of organic
disease of the nervous system and that the
December, 1950
181
findings pointed to a posterior cervical fibro-
myositis, such as usually occurs in people
who are quite neurotic. Four days later the
patients wife reported that he had been
“wild with headache,” that he had been
quite depressed for some eight months to the
extent that six months previously he had re-
fused a trip to Mayo’s for fear of suicide
en route, that he was an exceedingly con-
scientious individual who was under terrific
strain at work, that he was concerned about
lack of cooperation from fellow employees
and that on several occasions he had said,
“I can’t control my thinking.” At that time
he was referred for psychiatric treatment
with the notation that a depression of such
serious proportions might necessitate , shock
therapy.
When first seen on June 30, 1949, he com-
plained of severe headache not relieved by
large amounts of sedation taken for several
weeks, transient diplopia, insomnia, ano-
rexia, depression and periods of extreme
restlessness. He was hospitalized for psy-
chiatric observation. Next morning he re-
ported himself to be free of pain and to be
hungry for the first time in a month. Per-
tinent features of the personality study in-
cluded average social adjustment and an
unusually close relationship to his father,
both diminishing after marriage; strain of
living with in-laws leading to purchase of a
house with consequent increased worry
about finances; exacerbation of gastrointes-
tinal symptoms concurrently with occupan-
cy of the house; sensation of decreasing
efficiency in performance of duties in which
two predecessors had “cracked up,” a fate
which he feared for himself; and during a
two week vacation in June 1949, realization
that he could not continue in an executive
,{ i
capacity but must return to a routine job at
half the pay. A member of his family stat-
ed. “When the time drew near for him to go
'2T
back to work and he had to go back on the
job, he felt defeated — -perhaps he felt guilty
within himself that he had been a failure
and wasn’t going to be able to provide his
family with as much as he had been able to
provide them with and started developing
these headaches because they got worse the
week before he was to go back."
Although there w?as no doubt about the
presence of a serious depression, further in-
vestigation was considered necessary before
recourse to shock therapy. X-rays of the
cervical spine, glucose tolerance, blood
studies and urinalysis were noncontributory
and no change neurologically was noted.
QnMie fourth hospital day, with awareness
of the classic admonition to avoid lumbar
puncture in the presence of increased intra-
cranial pressure, a twenty gauge spinal
needle was introduced through the fdurth
lumbar space without difficulty. Initial pres-
sure of 160 mm. of fluid wras recorded and
10 cc. of clear fluid w-as withdrawn, with no
apparent obstruction. The Kahn test was
negative, 3 r.b.c. were found and protein
was reported as 40. No change was noted
in his condition until the third and fourth
days after the tap, when he complained of
increased headache. Observers agreed that
increased symptoms were related to certain
observed emotionally disturbing incidents.
However, the following day he complained
more bitterly of headache, became comatose
ten minutes after receiving his routine after-
noon insulin (10 units) and died almost
immediately.
The death was totally unexpected and,
prior to autopsy, there was no reasonable
hypothesis as to the cause of death. Positive
findings, except for a small area of casea-
tion in the right lung, were noted only after
the skull was opened. A marked degree of
cerebral edema was apparent, and when the
brain was dissected from its attachments
there was seen a pressure cone of the in-
ferior cerebellum into the occipital fora-
men, indicating that the passage of fluid
482
The Journal of the Medical Association of Georgia
through the fourth ventricle had been
blocked. The right cerebellar hemisphere
was considerably enlarged and was largely
occupied by a cyst containing watery light
yellow fluid. The cyst lining was smooth
except for a plaque 8 mm. in diameter. The
pathologist reported: “The whole picture of
this cyst is unusual. Such a cyst, according
to Lindau, probably is the result of degen-
eration of either an astrocytoma or a heman-
gioma. It is my feeling that the latter view
is correct in this case, even though only a
very small remnant of hemangiomatous
tissue remains.” This condition differs from
typical Lindau’s disease in the absence of
hemangiomas in the skin and liver. It was
the opinion of those who saw the cyst that
it may have been present for years.
In speculating as to the immediate cause
of death, an unwelcome conclusion presents
itself. Loss of fluid from the spinal canal,
including probable post tap seepage, per-
mitted the increasingly edematous brain
suddenly to shift in position so as to produce
an immediately fatal medullary compres-
sion.
The emotional picture can best be ac-
counted for on the basis of an original anx-
iety, aggravated by situational factors and
complicated by an increasing awareness of
inadequacy to cope with enviromental de-
mands. The preponderance of elements of
situational reaction rather than of endo-
genous depression indicated poor prognosis
in response to electro-shock, — hence, it was
not used.
Important features of this case include:
relative infrequence of cerebellar tumors in
comparison with tumors of the cerebrum
which are known to produce emotional dis-
turbances, absence of signs of increased
intracranial pressure, definite functional
symptoms which are commonly seen in
states of depression, and paucity of neu-
rologic findings. In the latter connection, it
was interesting to find a few days later a
case in which chief signs and symptoms of
severe occipitocervical headache, horizontal
and vertical nystagmus, extreme unsteadi-
ness of gait, and depression cleared up
under withdrawal of heavy sedation and
psychotherapy.
The psychiatrist, neurologist, internist
and general practioner involved at various
stages have each profitted by reemphasis
from this experience. Functional and or-
ganic symptoms can and usually do exist
simultaneously. The autopsy remains of
prime importance in our program of con-
tinuing medical education. Spinal puncture,
although technically simple and the source
of invaluable information, is a potentially
dangerous procedure. Sedation may mask
vital signs and symptoms and indeed may
produce misleading findings.
While some of our most valuable lessons
come as the result of bitter experience, we
must avoid extreme overcautiousness which
would blind us to the obvious while search-
ing for the obscure.
REFERENCES
1. Menninger von Lerchenthal, Erich: Death from Psychic
Causes, Bull. Menninger Clin. 12:31-36 (Jan.) 1948.
2. Will, O. A., Jr.; Rehfeldt, F. C.; and Neumann, M. A.:
Fatality in Electroshock Therapy; Report of Case and
Review of Certain Previously Described Cases, J. Nerv. &
Ment. Dis. 107:105-126 (Feb.) 1948.
3. Brock, Samuel, and Wiesel, Benjamin: Psychotic Symp-
toms Masking Onset in Cases of Brain Tumor, M. Clin.
North America 32:759-767 (May) 1948.
4. McIntyre, H. D., and McIntyre, A. P. : The Problem
of Brain Tumor in Psychiatric Diagnosis, Am. J. Psychiat.
98:720-726 (Mar.) 1942.
THE ADRENOGENITAL SYNDROME
Ralph Hill Chaney, M.D.
and
Robert B. Greenblatt, M.D.
A ugusta
The adrenal cortex elaborates many hor-
mones. Forty-two steroid compounds have
been isolated from the adrenals. Many of
From the Departments of Surgery and Endocrinology, The
Medical College of Georgia. Augusta.
Read before the Medical Association of Georgia in annual
session, Macon, April 20, 1950.
December, 1950
485
these steroids have been shown to possess
certain biologic effects while others appear
to be physiologically inactive. In general it
may be said that there are three main cate-
gories into which these steroids fall: ana-
bolic, catabolic and electrolytic. In the ana-
bolic group are the gonad like steroids with
properties resembling either the androgens,
estrogens or progestogens. The commonest
of these are those with androgenic properties
and are represented by the 17-ketosteroids.
In the catabolic group are those steroids
classed as the sugar regulating hormones.
These are concerned with gluconeogenesis,
i.e., the conversion of protein into carbohy-
drates and probably with the neutralization
of insulin. The steroid characteristic of this
group is 11-17 hydroxycorticosterone. The
electrolytic group are the steroids which
regulate electrolyte and water metabolism.
Desoxycorticosterone is representative of
this group although many of the gonadal
and adrenal steroids influence electrolyte or
water metabolism.
Hypercorticoidism suggests the overpro-
duction of corticoid hormones. This may be
due to hyperplasia, adenoma or carcinoma
of the adrenal cortex. The stimulus for in-
creased rate or aberration of cortical steroid
metabolism may be inherent in the gland
itself (primary) or may be pituitary in
origin. When the corticoids produced by
the adrenals produce signs and symptoms
the clinical picture will depend on which
corticosteroids are predominant. Frequently
the picture is well defined and points to the
anabolic group of corticoids (adrenogenital
syndrome) and again it points to the cata-
bolic group (Cushing’s syndrome). At other
times, there is much overlapping and the
clinical picture is not clear cut. Indeed,
Haymaker and Anderson1 express the opin-
ion that the adrenogenital syndrome differs
from Cushing’s Syndrome in that the over-
production of cortical hormones acting on
carbohydrate and electrolyte metabolism
supervenes in the latter and that of sex hor-
mones in the former.
Clinical Characteristics
The adrenogenital syndrome in the broad-
est sense of the term comprises all condi-
tions in which abnormal changes in the sex-
ual sphere are referable to organic or func-
tional disturbances in the adrenal cortex".
In the narrower sense as employed here, the
syndrome refers to true masculinization of
the female as opposed to pseudo-masculin-
ization of Cushing’s syndrome. In the for-
mer the features of positive protein balance
and increased strength are arraigned against
the negative protein balance and muscular
weakness of the latter.
The adrenogenital syndrome is seen far
more frequently in females. The signs and
symptoms will depend on the time of de-
velopment of the adrenal disorder. When
the lesion occurs in prenatal life, the picture
is usually that of pseudo-hermaphroditism.
In such instances the clitoris enlarges so as
to resemble an hypospadias penis, the va-
gina is absent or rudimentary. Physical con-
figuration, hair distribution and the psyche
are masculine. The internal genitalia, uter-
us, tubes and ovaries remain infantile3.
If the onset occurs later in prepubertal
life, the masculinization is usually less com-
plete. Precocious puberty with enlargement
of the clitoris and labia majora, appearance
of pubic hair and hirsutism may occur.
Sometimes breast growth and menstruation
may be found. The powerful muscular de-
velopment seen in male precocity, “the in-
fant Hercules" type, is not seen in the fe-
male though milder degrees may be ob-
served4.
When the syndrome becomes established
in adults after normal puberty, hirsutism,
amenorrhea, lowering of pitch of voice, en-
largement of the clitoris and increased mus-
cular strength, i.e., true virilism, sets in.
The Journal of the Medical Association of Georgia
18J
Figure 1. Profile view Case I showing the masculine form,
receeding alopecia of scalp and marked hirsutism of face,
arms, legs and trunk.
In the adult man the disease is rare and
then the tendency is more frequently toward
feminization, with gynecomastia and genital
atrophy rather than toward increased viril-
ity-
Differential Diagnosis
Adrenogenital syndrome is in many ways
the exact antithesis of Cushing’s syndrome.
In this syndrome the excess corticoids in-
stead of converting proteins into sugar, con-
serve protein and facilitate growth. Sugar
metabolism is usually not disturbed. Obesity
may or may not be present. Hypertension
is usually absent. In Cushing’s syndrome
the signs and symptoms are similar to that
Figure 2. Intravenous pyelogram, Case 1, showing tlje right
kidney pushed downward and rotated by tumor above.
of Cushing’s disease. The fundamental dis-
order is in the adrenal in both, but in the
former it is intririsic while in the latter it
is due to excessive pituitary stimulation of
the adrenal. In Cushing’s disease as in
Cushing’s syndrome the main physiologic
disturbance is one of hypergluconeogenesis.
The hirsutism is usually not attended by
other signs of true virilism such as enlarged
clitoris or voice changes. It is true, however,
that in some instances there is tremendous
overlapping of the syndromes and mixed
cases of virilism and Cushing’s syndrome
have been observed. In general some signs
and symptoms that aid in differentiation be-
tween Cushing’s syndrome and adrenogeni-
talism are the muscular weakness and pseu-
dovirilism of the one and the increased
strength and true virilism of the other.
However, when the underlying pathology is
due to adrenal carcinoma, differentiation
may be exceedingly difficult, since weak-
December, 1950
485
Figure 3. Unopened tumor removed from Case 1.
Figure 4. Tumor removed from Case 1 after splitting tumor
in half.
ness and ultimate emaciation become com-
mon denominators of both syndromes.
True virilization may occur in arrheno-
blastoma and hypernephromas of the ovary
and differentiation may be difficult unless a
palpable tumor of the ovary is present.
Diagnosis
Aids in diagnosis are glucose and insulin
tolerance tests. Insulin resistance and de-
creased carbohydrate tolerance point to the
involvement of the carbohydrate regulating
factors of the adrenal. Urinary assays for
17-ketosteroids are important. They are
increased in the adrenogenital syndrome and
values may range from 40 to 120 mg. per 24
hour specimen and higher. In pure unmixed
cases of Cushing’s syndrome the 17-ketoste-
roids are normal or slightly increased, hut
the 11-17 corticoids are increased. Peri-
renal insufflation and pyelography may
Figure 5. Low power photomicrograph tumor removed in
Case 1. Normal adrenal tissue on left, neoplasm on right.
Figure 6. High power photomicrograph tumor removed in
Case 1. Normal adrenal tissue on left, neoplasm on right.
prove of value in locating suspected adrenal
tumors.
Therapy
Surgical intervention by removal of the
adrenal tumor or bisecting the hyperplastic
adrenal gland may he resorted to. Many of
the symptoms usually disappear with resti-
tution toward the norm.
Two case studies are presented to show
some of the differential points in the diag-
nosis of adrenogenital syndrome (Case 1)
and Cushing’s syndrome (Case 2).
REPORT OF CASES
Case 1. A single woman of 40 years was first
seen in October 1949 when her complaints were
general weakness, fatigue and masculinization. Menses
had appeared at 12 ; they were scanty and irregular
through her high school period ; in her college years
the amount of flow was normal but the interval irregu-
436
The Journal of the Medical Association of Georgia
Date Total
17-keto .
1949
11-14
1149
mg.
11-25
1227
mg.
1950
1-3
16.6
mg.
1-4
14.1
mg.
1-5
19.1
mg.
1-6
10.2
mg.
Figure 7. 17-ketosteroid assays preoperatively and post-
operatively in Case 1.
Figure 8. Profile view Case 2 showing extreme degree of
obesity.
lar. In her last college year (1928) she had an almost
constant discolored discharge requiring the constant
use of a guard and that summer had a single excessive
period lasting ten days. She was treated all through
the summers of 1928 and 1929 by some type of injec-
tion which failed to restore normal menstrual func-
tion. Thereafter only occasional spotty bleeding
occurred at irregular intervals until February 1949.
Hot flushes had made their appearance two years earlier
Figure 9. Photomicrograph pituitary tumor removed in
Case 2.
but had never been marked. Excessive hair growth
started 20 years ago and had not previously been
considered as a factor in her problem. Physical exami-
nation showed a slender, well developed, but under-
nourished female, presenting excessive hirsutism of
face, arms, legs and abdomen and receding alopecia
of the scalp. The blood pressure was 128/92. The
abdomen was below the plane and there was a sug-
gestion that the right kidney was low. The pelvic
examination showed a moderate enlargement of the
clitoris, a nulliparous outlet, a small clean cervix with
an open os, a miniature fundus and normal adnexa.
Laboratory examinations showed normal blood, urine
and kidney function tests. The basal metabolism was
plus 10.4 per cent. The 17-kerosteroid determination
(urine) indicated 1227 mg. per 24 hour specimen.
The insulin tolerance test showed insulin sensitivity.
The eosinophil response to adrenalin was good, falling
from 150 to 50 in 4 hours. Intravenous pyelograms
showed the left kidney normal, the right kidney pushed
down and rotated by an apparent tumor existing above
the kidney. Perirenal air studies showed the left side
to be normal and that an adrenal tumor 10 cm. in
diamenter existed on the right, the long axis dimension
being obscured by the liver shadow. At operation
December 29, 1949 (R.H.C.) through a lumbar incision
which removed the twelfth rib, the adrenal area was
exposed and an encapsulated tumor 8 by 10 by 20 cm.
in size was completely enucleated and the wound
closed anatomically without drainage. The pathologic
report (Dr. Edgar R. Pund) stated: “Solid carcinoma
of the cortex of the suprarenal. The neoplasm arises
in one portion of the suprarenal gland, the uninvolved
portion being attenuated and measuring 9.5 by 5 cm.
and varying in thickness from 0.1 to 0.8 cm. The
neoplasm forms an encapsulated mass weighing 720
grams and measuring 15 by 10 by 8 cm. ; while most
of the cells of the neoplasm are fairly well differenti-
ated, there are numerous clusters of cells in which the
nuclei are increased in size, hyperchromic and, in
these areas, there are many multinucleated giant cells.’
Convalescence was uneventful and early in February
1950 she had gained 12 pounds in weight, showed a
return of feminine characteristics, a disappearance of
hair from face, extremities and abdomen, and a de-
crease in the size of clitoris. The vaginal smears which
were atrophic before operation became mature one
month following. Two normal menses have occurred
since operation at monthly intervals, each of 4 day
duration, the first such normal menstral flow to occur
in 20 years. Just prior to the onset of the last period
suction curettage revealed an ovulatory secretory en-
dometrium. She returned to her vocation of teaching
school on February 1, 1950.
December, 1950
187
Case 2. A housewife of 26 was first seen in July
1946. Amenorrhea had set in one year after the birth
of her last child in May 1940. Since then her weight
had increased considerably, hypertrichosis of arms,
legs and trunk had arisen. Headaches were constant.
Physical examination showed a large, overweight
female, markedly obese. Weight 222. Blood pressure
was slightly elevated 140/100. Facial hirsuties,- shaves
daily. The abdomen showed many striae. Pelvic
examination showed slight enlargement of clitoris, but
otherwise normal. The vaginal smear was atrophic
(castrate smear). The endometrium (suction curettage)
was atrophic. Glucose tolerance test indicated moderate
decreased glucose tolerance (mild diabetic curve). In-
sulin tolerance test showed definite insulin resist-
ance. Red blood cells 5.1 millions. Hemoglobin 16
grams. 17-ketosteroids showed average 31 mg. per
24 hour specimen (normal 7-14). Roentgenologic
studies indicated a mild osteoporosis of spine, a
normal sella, and perirenal insufflation showed an
enlarged left adrenal gland. Operation (Dr. J. H.
Sherman) was performed March 1947 and one-half of
the left adrenal, which was twice the normal size
was removed. Pathologic study of the removed tissue
was suggestive of adrenal hyperplasia. Postoperatively
pneumonia and subdiaphragmic abc ess developed and
death took place. Postmorten examination revealed an
early basophilic carcinoma of the pituitary gland.
Summary
We have presented the etiology and symp-
tomatology of the adrenogenital syndrome
in contrast to Cushing’s syndrome and illus-
trated these differences by cases of each.
REFERENCES
1. Haymaker, W., and Anderson, E. : The Syndromes
Arising from Hyperfunction of the Adrenal Cortex, Internat.
Clin. 4:245, 1938.
2. Wintersteiner, O. : The Adrenogenital Syndrome, Glan-
dular Physiology and Therapy, 1942.
3. Melicon, M. M., and Cahill, G. F. : Adrenal Cortex in
Somatosexual Disturbances in Children, J. Clin. Endocrinol.
10:12, 1950.
4. Novak, Emil: Gynecology and Female Endocrinology,
Boston, Little, Brown & Co., 1941.
5. Wilkins, L. : J. Clin. Endocrinol. 8:111. 1948.
THE COMMON TUMORS OF THE
GENITO-URINARY TRACT— CLINICAL
ASPECTS
Robert W. McAllister, M.D.
Macon
Cancer of the urinary tract is on the
increase. Approximately 200,000 persons
will die of cancer in 1950, and of these 22.7
per cent will die of malignant disease of the
genito-urinary tract. It follows then that the
urologist must treat approximately one of
every four cancer patients.
The increase in incidence of cancer of
Read before the Medical Association of Georgia in annual
session, Macon, April 20, 1950.
the genito-urinary tract is due to increased
individual life expectancy and to the in-
creased total population of the United
States. Life expectancy at birth increased
from 46 years in 1911 to 67^4 years in
1950, and the total population of this coun-
try has increased from 76 million in 1900
to an estimated 151 million in 1950.
The three most common sites of urinary
tract cancer are the prostate gland, the blad-
der and the kidney (Table 1). Cancers of
the testis, penis and ureter are rare only by
comparative incidence. Most urologists have
occasion to treat a moderate number of
these tumors during their careers.
Histologically the most common malig-
nant tumors occurring in the three common
sites are adenocarcinoma of the prostate
gland, papillary carcinoma of the bladder
and the clear cell carcinoma of the kidney,
or the so called hypernephroma. Cancer of
the prostate gland is the leading cause of
death in this group of tumors, followed in
order by cancer of the bladder and cancer
of the kidney (Table 2).
The average age at the time of initial
treatment of these tumors is as follows:
Ca rcinoma of the prostate gland, 70.4 years;
TABLE 1
INCIDENCE OF CANCER OF UROGENITAL
TRACT— BY SEX AND SITE— PER
100,000 POPULATION
Connecticut, Dorn1, New York Stater ( Averages )
Genito-urinary Organs
Male Rate
Per 100,000
Female Rate
Per 100,000
Prostate Gland
21.5
Bladder
11.1
4.4
Kidney
3.6
2.1
Testis
1.8
Penis
.72
Rate not
Scrotum
available
Rate not
Other Unspecified Sites
available
1. Rates of the white population of ten urban areas.
1937-1939, standardized for age on the 1940 total urban
population of the United States.
2. New York State, exclusive of New York City.
Source: H. F. Dorn, U. S. P. H. S. Reprint No. 2537;
E. J. Macdonald, Connecticut State Department of Health:
New York State Department of Health, 66th Annual Report.
The Journal of the Medical Association of Georgia
loo
TABLE 2
THE THREE MOST COMMON SITES OF
UROGENITAL CANCER
Incidence and Death Rate* Both Sexes
SITE
Male Rate
Per
100,000
Female
Rate Per
100,000
No. of
Deaths
1946
Death
Rate Per
100,000
Per Cent
of Alt,
Deaths
Prostate
Gland
21.5
10.616
7.5
5.8
Bladder
11.1
4.4
5,746
4.1
3.2
Kidney
3.6
2.1
2.900
2.1
1.6
♦Death rate in United States — 1946.
carcinoma of the bladder, 63.5 years and
carcinoma of the kidney, 52.6 years (Table
3). With our present life expectancy being
sixty-seven and one half years, these fig-
ures readily demonstrate why malginant
disease of the urinary tract is becoming
more common.
Diagnosis of the Common Tumors
of the Urinary Tract
Early diagnosis of the common malig-
nant tumors of the urinary tract is essential,
as it is with all other malignant neoplasms,
if chance for cure is favorable. Until newer
and improved methods of treatment for
these cancers are developed, early diag-
nosis is our only means of increasing their
cure rates.
All engaged in the practice of medicine
should have some familiarity with the clini-
cal features and treatment of cancers of the
prostate gland, urinary bladder and kidney.
Such knowledge is essential to the physi-
cian; otherwise, his suspicions may not be
aroused when the signs and symptoms of
these neoplasms are manifest. Of funda-
mental importance in the diagnosis of the
common urinary tract tumors are a thought-
fully taken history, careful inspection and
thorough palpation. When these prerequi-
sites are followed by a thorough and com-
plete urologic investigation, a definite diag-
nosis can usually be established.
The two most common symptoms of can-
cer of the urinary system are hematuria and
urinary tract infection. Pain and palpable
masses are not uncommon symptoms. Loss
of weight, weakness, anemia and' . unex-
plained fever are late symptoms of neo-
plastic disease of the urinary tract.
Grossly bloody urine always demands a
prompt and accurate explanation. The same
TABLE 3
AVERAGE AGE AT TIME OF TREATMENT
OF UROGENITAL CANCER— THREE
MOST COMMON SITES
Average
Age of Patient
Male
Female
Prostate Gland
70.4
Bladder
62.6
64.4
Kidney
54.5
50.8
is true for microscopic hematuria. Blood in
the urine should never be treated only
symptomatically. Gross bleeding from uri-
nary tract tumors is seldom constant: weeks,
months and occasionally years may elapse
between episodes. Therefore, no oppor-
tunity should be lost to locate the source
while the bleeding is still present.
Persistent urinary tract infection fre-
quently accompanies urinary tract tumors,
and likewise demands an explanation. An
unqualified diagnosis of cystitis should
never be made. The physician who does so
is not only careless, but he subjects his
patients to danger. Infection accompany-
ing cancer of the urinary tract may occur
early or late, depending upon the degree
of ulceration and obstruction of urinary
flow. Pain is usually a late symptom of
urinary tract tumors. It may occur during
the first few days of an infection, and also
with the passage of ureteral blood clots.
Rarely is pain produced by urinary tract
mass alone.
Laboratory Aids in the Diagnosis of the
Common Tumors of the Urinary Tract
Occasionally small fragments of tumor
tissue are passed from the bladder during
micturition. Histologic diagnosis can fre-
quently be made when this occurs.
December, 1950
189
Marked elevation of the serum acid phos-
photase (normal 0 to 4 Bodansky units) in
the male patient is usually diagnostic of car-
cinoma of the prostate gland with bone
metastases. Normal acid phosphatase levels
do not rule out the disease.
During recent years cytologic study of
stained urinary sediments and prostatic se-
cretions has attained considerable promi-
nence. Reports are becoming more numer-
ous in the literature concerning specific in-
stances of early cancer detection of urinary
tract tumors by this method. Carcinoma in
situ of a kidney1 has been detected and
proved in the nephrectomized organ. Also,
early prostatic carcinoma2 has been de-
tected by exfoliative cytology. We empha-
size detection rather than diagnosis, because
the percentage of error in exfoliative cy-
tology is too great at the present time for
this method to be considered a true diag-
nostic procedure. No kidney, bladder or
prostate gland should be removed or op-
erated upon as yet because of a positive
exfoliative cytologic report, without addi-
tional evidence of the presence of cancer.
Carcinoma of the Prostate Gland
Carcinoma of the prostate gland, because
of its silent onset and the infrequency of
early diagnosis, has at all times presented
a discouraging therapeutic problem.
Moore5 and Rich4, working independent-
ly, found from autopsy specimens that the
incidence of carcinoma of the prostate gland
is apparently 14 to 21 per cent in all men
past 50 years of age. Baron and Angrist",
conducting a meticulous study of serial sec-
tions, have identified “occult” carcinoma
of the prostate in 46 per cent of 50 con-
secutive autopsies on men past 50 years of
age who died of other causes. The frequent
occurrence of this disease in men past 50
years of age makes it imperative that we
continue to seek improved methods both in
early diagnosis and treatment.
Rectal palpation of a stony hard nodule
or larger mass beneath the prostatic capsule
is diagnostic of carcinoma of the prostate
gland in 75 per cent of cases. However,
prostatic calculi and inflammatory indura-
tion require differentiation. Twenty-five
per cent of these malignancies develop with-
in the lateral lobes nearer the urethra and
are not palpable rectally.
If a solitary stony hard nodule is palpated
rectally and is confined to the gland itself,
and metastatic lesions are not found in
x-ray films of the lumbar spine, bony pelvis
and chest and if serum acid phosphotase
levels are not elevated; perineal exploration
is indicated. If frozen sections are diagnos-
tic of cancer, radical perineal prostatectomy
is indicated. In fact, and in theory, this is
the only method of treatment of carcinoma
of the prostate gland aimed at cure.
Unfortunately, treatment aimed at cure
by radical perineal prostatectomy because
of extension of the cancer beyond the cap-
sule of the gland when diagnosed, is ap-
plicable to only three1’ or four' per cent of
all patients suffering from the disease. We
must educate the public to the value of
regular and careful rectal and palpation of
the gland in men over 40 years of age in
order that more than this small percentage
of patients with the disease will have a
chance for cure.
Under present methods, 97 per cent or
more of all patients with this disease are
treated by palliation. Since Huggins8 in
1941 introduced androgen control therapy,
the variations of this method have been the
palliative treatment of choice in carcinoma
of the prostate gland. There are four meth-
ods of treatment in androgen control ther-
apy.
1. Primary bilateral orchiectomy.
2. Bilateral orchiectomy plus the admin-
istration of estrogens.
3. Administration of estrogens alone.
The Journal of the Medical Association of Georgia
190
4. Administration of estrogens until ‘‘de-
layed failure” appears, then the operation
of bilateral orchiectomy.
It has not been proved that bilateral
orchiectomy is superior to estrogenic ther-
apy. In patients whose prostate glands are
inoperable from the point of view of cure of
cancer, and who we think will be coopera-
tive, we employ the use of estrogens until
the hormone is no longer effective, and then
resort to bilateral orchiectomy. It has been
our experience that secondary castration not
infrequently relieves patients of pain from
metastases and certain other symptoms fol-
lowing estrogenic therapy “delayed fail-
ure". Estrogens are rarely of value in “de-
layed failure" following primary castra-
tion. We do not generally employ estrogens
in inoperable carcinoma of the prostate
gland until the patient develops pain from
metastases, because its effects are usually
beneficial for a limited period, varying
from a few months to several years.
Transurethral resection of the prostate
gland is the method of choice in relieving
bladder neck obstruction in patients with
this disease who are being treated pallia-
tively.
It has not been proved that androgen con-
trol therapy effects a net prolongation of
life. However, there are some who are of
the opinion that a net gain of one vear of
life is added by this therapy. The one point
all seem to agree upon is that androgen con-
trol therapy is affording to many elderly
men periods of normal, or near normal, life
that they might not otherwise have.
Cancer of the Bladder
Morphologically, 80 to 90 per cent of
bladder tumors are papillary. The remain-
der are flat tumors, and usually with the pat-
tern of transitional epithelium retained, ex-
cept in the less common squamous cell tum-
ors. Although the existence of benign papil-
lomas cannot be denied, some prove to be
malignant, and for this reason most urol-
ogists treat them as malignant, or at least
potentially malignant tumors.
The over all mortality of bladder tumors
is about 50 per cent. Only about 10 per
cent of these tumors metastasize The ma-
jority of patients with cancer of the bladder
die of infections of the upper urinary tract.
Hematuria is the first and only symptom
in 75 per cent of cases of early carcinoma
of the bladder. Vesical irritation is the sec-
ond most common symptom. A great oppor-
tunity for early recognition is offered in
cancer of the bladder. Therefore, the phy-
sician should advise immediate urologic
investigation for patients with hematuria.
More than two-thirds of bladder tumors
are located on the posterior wall near or on
the trigone. Tumors on the anterior w^all
are uncommon.
The management of the bladder tumor
depends upon its site and its degree of in-
filtration. Investigation of the upper uri-
nary tract should be done by excretory uro-
graphy in all patients, if not contraindicat-
ed. Every effort should be made to deter-
mine the degree of infiltration of the blad-
der wall. This is best done by bimanual
palpation with the patient under deep anes-
thesia". It has been demonstrated that the
potential curability of the patient decreases
as the penetration of the bladder wall, by
cancer, increases1’.
Generally the small tumors, papillary or
sessile, can be electrocoagulated cystoscop-
ically with good results. Many of the larger
papillary tumors can be resected transure-
thrally with the Stern-McCarthy resecto-
scope, followed by thorough coagulation of
the tumor base. Suprapubic cystotomy with
controlled electrocoagulation is the treat-
ment used most frequently when tumors
cannot be destroyed transurethrally.
The implantation of radium alone, either
in needles or as radon seeds, has proved to
be inadequate as a method of cure in the
treatment of bladder cancer. Roentgen ther-
December, 1950
491
apy alone, aimed at cure, is ineffective ex-
cept in rare instances, and should not be
employed. We feel that external roentgen
therapy is of value following coagulation or
segmental resection of malignant tumors of
the bladder on the theory that microscopic
implants may be destroyed, thus possibly
preventing recurrent growths.
Segmental resection of the bladder wall
may be successfully used in removing tum-
ors involving the dome and upper wall of
the bladder.
Total cystectomy with uretero-intestinal
anastomosis is sometimes the only method
of cure in cancer of the bladder; particu-
larly in instances where malignant tumors
infiltrate the trigone or prostate gland; cases
in which numerous benign or malignant
tumors exist to such an extent that most of
the bladder wall would be destroyed if
electrocoagulation were employed as a
method of treatment. Radical surgery is
also indicated in instances where electro-
coagulation is likely to produce ureteral ob-
struction, particularly if bilateral. This
method of treatment should not be used
when less radical procedures will suffice,
because drainage of urine through the bowel
is not physiologic, and also because of the
constant threat of upper urinary tract in-
fection.
It must be stated that in all patients upon
whom total cystectomy is not done, routine
cytsoscopic inspection should be done at
least two to four times yearly to rule out
the presence of recurrent tumors.
Cancer of the Kidney
Cancer of the kidney occurs during in-
fancy and aging adult life. In infancy there
occurs the highly malignant renal embry-
oma or Wilms tumor, which is considered
to be the second most common cancer of in-
fancy and is fatal in more than 90 per cent
of cases. Not more than 55 five year surviv-
als have been reported. In middle aged or
elderly adults there occurs the various epi-
thelial tumors of the kidney, which may
arise from parenchymal cells, or from the
mucosal surface of the emptying portion of
the kidney.
The Wilms tumor usually is discovered
late by a parent or nurse who palpates or
notices an abdominal mass. Usually there
is no symptom other than the presenting
mass. Hematuria is rare.
The Wilms tumor initially is highly sensi-
tive to x-radiation, and frequently can be
reduced to one third its size noted at the
time of diagnosis, by this preoperative ther-
apy. After maximum reduction in size of
the tumor by x-ray therapy is attained,
nephrectomy should be done, if no demon-
strable metastases have been noted. If pos-
sible, ligation of the renal pedicle and other
renal vessels should be done before the kid-
ney is mobilized.
Most agree that preoperative roentgen
therapy followed by nephrectomy, and sub-
sequently extensive postoperative irradia-
tion, constitute the treatment of choice for
this type of growth.
The epithelial growths of the kidney in
the adult patients form a complex and con-
fusing group of tumors. However, exclud-
ing mixed tumors, a rather simple classifi-
cation of the malignant epithelial tumors of
the kidney in the adult is as follows:
Renal Parenchymal Tumors
1. Renal celled carcinoma
a. Clear cell carcinoma (hyperne-
phroma) 78 per cent.
b. Granular cell carcinoma.
Cancer of the Renal Pelvis (9 per cent)
1. Papillary carcinoma
2. Squamous cell carcinoma
3. Undifferentiated carcinoma
The diagnosis of renal neoplasms is made
in the majority of instances on the basis of a
history of hematuria or persistent infection
and suggestive pyelographic evidence. I
wish to emphasize the importance of repeat-
ing urographic studies when upper urinary
192
The Journal of the Medical Association of Georgia
tract tumors are suspected. Constant uro-
graphic filling defects in the renal calyces,
pelvis and ureter are of particular signifi-
cance when neoplastic disease is strongly
suspected. When possible, urographic
studies should he repeated until neoplastic
disease is diagnosed or definitely ruled out.
The diagnosis of early renal neoplasms
must on occasions be based on suggestive
rather than positive evidence. When there
is strong presumptive evidence of renal
tumor, exploration is indicated. Needless
renal exploration is rare when a conscien-
tious and intelligent effort has been made
to establish a diagnosis of tumor.
X-ray therapy, either preoperative or
postoperative, is of questionable value in
regard to renal parenchymal tumors. Irra-
diation is considered to he of no value in the
treatment of malignant tumors of, the renal
pelvis. The treatment of choice in patients
with renal celled carcinoma is primary
nephrectomy. The clear cell renal carci-
nomas have a much lower percentage of re-
currences than do the granular or mixed
tumors.
The treatment of cancers of the renal pel-
vis, whether papillary or sessile, differs
from the treatment of renal celled carci-
noma, in that complete nephro-ureterectomy
should be carried out, including the intra-
mural portion of the ureter, if the best re-
sults are to he attained. This is true because
of the tendency of this type of tumor to
recur in the ureter, if the ureter is not re-
moved completely.
Summary and Conclusions
1. Cancer of the urinary tract is on the
increase. Approximately 23 per cent of
total cancer deaths are due to malignant
disease of the urinary tract.
2. The common sites of urinary tract
tumors, as they occur in order of frequency,
are the prostate gland, the bladder and the
kidney.
3. Histologically the most common ma-
lignant tumors of the urinary tract are ade-
nocarcinoma of the prostate gland, transi-
tional cell papillary carcinoma of the blad-
der and renal celled carcinoma (clear cell
type — hypernephroma ) .
4. Early diagnosis is our only hope,
using present methods of treatment, of in-
creasing our percentage of cures.
5. In a general manner the various types
of treatments of the common urinary tract
tumors have been discussed.
BIBLIOGRAPHY
1. Foot, N. Chandler, and Papanicolaou. G. N.: Early
Renal Carcinoma in Situ; J.A.M.A. 139:356, 1949.
2. Albers, Donald O. ; McDonald, John R. and Thompson,
Gershon, J.: Carcinoma Cells in Prostatic Secretions,
J.A.M.A. 139:299, 1949.
3. Moore, R. A.: Morphology of Small Prostatic Car-
cinoma, J. Urol. 33:224, 1935.
4. Rich. A. R. : Frequency and Occurrence of Occult
Carcinoma of the Prostate, J. Urol. 33:215, 1935.
5. Baron, E., and Angrist, A.: Incidence of Occult Carci-
noma After Fifty Years of Age: In Cancer of Prostate,
Arch. Path. 32:787-793, 1941.
6. Young, H. H. : The Radical Cure of Cancer of the
Prostate, Surg., Gynec. & Obst. 64:472-484. 1937.
7. Barringer, B. S. : Prostatic Carcinoma, J. Urol. 35:616-
620, 1935.
8. Huggins, C., and Hodges, C. V.: Studies on Prostatic
Cancer I. The Effect of Castration, of Estrogen and of
Androgen on Serum Phosphatases in Metastatic Carcinoma
of the Prostate, Cancer Research 1:293-297. 1941.
9. Jewett. H. J. : Carcinoma of the Bladder: The Im-
portance of Recto-Abdominal Palpation Under Anesthesia
in the Selection of Cases for Total Cystectomy. J. Urol.
49:34, 1943.
10. Jewett, H. J.: Infiltrating Carcinoma of the Urinary
Bladder: Diagnosis and Clinical Evaluation of Curability,
South. M. J. 39:203-208, 1946.
70C Spring Street, Macon.
DISCUSSIONS
DR. C. F. HOLTON (Savannah I: Mr. President,
about the only thing I can discuss is Dr. Semans" paper
on trauma. He confined it mostly to injuries to the
urethra. About the best discussion 1 could give would
be to speak about the urologist.
On the general subject of trauma about the pelvis,
damage to the urethra should be suspected in all
cases, and ruled out. It is simple enough to insert
a small soft catheter into the bladder, and if the
catheter goes in without trouble you do not have a
rupture of the urethra.
There is nothing more distressing and more danger-
ous to a patient than an undiagnosed urethral rupture.
Certainly if it goes untreated for a day the patient
is going to become infected and will have a pro-
longed hospital stay.
Any trauma about the pelvis especially should 1 be
x-rayed freely, not only the pelvis but the dorsal and
lumbar spine. There is nothing more embarrassing
to the doctor than to have an x-ray of the pelvic bones
made and to tell the patient he has not been damaged,
and then, two or three weeks later, find that he has a
compression fracture in the thoracic spine. I have
seen many such cases.
I have a case of a woman who was thrown out of
the back seat of an automobile to the floor without
much trauma and apparently was uninjured, yet she
had a marked compression fracture in the thoracic
spine.
Just last week, to illustrate what can happen in
these traumatic cases, we had a colored man brought
December, 1950
493
to the Central of Georgia Hospital, in Savannah who
had been crushed by a truck. Examination at first
appeared to show only a rather trivial injury, but
when we put him into the operating room under
anesthesia, and by that time he was in considerable
shock and we had to transfuse him, we found that
his entire rear end had been turned out. That was
the first time 1 had ever seen the urethra from stem
to stern. It was competely dissected up, lmt fortunately
not ruptured.
One could run a finger up and down the urethra,
and the same with the rectum, but neither rectum
nor urethra was damaged. Every nerve and muscle
and bone, practically, in his pelvis could be demon-
strated as if it were on an anatomical table.
Any traumatic cases warrant an immediate investi-
gation by a doctor. Too many of us, called in the
middle of the night to treat trauma, tell the family to
put the person to bed and that we will see him the
following morning. If we have trauma about the pelvis
we should check the patient immediately, because if
he does have a ruptured urethra six hours is entirely
too late.
Thank you.
DR. H. D. ALLEN, JR. (Milledgeville) : Mr. Presi-
dent and fellow physicians, I think we are to be con-
gratulated that we have heard three such excellent
papers. I did not have the opportunity to read Dr.
Thigpen's paper, but I did have an opportunity to
review Dr. Brawner’s paper, and I am sorry he did
not have enough time to give his paper in more detail.
It certainly is a most exhaustive study in the investiga-
tion of the use of a new remedy which I think is
rather unique in its pharmacologic reactions.
Here we have a substance that you can take into
the system, unfortunately only by mouth. If we could
give it to the patient hypodermically and give him a
month’s supply at one time, 1 think it would be much
more effective. We have to depend upon the patient
taking it every day.
It brings about a reaction that was already known
before the medicine was discovered. At the time
Dr. Jacobsen and Dr. Jens IJald ran into this reaction
from their own personal experience, they were studying
the drug as a vermifuge. It is a rather crude drug
and is used extensively in industrial softening of
rubber.
It was noted that the people handling this substance
could not take much alcohol. They also found that
Dr. Elmer Stotz of McLain Hospital in Boston, had
done work showing that after the system gets so
much alcohol in it the complete metabolism of alcohol
breaks down, or the oxydation of alcohol to CO- goes
through an intermediate stage in which a very toxic
substance, acidaldehyde, develops in the blood.
These reactions that Dr. Brawner has observed so
carefully and has diagrammed all can be reproduced
by an infusion of acidaldehyde into the blood.
I think Dr. Brawner is to be congratulated particularly
on the way he selected his material. He has given
these patients the opportunity to take the medicine.
His experience has been much more extensive than
mine. I have had to limit my treatments to patients
whose families too often wanted them to take it. They
agreed to take it, and the relapses in the eleven
patients I have treated have been practically 100 per
cent. However, we are able to tell these people that
we can do something for them, and that is worth
a lot. •
I read a paper on this and my final conclusion was
that it was a good test of the patient’s sincerity.
I have had no experience with hypnosis since I wyas
a child, when I used to hypnotize chickens and rabbits,
but I did come into contact with hypnosis later. Putting
it through some special tests, we felt that a person
had to have a certain amount of dramatic ability to
be subject to hypnotism, and that was the reason it
was more successful on the stage than it was as a
therapeutic measure.
I wish to congratulate Dr. McElroy for bringing
to our attention the fact that we need to exercise care
before giving electroshock, although electroshock is
not particularly injurious to brain tumor and is used
quite frequently in general paresis with good effect
on the mental state of the patient after intensive peni-
cillin or malaria treatments.
DR. NEWDIGATE M. OWENSBY (Atlanta) : The
presentation and organization of a paper is often indica-
tive of its quality. Logical order, sustained relevancy
and summarization should always be kept in mind in
medical reporting. A good paper should read as well
backwards as forwards, and the gist of it should be
found in the last sentence. This has been accomplished
in the papers we have just had the privilege of hearing.
We, in psychiatry, are attacking a vast amount of
unknown, and are forced to wyade through the muddy
water of hypothesis much of the time. Therefore,
every bit of light that can be cast on this unknown,
every single fact that can be established out of
hypothesis, is an achievement which we should all
hail. The Drs. Brawner have sifted the current litera-
ture with rare discrimination and a fine sense of
responsibility in an effort to determine the worth of
Antabuse in alcoholism and their clinical and research
implications is an excellent piece of scientific work
which will receive universal recognition.
Dr. McElroy ’s paper reiterates the fact that psychiatry
can be of value only to the degree that it advances
in the great stream of medicine itself. However far
it may explore distant horizons, its valid contributions
inevitably seep back into that stream, leaving behind
all work of questionable merit.
DR. RICHARD B. WILSON (Atlanta): The fate
of the patient reported by Dr. McElroy was the result
of my own diagnostic failure. I am still perplexed,
after almost a year, and it is a problem that I haven't
the answer to.
You will recall this man was presenting suicidal
manifestations some months before the onset of head-
ache. That certainly is not a symptom of a posterior
fossa lesion. Recall, also, that he had no clinical
signs of increased intracranial pressure. His disc
margins were sharply defined, and he had a well
developed physiologic cup. He had occipital head-
aches, nystagmus, and an unsteady gait.
The latter two conditions are consistent with a
gross posterior fossa lesion, but it may be the result
of toxic effect on these structures, such as we com-
monly see in acute alcoholism, barbiturate intoxication,
and other sedations. This man admitted taking up
to twelve empirin tablets daily, together with other pre-
scription given him. Certainly there seemed to be
the history of sufficient sedation to account for the
nystagmus and unsteady gait.
To elaborate upon another patient we happened
to see on the same ward, a few months later: a girl
with intractable suboccipital headaches, a much more
pronounced nystagmus than had the first patient. She
was so- ataxic that she could not stand, and she had
very profound limb ataxia not manifested by the first
patient. In this case, after sedation was removed, her
nystagmus had cleared entirely within a week, as
did her ataxia; and a diagnosis of hysteria was verified.
Howt these cases are to be differentiated, I don’t
know. I think we will have to conclude that any
patient presenting symptoms or signs that conceivably
might have an organic structural basis, who at the
same time are over-sedated, must be taken off sedation
before we can feel it is not structural.
The Journal uc the Medical Association of Georcia
494
CHARLES L. PRINCE (Savannah) : Drs. Chaney
and Greenblatt have presented a very concise and to
the point discussion of two of our most perplexing
problems: Cushing's syndrome, and the adrenogenital
syndrome. He who solves the riddle of these two
conditions will do a great service to medicine and to
mankind.
In recent months, great strides have been made in
the management of both of these baffling conditions,
giving us hope that their ultimate complete solution
is not too far away. The striking response of some
cases of Cushing’s syndrome to testosterone therapy
is most gratifying. It was Albright’s theory of the
antagonistic action of the “S” hormone (Compound
E, corticosterone) of the adrenal cortex to the “N”
hormone, whose action is closely akin to that of testo-
sterone in many respects, which led to the trial of
the male sex hormone in the treatment of this con-
dition. Recently, surgery has been used in cases of
Cushing’s syndrome due to cortical hyperplasia, and
shows possible promise. Staged resection of both
adrenals, with removal of approximately 90 per cent
of all adrenal tissue has been performed in a number
of cases with encouraging results. This latter work,
however, is still much in the experimental stage, and
postoperative management is time-consuming, difficult,
and expensive, and the mortality is still high. In
Cushing’s syndrome due to tumor, the ultimate outlook
is quite favorable, if the tumor is removed, unless an
extensive malignant neoplasm is present. Fortunately,
most tumors of the adrenal cortex are benign or of low
grade malignancy and generally well encapsulated.
Proper postoperative supportive therapy is most im-
portant after removal of a functioning adrenal cortical
tumor, for under these circumstances the remaining
portion of the adrenal glands is atrophic and time is
required before it evidences adequate function to
sustain life.
For patients presenting clinical syndromes known
to be associated with hyperfunction of the adrenal cor-
tex, the problem of differentiating between tumor and
hyperplasia has been simplified, though not entirely
solved, by methods of urinary assay. Higli excretory
rates of the 17-ketosteroids usually indicate adrenal
hyperplasia or cortical tumors, or interstitial cell tumors
of the testicle. The latter is distinguished by the
increased size of the affected testicle. The excretion
of 17-ketosteriods in normal adults is 2.7 to 8.1 mg.
in women and 3.4 to 15.0 in men every 24 hours.
With this as a basis, estimation of the output of the
17-ketosteroids will distinguish adrenal cortical tumors
from pituitary, ovarian or other conditions, but will
not differentiate adrenal cortical hyperplasia from
carcinoma, as both show an increased production of
androgen. The 17-ketosteroids, however, can be separ-
ated into alpha and beta fractions. It appears that
the alpha fraction arises from both adrenals and
testes, hut the beta ketosteroid comes only from the
adrenal cortex. Adrenal cortical carcinoma may there-
fore be differentiated from hyperplasia by fractionation
of the total 17-ketosteroids.
Cases of adrenogenital syndrome due to adrenal
cortical tumors respond promptly and gratifyingly to
surgical removal of the growth, and with gradual
disappearance of all masculinizing signs. Unfortunately,
however, the majority of cases of hyperadrenocorticism
are not due to neoplasm, hut to a hyperplasia of the
androgenic zone of the adrenal cortex, which change
is invariably bilateral. In my experience, surgery in
this group of cases has proved to be of no benefit.
I have removed one whole adrenal and half of the
other without affecting the masculinization which has
taken place, and even then, virilization progresses. No
amount of estrogen will repress the androgenic effects
that are being produced, even though only 25 per cent
of the original adrenal tissue remains. In the past,
therefore, surgery directed at the adrenals has been
practically useless. Most of these patients are female
pseudohermaphrodites, and there has always been a
great diversity of opinion as to how they should be
handled, and whether they should be raised as males
or females. In the cases that I have seen at an early
age, I have advised almost invariably that they be
reared as males, in spite of the fact that their internal
sex organs are female. This we have done because
we know that the excessive secretion of androgen will
continue throughout life, since up to now we have
lacked any substance which will successfully counteract
the adrenal androgen. These female children develop
a beard, masculine voice and torso, never menstruate,
and never attain any breast development whatever.
Plastic procedures to excise the vagina, lengthen
and straighten the enlarged clitoris, and to construct
a urethra the length of the phallus have resulted quite
satisfactorily, and emotionally these patients have
seemed happier under such circumstances as males.
Recent work by Dr. Lawson Wilkins of the Johns
Hopkins Hospital, however, may solve this whole dif-
ficult problem of hyperadrenocorticism. He has found
that the administration of cortisone in these cases
results in rapid and marked regression of the masculin-
izing features, and apparently in complete subjugation
of the adrenal androgen. In four cases, he reports ex-
cellent results, and his work may prove to be the
basis of the solution of this heretofore hopeless problem.
If so, numbers of children with congenital adrenal
cortical hyperplasia, and many women with the same
condition suffering from virilism will be relieved of
their distressing physical and mental states, and a
tremendous service will have been rendered.
Dr. McAllister has given us an excellent brief
review of the neoplasms of the genito-urinary tract; of
their incidence, signs and symptoms, and treatment.
He has pointed out, and I should like to stress again
the importance of a complete urologic investigation in
the presence of hematuria, and in cases of persistent
or recurrent urinary tract infection.
The incidence of cancer of the genito-urinary tract
as reported by Dr. McAllister is amazing. I am sure
that few urologists and fewer general practitioners
have realized that almost 25 per cent of the deaths from
cancer are attributable to the genito-urinary tract.
I should like to add briefly to Dr. McAllister’s re-
marks concerning prostatic carcinoma for two reasons:
first, because it is the most common malignant neoplasm
of the genito-urinary tract, and is responsible for more
deaths than all others combined, and, second, because
I do not feel that the picture concerning the cure of
prostatic carcinoma by radical surgery is as dark as
he has painted it.
Radical perineal prostatectomy is the only method by
which carcinoma of the prostate can be cured, and,
in suitable cases, one may expect at least a 50 per
cent five year survival rate. Dr. McAllister states that
radical surgery is applicable in only 3.4 to 4.5 per cent
of patients suffering from the disease. I cannot agree
with this. In 189 consecutive cases reported elsewhere,
I found radical perineal prostatectomy to be feasible
in 9 per cent. In 713 cases of prostatic carcinoma
seen at the Brady Urological Institute at the Johns
Hopkins Hospital between 1938 and 1948, the opera-
tion was found to be applicable in 11.2 per cent. The
chances for complete cure, therefore, are not too dim,
if the lesion is discovered sufficiently early. It is mainly
through careful routine, yearly rectal examinations
by the medical man and general practitioner upon all
men past 45 that more cases of prostatic cancer may
be discovered sufficiently early for radical surgery to
be feasible and curative.
Since Huggins first reported success in the partial
control of prostatic carcinoma by orchiectomy and
estrogenic hormone therapy, many urologists have felt
that neither orchiectomy, estrogens, or the two in
combination counteract completely all androgen secreted
December, 1950
495
by the patient. Many have postulated that the androgen
which is not counteracted comes from the adrenal
cortex, and that it is this androgen which is
responsible for the fact that both estrogens and
orchiectomy lose their beneficial effect after varying
periods of time. As a matter of fact, adrenalectomy,
and even bilateral adrenalectomy, have been attempted
in such hopeless cases, and have resulted in a marked
decrease in the 17-ketosteroid output of these patients.
In view of Dr. Wilkins’ recent work mentioned above,
it will be extremely interesting to see the effect of
castration and estrogens used in combination with
cortisone in carcinoma of the prostate. Counteraction
of the adrenal androgen by cortisone in prostatic
carcinoma may yet prove to be another milestone in
the treatment of this condition.
REFERENCES
1. Prince, C. L., and Vest, S. A.: South. M. J. 36:680,
1943.
2. Jewett. H. J. : J. Urol. 61:277, 1949.
VOCATIONAL REHABILITATION OF
CARDIAC PATIENTS
Joseph C. Massee, M.D.
Atlanta
There are eight million persons in the
United States suffering from some form of
heart disease. It is important to consider
some problems that concern this large seg-
ment of the population. Should they be kept
at work or restored to work? Obviously if
five per cent of our population is unable to
work a tremendous loss of productivity re-
sults. Likewise an enormous economic bur-
den develops in the care of such a large
number of disabled persons. Taken as indi-
viduals it would seem desirable that every
cardiac patient who can work should do so
in older to increase his income and produc-
tivity, to improve his happiness and self
respect, and to lift the burden of his main-
tenance from his family or community.
First the question arises: Can persons
work if they have heart disease? The answer
is definitely yes, in a large per cent of cases.
A report of the third division cardiac clinic
of Bellevue Hospital in 1944 included an
occupational analysis of about 2000 patients
who were attending cardiac clinics in New
York City. The analysis showed that 84 per
cent of 1019 males were working and a con-
•Voeational Rehabilitation Committee, Georgia Heart Asso-
ciation.
siderable portion of the females were doing
housework requiring physical effort at least
equivalent to that required in most factory
jobs. An earlier study had indicated that
65 per cent of 2000 unselected cases were
performing some useful or productive work.
In each individual case the question of
ability to work must be decided after a diag-
nosis is made following a thorough exami-
nation by a competent physician. The use
of the American Heart Association’s func-
tional classification is then suggested.
Group 1. Cardiacs requiring no limita-
tion of physical activity.
Group 2. Cardiacs requiring moderate
limitation of physical activity.
Group 3. Cardiacs requiring marked lim-
itation of physical activity.
Group 4. Cardiacs requiring complete
limitation of physical activity, i.e., bed rest.
Having received a functional classifica-
tion it then becomes desirable to be classi-
fied as to job requirements. Large industries
often have work classification or job analy-
sis experts who perform this function ad-
mirably. Where they can cooperate with
industrial or plant physicians excellent re-
sults are achieved. This is demonstrated by
the fact that in certain skilled trades absen-
teeism and loss of time from sickness is less
among cardiacs than in unhandicapped
workers. Also production quotas are higher
and rejection of imperfect work is less. Of
course this stresses the importance of as-
signing cardiacs to certain skilled jobs, since
they can hardly be expected to perform tbe
heavier laboring work.
It is just here that the State Department of
Vocational Rehabilitation is doing such fine
work. Any cardiac who can show need will
be given a competent medical examination
and functional classification. He will also
receive a work classification and training in
the type of skilled work which he chooses.
The expense incurred in this work is repaid
496
The Journal of the Medical Association of Georcia
many times over by the increased income
of the patients and the relief of the eco-
nomic burden of caring for disabled per-
sons. Many more cardiacs can be given this
service than now receive it without taxing
the facilities of the department.
The Committee of Vocational Rehabilita-
tion of the Georgia Heart Association is try-
ing to spread this good work by a study of
the employment problems which arise with
cardiacs in industry. Physicians throughout
the State are being urged to attend courses
and clinics offered by the heart association
on problems and classification of cardiacs.
In addition, a campaign is being conducted
to educate the self-employed or home work-
er with cardiac limitation, such as house-
wives, in more efficient and less taxing meth-
ods of work.
Some of the larger industrial employers
have instituted screening tests for new and
old employees in an attempt to identify
employees with cardiac defects. It is em-
phasized that this screening is to guide
proper job placement and not for elimina-
tion of cardiacs. Proper tests should include
a medical history of possible predisposing
diseases or symptoms of cardiac disability,
a physical examination, a fluoroscopic or
x-ray examination of the chest, a urinalysis,,
a blood Kahn test and an electrocardiogram.
With such an examination combined with
expert job analysis and job placement, it is
believed that industry will benefit by the
employment of many persons now consid-
ered as employment risks, and that many
now dependent will become self supporting.
Let us consider some of the problems
which arise in the employment of cardiacs.
The question of danger to the patient or to
others is always raised. Cannot an attack
of Adams-Stokes syndrome, severe angina
pectoris, acute cardiac decompensation or
cerebral vascular accident create a danger-
ous situation ? The answer is obviously that
the danger from such an attack is greatest
when heart disease is unsuspected. If car-
diacs are properly screened and placed in
jobs suitable for them these dangers are
largely overcome.
In spite of the obviously greater safety
for himself or others, a cardiac may oppose
job placement for several reasons. Trans-
fer to a more suitable job may mean a re-
duction in income or loss of seniority. In
many cases such a change of jobs may come
into conflict with union rules, which forbid a
transfer of job which entails a loss of sen-
iority or a reduction in income. Sometimes
a transfer to a less strenuous job will cause
jealousy among other workers who do not
realize the cause of the transfer and think
only that favoritism is being shown. In fact,
it is the very invisible or intangible nature
of the disability which causes the misunder-
standing. If the patient had lost a leg or an
eye the other workers could see the cause of
seeming preference in job placement. The
worker, on the other hand, would accept de-
creased income resulting from an obvious
visible defect as a matter of course and even
witli gratitude that he was still able to do
some work. After suffering a heart attack,
however, a man faced with the necessity of
supporting a family or meeting other de-
mands on his income may actually try to
minimize or hide his need for reduced phys-
ical effort and thus endanger himself and
others. This is particularly true of heavy
manual workers who have no skilled trade
to fall back on. This points to the prime
importance of a proper cooperation between
the patient, his physician and the plant phy-
sician, nurse, or foreman, in cases of ill-
ness occurring among factory workers. A
case in point is that of a man who has a
cardiac infarction and was out of work for
three months. Should he return to work with
a statement from his physician simply that
he had been ill and absence from work was
December, 1950
497
necessary, or should his sickness report he
misleading or inadequate, great harm may
he done. He may return to strenuous work
too soon, thus causing harm to himself or
inefficiency at his work. Even if his true con-
dition is discovered it may take some time to
find a job suitable to his condition or to give
him training for a new job. All this means
loss of time, loss of income, frustration and
unhappiness for the worker. How much
better it would be for the family doctor, who
can prognose the patient’s capabilities and
needs, to contact the employer before the
patient returns to work. Then a frank dis-
cussion with the plant physician, nurse, or
foreman would enable suitable work to be
planned in advance of the return to work.
The worker and employer would be better
served. This is one of many examples which
might be given. It is meant to call attention
to this most important aspect of the im-
proved care of cardiacs in industrv which
will be attained when the physician, worker,
and employer understand the reason for, and
the manner of cooperation.
Certain insurance aspects of the employ-
ment of cardiacs should be considered. At
present the incidence or development of
heart disease is not considered compensable
in industrial compensation insurance. How-
ever, any aggravation of existing disease
may be compensable. The increase in insur-
ance load entailed by such cases makes some
employers hesitate to employ persons with
known cardiac disability. Unfortunately, in
some cases where industrial compensation
has been denied, civil suits brought by pa-
tients, his family, or survivors have resulted
in great expense to employers. Jurors un-
trained in medical and legal facts, and
swayed by a natural sympathy for the un-
fortunate, have handed down decisions more
charitable than just. It is hoped that popu- .
lar knowledge may be increased so that
right may be done more often. It has also
been suggested that the inclusion of cardiac
disability in the second injury clause of in-
surance contracts may increase the protec-
tion of employers and more fairly provide
for financial help in this form of disability.
Although not strictly in industry there is
a large number of self-employed persons,
particularly housewives, who suffer from
heart disease and who must perform work
comparable in physical effort to that done
by many factory workers. It is the purpose
of the Georgia Heart Association to help in
this category of patients through a study of
their work efficiency needs, and a program
of education designed to meet these needs.
The Vocational Rehabilitation Committee
of the New York Heart Association with job
analysis and work efficiency experts has
prepared a booklet, “The Heart of the
Home”, which is available to all through
application to the American Heart Associa-
tion or its Georgia chapter. Any housewufe
will be helped by a study of this excellent
pamphlet, but any cardiac will find a real
means of relieving her load by planning and
increased efficiency of performance of her
household duties. A film with lecture ac-
companying it has been prepared by the
American Gas Association based on this
booklet. The film has already been shown
on several occasions in Georgia and will be
available through the Heart Association for
use of local clubs, study groups, schools,
etc., interested in health education. The
Atlanta Gas Light Company, as a public
service, is preparing a model kitchen based
on this work to be used in connection with
the film in teaching housewives.
In conclusion, attention is called to the
importance of the vocational rehabilitation
of cardiacs and the number of persons in-
volved. The procedures of diagnosis, func-
tional classification, job analysis and job
placement are stressed. A plea is made for
the cooperation of all concerned — the pa-
tient, the family physician, and the plant
physician, or the employer in industry. Cer-
198
The Journal of the Medical Association of Georcia
tain difficulties related to job transfer, the
intangible nature of the disability, and the
insurance implications have been discussed.
In addition, job analysis and efficiency plan-
ning are offered to the self-employed or
home workers.
REFERENCES
1. Bielowski, John G.: Employment Problems Faced by
the Cardiac Patient, J. Michigan M. Soc. 48:1468-71 (Dec.)
1949. „
2. Goldwater, Leonard J. : Heart Disease and Employment,
Rhode Island M. J. 30:179-186 (March) 1947.
3. Kossman, Chas. E. : Goldwater, Leonard J., and De La
Chapelle, Clarence E. : Selective Placement of Patients with
Heart Disease in Competitive Employment, Occup. Med. 3:531-
535 (June) 1947.
4. Crain, Rufus Baker, and Missal, Morris E.: The
Industrial Employee with Myocardial Infarction, Arch. Indust.
Hyg. & Occup. Med. 1:525-538 (May) 1950.
THE M.D. GOES PR
Lawrence W. Rember
Chicago
It is good to be back in the beautiful and
warm state of Georgia. In 1935, I came here
as a Yankee Congregationalist. In 1936. I left
as a Georgia Baptist. You succeeded further
in raising my development level from a Northern
church usher to a Southern church deacon.
Consequently, I feel right religious being here
in Georgia tonight, and also I feel very much
at home.
I feel particularly at home to be on the
same speaking program as your distinguished
Governor and the distinguished Dean of your
renowned State University’s journalism school.
“Herman,” as we used to call him on the
campus, was a senior at the University when I
taught journalism and advertising for Dean
Drewry. He was driving a yellow Packard
roadster, as I recall, and be lived at the Sigma
Nu house. I had the good fortune also of
being invited to one of his father’s famous
barbecues in the neighborhood of Athens.
As for the Dean, I have always felt that he
gave me a postgraduate education of the highest
quality and value during my year of teaching
and I shall always be indebted to him for it.
There is another reason why I feel at home
tonight. Dean Drewry saw to it that I had
the privilege of attending your famous Press
Institutes. In addition, I did special news and
feature assignments for both the Athens Banner-
Herald and the Athens Times. On one of these
I was asked to interview Dr. Hugh H. Young,
of Baltimore, at the Georgian Hotel. He had
come from Johns Hopkins and was on his way
to Danielsville to dedicate a monument to Craw-
ford W. Long. The question which I put to
Delivered to the First Annual Statewide Medical Press
and Radio Conference under the auspices of the Medical
Association of Georgia, by Lawrence W. Rember, Chicago,
Assistant to the General Manager. American Medical Asso-
ciation, October 2, 1950.
Dr. Young was: “What are the 10 greatest
boons to suffering humanity, and where does
Dr. Long’s discovery of anesthesia rank in the
list?’" Fortunately for me, he placed Dr. Long’s
discovery first, and even ahead of such medical
landmarks as Louis Pasteur’s germ theory of
disease, Joseph Lister’s introduction of antiseptic
surgery, and F. G. Banting’s discovery of insulin.
Radio, too, extended its hand of welcome
during my stay in Athens. For sometime, I
broadcasted nightly a news program over what
is now Station WGAU. So you can understand
why I am delighted that this audience is com-
posed of so many men of the press and of the
radio.
I consider the doctors of Georgia particularly
my friends. Dr. James Edgar Paullin, as past
president of the American Medical Association,
has held the highest honor that medicine has
to give. Doctors Allen H. Bunce and Eustace
A. Allen, who will succeed him next January,
of Atlanta, Charles H. Richardson, of Macon,
and Benjamin H. Minchew, of Waycross, are
most able representatives of your great state
in the House of Delegates of the American
Medical Association. This democratic body of
198 members establishes the policies by which
the A.M.A. operates in the fields of scientific
medicine and in the social, political, and eco-
nomic areas of medical care. Dr. Edgar Shanks,
who is most highly regarded as secretarv of
your state medical society, has been of tremend-
ous help to me in acquainting me with the medi-
cal history and medical activities of Georgia.
Dr. Stephen T. Brown, public relations chair-
man, Mr. Dick Eales, executive secretary in
charge of public relations, and their committee
are carrying this state swiftly forward in medical
public relations, and I have had the good for-
tune of their friendship.
So all told, I feel that I am here to take part
in one great, grand homecoming.
The title of my talk tonight is: “The M.D.
Goes PR.” It is a good tiling for the doctor;
it is a good thing for his special publics; and
it is a good thing for the general public that
the doctor is nowr out to cure social, economic
and political health ills, as wrell as the ills of
the individual human body.
Historically, the doctor has looked upon his
publics as numbering only two; his owm patients;
and his fellow practitioners. He took proper
care of these twro publics by advancing his
knowledge and technics of scientific medical
practice and by observing faithfully the Hippo-
cratic Oath and Principles of Ethics of his
profession.
NewT and broadly different public relations
problems were posed, however, when medical
practice changed from the home and the “black
bag” to the office, laboratory and hospital and
when, spurred on by World War I, the tempo
of America’s industrialization speeded up greatly.
December, 1950
499
Five problems emerged which required public
relations solutions well beyond the purely scien-
tific and ethical areas of medicine:
First, all of the people, regardless of location or
economic status, began to want the best of modern
medical care.
Second, this modern type of medical care costs con-
siderably more to deliver and purchase.
Third, the specialist does not function in the same
personal role as a family doctor.
Fourth, modern facilities for delivering health care
center around medical schools, and metropolitan areas
draw doctors away from rural areas.
Fifth, the labor unions and government socializes
moved into high gear in their political attacks against
the voluntary system of medical care.
To cope with these problems, the American
Medical Association has enlarged its program
activities to include considerably more than its
purely professional and scientific functions of
improving medical education, approving hos-
pitals for intern and residency training, passing
upon the health value of drugs, foods, physical
devices and appliances, distributing medical
films, publishing medical journals, conducting
clinical sessions, and educating the public in
scientific health.
The A.M.A. has established, largely since
1940, a Council on Medical Service, a Commit-
tee on Rural Health, a Council on Industrial
Health, a Council of National Emergency Medi-
cal Service, a Bureau of Medical Economic
Research, a Washington Information Office,
(headed by a doctor), a Department of Public
Relations, and a National Education Campaign,
to meet its growing public relations challenges.
The 48 constituent state medical associations,
the District of Columbia, and the 2,011 com-
ponent county medical societies have likewise
made great strides toward solving the social and
economic and political aspects of medical care
problems. This substantial undertaking is sup-
ported wholeheartedly by the 148,000 doctors
who pay national, state, and local dues and
who in considerable numbers contribute much
of their time and effort in committee and overall
organization activities.
A few facts will paint the picture for you
of how widely and thoroughly the state medical
societies have organized for conducting a public
relations offensive on medical care problems.
Public relations committees have been estab-
lished by every state society in the nation during
the past five years. These committees operate
on a top policy level. They are chairmaned
mostly by men who are either past presidents
of the state society or presidents on the way up.
Their members are doctors having sound ex-
perience in medical affairs, holding key responsi-
bilities in the state society, and with an aptitude
toward public understanding and action.
Each councilor district of the state has a
public relations chairman, and each county
society has either set up an active public rela-
tions committee or has been urged to do so.
Five years ago, it would have been difficult
to find one stale medical society with a specific
public relations budget and specialized per-
sonnel to administer and execute a PR program.
Today, 35 states, including your state of Georgia,
have specific public relations budgets, and 11
more state medical societies appropriate funds
as needed. Budgets range from $1,000 in North
Dakota to over $100,000 in California and
Michigan. Twenty-five states employ a full-
time PR Director, usually trained in journalism
or radio or some other key facet of public
relations.
In the Southeast, Alabama has a 5-point pro-
gram, South Carolina a 10-point program, and
Florida an 8-point program that serve as guide-
posts on the road which the medical profession
of these states have chosen to follow in their
genuine effort to advance the health of the
people. Tour own state of Georgia is deter-
mined to make its public relations program a
positive one, soft-pedalling propaganda and em-
phasizing performance. This is most commend-
able.
Georgia and state associations throughout
the nation believe that they have something
better to offer the American people than social-
ized medicine. Some honest soul-searching has
convinced the doctors that the public is demand-
ing definite improvements in medical service
and the correction of certain existing faults in
the practice of medicine. The profession is also
convinced that not all the good things that
medicine is doing on behalf of the people are
known to them. So the profession has the
triangular task of being good, doing good, and
letting the public know how good it is.
The American Medical Association assists,
the state societies in this task by sponsoring
an annual National Medical Public Relations
Conference and by issuing bimonthly a medical
public relations news letter and exchange service
called the “PR DOCTOR”.
M.D. Charimen of statewide public relations
committees and the executive secretaries and
the PR Directors of state societies attend the
conferences. The conferences deal with themes
such as “Shooting at Common Medical Public
Relations Targets,” “A Program of Public Rela-
tions for State Societies,” and “Effective Public
Relations for County Medical Societies.” Next
year we plan to devote the entire conference
to "Making the Best Use of Communication
Media.”
The PR Doctor reports on the progress being
made in medical public relations by the state
and county medical societies. The Exchange
distributes case histories and actual working
materials of the most constructive and resultful
projects which have been conducted in the states
and in the counties to meet health needs.
The January, 1950, issue of our PR Doctor
recommended to the state associations and
The Journal of the Medical Association of Georgia
500
count) societies that they maintain and step
up these public relations goals:
1. Establish a state grievance committee to hear
and settle patient complaints.
2. Make sure that every community in the state
has an adequate night and emergency call system.
3. Encourage doctors throughout the state to exercise
constructive leadership in solving community health
problems and in bettering local health facilities. This
calls for increased cooperation with the local health
council, public health unit, city government officials,
school authorities, civic organizations, and so forth.
4. Strive to get doctors into rural areas and more
family doctors graduated.
5. Promote in every way possible voluntary health
insurance plans, and make sure that those who need
medical care do not hesitate to seek it for financial
reasons.
6. Consciously develop better relations with the press
and radio. This calls for some type of press-radio con-
ference on either a state or local basis, development
of a joint code of cooperation, designation of official
spokesmen for each county society, and every-day-of-
the-year cooperation with reporters, editors and broads
casters in getting authentic stories and scripts and
desired ethical pictures.
7. Encourage and help your Woman’s Auxiliary in
devloping a strong organization and a constructive,
community-service public relations program.
In the minutes that remain, I believe that it
would lie of interest to you to review briefly
some of the solid accomplishments which are
being made by the medical profession in im-
proving medical care in these various public
relations phases.
Three years ago a state medical society in
the Rocky Mountain area announced that it
was establishing an official agency of the society
to which a dissatisfied patient could complain.
The society since its founding, like other
societies, had maintained a disciplinary body
whereby one doctor could complain against
another, but the idea of a patient complaining
against a doctor through the machinery of the
society was a new concept.
Within two years, five other state societies
had set up similar committees to hear and act
upon patient grievances. The A.M.A.’s Board
of Trustees and House of Delegates last Decem-
ber recommended to state societies everywhere
that they consider establishing such committees.
A survey made recently showed that 34 states
had done so, including the state of Georgia. In
your own state, I understand that public com-
plaints are handled by the governing council
of the state medical association.
The pattern, under the committee setup, is
generally this: Any patient who is dissatisfied
with the service his doctor renders, or who
feels that he has been overcharged, or who is
dissatisfied for any other reason may take his
complaint to the medical society. The Commit-
tee on Professional Conduct, as most of these
patient-complaint committees are called, will con-
sider his charges, discuss them with the physi-
cian concerned, and recommend a solution.
Experience has shown that most complaints
arise out of misunderstandings that are quickly
and amicably settled. In cases involving fees,
many difficulties occur solely because the physi-
cian and the patient neglect to discuss charges.
Patients do not often realize that many tests
and treatments are included under the simple
heading, “For Professional Services Rendered.”
After a committee-arranged conference between
doctor and patient, these troubles usually evap-
orate.
In those cases where a committee finds that
a doctor has erred, very little difficulty is ex-
perienced in settling complaints. Committee
after committee has reported to the A.M.A. that
they have never had a doctor refuse to accept
their recommendations. If more stringent dis-
cipline should be required, however, the medical
society has the power to expel the physician
involved from membership, or, if the charges
warrant, can even go so far as to request revoca-
tion of his license by the state licensing board.
Many county societies, especially in the metro-
politan areas, are establishing local committees
to hear and resolve grievances as a further
contribution to this public relations goal.
Goal number two which I mentioned is also
being fast achieved. As you editors and broad-
casters know, it is not the doctor who con-
scientiously gets up in the middle of the night
or in the wee hours of the morning to answer
a sick call that is featured in your headlines
or on your newscast. On the contrary, it is the
much rarer instance of the person who called 12
doctors and couldn’t get a one to come that rates
the 36-point gothic or 48-point bodoni display
type or the top-notch commentator mention.
The profession nevertheless is determined
that everyone shall be able to obtain a doctor
24 hours around the clock, regardless of whether
it is nights, week-ends, or the doctor’s day off.
In 1948, only 57 county medical societies
reported that they had a telephone answering
service and emergency medical call program.
In a recent survey, out of the first 555 ques-
tionnaires returned, 237 county societies report-
ed that they have emergency medical call pro-
grams and 140 county societies reported that
they have a 24-hour telephone answering service.
Eight county societies in Georgia reported such
systems.
The doctors are becoming so conscious of the
public relations necessity of responding to night
and emergency calls, that recently in Shelby
County, Indiana, seven doctors rushed to the
scene of a bad automobile accident in answer
to a call for doctors. Time reports in its August
28 issue that Dr. Leander Bryan of Rutledge,
Tennessee, fumed and fussed for years over
poor telephone service. He even went so far
as to buy out the local telephone company so
that he could keep in touch with, and serve,
his widely scattered patients.
A number of you no doubt read the Clive
Howard article, “The Best Doctor For You,”
December, 1950
501
in the August issue of the Woman’s Home Com-
panion. The writer makes as his main point
the fact that a sick or injured person would
have no difficulty in securing a doctor at night
or in an emergency if he had previously estab-
lished patient relationship with a family doctor.
The Toledo Academy of Medicine is cur-
rently conducting an advertising campaign to
persuade Toledo citizens who do not have a
family physician to select one. The Academy
provides information and makes recommenda-
tions to anyone requesting assistance in selecting
a qualified family doctor.
Goal number three of exercising constructive
leadership in solving community health prob-
lems and in bettering local health facilities is
well on the road toward accomplishment. The
best instrument we know at present for improv-
ing community health is the Health Council.
Community health councils are made up of
key representatives of all of the professional and
lay groups that are interested in, or are func-
tioning in, the field of health. The solving of
any community health problem is within the
field of planning and of action of such a council.
Yesterday in Detroit, 1 attended a national
conference on M.D. Participation in Health
Councils, which was sponsored jointly by the
American Medical Association and the Michigan
State Medical Society. We were informed that
1,190 local health councils and committees have
been organized among the 2,843 counties cov-
ered in the survey. Georgia reported 36 com-
munity councils.
State health councils have been formed in
31 states with the fullest support and participa-
tion of the medical profession. This amazingly
rapid growth stems primarily from 1945. As
Victor Hugo said: “There is nothing so power-
ful as- an idea whose time has come.” And
apparently, the time for health council organi-
zation and activity has now come.
The philosophy behind the health council is
that it enables all citizens to assume their proper
responsibilities in bettering community health.
Such improvement is not a matter for doctors
alone, but for the whole community.
The medical profession is getting together
also with educators and public health officers
to improve school health. Every two years the
American Medical Association sponsors a na-
tional conference on Physicians and Schools
to which states send representatives from the
three groups mentioned. These delegates go
back home to apply what they have learned
from an exchange of ideas and action case
histories.
The doctors are striving to be good citizens
in other ways, too. They are giving utmost
support to civilian defense plans. Two-thirds of
the 48 states now have active civil defense
organizations, and remaining states are in the
process of such implementation. The medical
profession is doing its best to bring about a
proper balance between the requirements of the
armed forces and the needs of local commu-
nities for adequate medical and health services
in event of atomic or other devastating attack.
The fourth goal I mentioned was that of
getting doctors into rural areas and more family
doctors graduated. Much progress is being
made toward these two highly desirable ends.
The American Medical Association has a
most able Committee on Rural Health operat-
ing, and which is made up of nine physicians
from different areas of the country, who work
with an advisory group of laymen. State com-
mittees on rural health are functioning in 45
states. Their common aim is to help rural re-
gions get adequate medical care.
Both the A.M.A. and the state societies operate
placement services for bringing together com-
munities needing doctors and doctors needing
communities. The A.M.A. alone will handle 500
such requests this year.
1 he rural health committees are also encour-
aging communities to do more to attract doctors.
People in some small towns get together and
provide an office for a new doctor. In some
places they arrange free rent for him in the
early stages. In some others, they make loans
to young doctors so they can open and equip
suitable quarters. A few towns collected money,
built clinics, and soon had doctors. The Hill-
Burton hospital construction act, which the
medical profession supported strongly, is pro-
viding over 1,000 hospitals, mostly in rural
areas, so that students trained to practice
modern medicine can have access to needed
facilities.
Legislatures or state medical societies in 15
states have put up cash for scholarships or loans
to help rural youths through medical schools.
About 300 students are now using such aid.
The sending of seniors out to spend some time
with country doctors and the establishment of
top-notch postgraduate programs designed to
keep rural doctors up-to-date are also advancing
medical care in rural areas.
Better distribution of doctors is combining
with a bigger supply of doctors to solve two
vital medical care problems. The medical schools
have now a bumper freshman crop. Last year
70 class A medical schools had a total enroll-
ment of 25,103 students. Thirty years ago,
70 class A medical schools had a total enroll-
ment of only 12,559 students. More doctors
will be graduated in the future than ever before.
While our general population is increasing
at the rate of 12 per cent, our doctor popula-
tion is increasing at the rate of 14 per cent.
State legislatures are recognizing the need for
appropriating more funds to manufacture more
doctors, and private schools are intensifying
their efforts in securing gifts and endowments
for enlarging medical schools.
The Journal of the Medical Association of Georgia
502
Furthermore, a great increase lias occurred
during the past ten years in the number of
auxiliary personnel, as well as improvements
in therapeutic drugs and in doctor and patient
mobility. This has enhanced considerably the
amount of medical service which any 1,000
physicians can render. It is reliably estimated
that the increase in productivity per physician
during the 1940’s might have been as large as
one third.
You can rest assured that the medical profes-
sion of America is determined to see to it that
there are enough doctors to meet our nation s
health needs.
Goal number five was to promote in every
way possible voluntary health insurance plans,
and to provide medical care by some means
to everyone regardless of financial status. 1 he
enrollment of the American people in hospital
and surgical prepayment plans has been abso-
lutely phenomenal during the past few years.
As of December 31, 66,000,000 Americans were
budgeting their hospital bills in advance, 41,-
000,000 were doing likewise with their surgical
bills, and 17,000,000 were financially protected
against medical bills.
The primary purpose for which the Council
on Medical Service of the A.M.A. was set up and
for which state society medical service com-
mittees were formed was to promote enrollment
of the people in either Blue Shield or private
insurance company plans. Three years ago,
for example, the Blue Shield Commission bad
only 16 member plans with 51 per cent partici-
pation by doctors. Today there are 71 member
plans with 90 per cent participation of doctors
in active practice. The major effort of the
National Education Campaign of the A.M.A.
directed by Whitaker and Baxter is aimed toward
the rapid and complete enrollment of the Ameri-
can people in voluntary prepayment plans.
Goal number six in the public relations pro-
gram of the medical profession is well illustrated
by your being here tonight. During the current
year, six state societies have held press-radio
confreences, and many more will be held in
the future, I am sure.
This meeting tonight is most laudable and
will do much to increase mutual understanding
and cooperation. Doctors traditionally have
been schooled to avoid publicity, but they are
becoming increasingly aware that nature abhors
a vacuum, even though it is only an information
vacuum, and that their story must be told.
The genuine desire of the medical profession
to improve relations with you leaders of the
fourth estate is reflected in the action of the
House of Delegates of the American Medical
Association in Atlantic City last year. Changes
were voted in the Principles of Ethics which
now make it ethical for a physician “to meet
the request of a component county medical
society or a constituent state medical association
to write, act or speak for the general readers
or audiences.”
An addition to the Code says further that
“the adaptability of medical material for presen-
tation to the public may be perceived first by
publishers, motion picture producers or radio
officials.”
The code declares that “refusal to release
the material may be considered a refusal to
perform a public service, yet compliance may
bring the charge of self-seeking or solicitation.
It is recommended that the doctor be guided
by his state or county medical society. The
Principles, which are a moral guide to every
physician and surgeon, w'ere liberalized to serve
the public which does not have ready access to
medical journals, finds scientific terms hard
to understand, and yet today is more interested
in health and medical care information than
ever before.
California, Colorado, Massachusetts and other
state societies are working out codes of coopera-
tion between doctors, hospitals, newspaper and
radio stations. The medical society agrees to
act as an information center and clearing house,
to appoint publicity chairmen in each county
to serve as a spokesman, and to cooperate in
other ways. Hospitals agree also to name
spokesmen, and like the society, to furnish
such lists to press and radio.
Newspapers and radio stations agree to recog-
nize the doctor-patient relationship and to re-
spect the privacy and legal rights of patients,
to strive for utmost accuracy in reporting medi-
cal news, and to exercise due editorial judgment
in avoiding news which seeks solely to exploit
the patient, doctor, or hospital.
The power §nd proper function of press and
radio advertising in the public relations pro-
gram of the medical profession is recognized
in its nationwide advertising campaign which
is being conducted this month. Its purpose is
to help sell voluntary health insurance and to
strengthen the basic American ideal of individual
freedom, individual initiative, and freedom of
opportunity.
Twenty-nine daily newspapers, 203 weekly
newspapers, and 52 radio stations in Georgia
will carry this advertising beginning October 8.
The seventh public relations goal of the medi-
cal profession, as I stated, is that of utilizing
the great strength of the Woman’s Auxiliary
of the medical societies in conducting construc-
tive, community-service health programs. You
people in Georgia should take particular pride
in the Woman’s Auxiliary, since two of your
own loved Atlanta women rose through leader-
ship and service to the national presidency of
the Woman’s Auxiliary to the American Medical
Association. They are Mrs. Eustace A. Allen
and Mrs. Allen H. Bunce. Their great influences
and marvelous contributions will carry on for
(Continued on Page 511)
December, 1950
503
PUBLIC RELATIONS DEPARTMENT
THE GEORGIA PLAN
By this time every doctor in the Association
has received his copy of THE GEORGIA PLAN
— our voluntary prepaid surgical insurance plan.
The Public Relations Department urges every
doctor to sign the Participating Agreement with-
out delay, because this is a very important ele-
ment of our public relations program and will,
naturally, fail without wholehearted coopera-
tion and support.
Needless to say, there will be many objections
to the plan. An undertaking of this kind cannot
possibly meet with everyone’s complete approval.
Dr. W. S. Dorough and the members of his
committee recognize this fact. However, since
the committee was first formed every element
has been discussed and examined, and the plan
as it now stands is believed to be the one best
suited for a majority of the members and the
companies that will handle it. However, one
change has been made. Dr. Dorough and
his committee have decided to include the
words, “Does not cover prenatal and postnatal
home and office care” under the heading “Obstet-
rics.” This change was deemed necessary to
eliminate misunderstanding on the part of
policyholders.
The Georgia Plan was published in the April
issue of this Journal, at which time comments
were requested and received. These were con-
sidered and changes were made, where possible.
Even with this effort to make the plan agreeable
to all, the committee is aware that other changes
may be required as future needs necessitate.
This is but our first step — and a timely one —
toward solving some of the financial problems
of medical care.
Dr. Dorough has requested that anyone wish-
ing to comment on the plan write a letter to
him or to me and the observations will be dis-
cussed by the committee and action taken that
is deemed necessary.
Public Relations Conference
A statewide public relations conference has
been called for December 17. It will be held
at the Dempsey Hotel in Macon, and it will
have two objectives.
First, the information received at the Third
Annual Medical Public Relations Conference,
to be held in Cleveland, Ohio, on December 3
and 4, will be passed on to those attending.
Secondly, the organization of our public rela-
tions program will be discussed, and it is hoped
that ibe delegates will not withhold any sugges-
tion or recommendations they may have.
The Cleveland Conference, under the sponsor-
ship of A.M.A., is to be devoted to county
society public relations programs and the ac-
complishments of county societies in this field.
Our meeting on Sunday, December 17, should
he especially interesting to county P.R. chair-
men and other officers engaged in this work;
however, everyone is welcome. We hope the at-
tendance will be good.
The conference will convene at 11:00 a.m.
and will be interrupted for lunch at 12:00. It
will re-convene at 1 :00 p.m. and conclude at
2:00 in the afternoon.
As much time as possible will be devoted
to open discussion concerning the public rela-
tions program and any problems that members
may have. All phases of the program will be
planned with brevity and effectiveness in mind.
National Education Campaign
There have been no reports issued, as yet,
concerning the effectiveness of the recent Na-
tional Education Campaign advertising program,
but it did serve to show that a majority of the
newspapers in Georgia were sympathetic to
the doctors’ stand. A tentative analysis of the
coverage given the campaign shows that over
half of the State’s newspapers carried editorials
directed against socialized medicine.
From the clippings received in this office,
and in discussing the subject around the State,
it was noted that many county societies went
all-out in support of the program. One society
wrote and produced a number of radio shows in
which doctors participated and another spon-
sored the broadcast of a local football game.
Many societies purchased advertisements in com-
munity papers and bought radio time for an-
nouncements.
In order to compile a comprehensive report
of the support given to the campaign here in
Georgia, any clippings, notices or reports of
activities in this connection will be appreciated.
RICHARD J. EALES,
Executive Secretary in Charge of
Public Relations Department.
501
The Journal of the Medical Association of Georcia
THE JOURNAL
OF THE
MEDICAL ASSOCIATION OF GEORGIA
Edgar D. Shanks, M.D., Editor
478 Peachtree Street, N. E., Atlanta, Ga.
December. 1950
ROSTER OF THE ASSOCIATION
Elsewhere in this JOURNAL will be
found the 1950 roster of the Medical
Association of Georgia. All members should
examine the list and note if their names
have been spelled correctly and if the
addresses are correct. Errors should be
reported to the Secretary-Treasurer, Dr.
Edgar Shanks, 478 Peachtree St., N. E.,
Atlanta.
Further examination of this number of
THE JOURNAL will reveal a list of the
names that make up the Woman’s Auxiliary
to the Association.
REPORTS X-RAY SUPERIOR THERAPY
IN BREAST CANCER COMPLICATIONS
X-ray excels hormones in the treatment of
patients with inoperable, advanced breast cancer
which lias spread to bony structures, according
to a report to the American Medical Associa-
tion.
The report, submitted to the association's
Committee on Research of the Council of Pharm-
acy and Chemistry, is made public in the Novem-
ber 18 journal of the A.M.A. It was prepared
by a group of San Francisco physicians asso-
ciated with the San Francisco Hospital, Stanford
University Service — Drs. Leo H. Garland, Milton
L. Baker, William H. Picard, Jr., and Merrell
A. Sisson.
This group is one of about 50 throughout
the United States and Canada carrying on a
collaborative study of steroids and their effect
on breast cancer under the sponsorship of the
Committee on Research.
A high percentage of cases of advanced mam-
mary cancer develop complications in the form
of bone metastases, a spread of the cancer to
bony structures. This constitutes perhaps the
leading source of distress and disability from
the disease. In a majority of cases, there is
pain and in many there are fractures. The
question which the cooperative study is trying
to answer is whether these bone metastases
should be treated primarily with x-rays, with
steroid hormones or with a combination of both.
The San Francisco group reported on a study
of 79 patients treated with irradiation and of
20 patients to whom hormones were admin-
istered after it was proved that the breast cancer
had spread and that the problem was largely
one of relief of pain in the final stages of life.
1 hey also reviewed similar reports by other
groups.
The report said that about 70 per cent of
such patients are relieved of pain by roentgen
therapy, the relief lasting for from 50 to 100
per cent of- their survival time in some three
fourths of the cases.
In steroid hormone therapy from 40 to 75
per cent of such patients are relieved, the relief
being more pronounced in those receiving andro-
gens than those receiving estrogens.
‘ This relief lasts for a variable number of
months, the average being less in our experience
than that obtained with irradiation,” said the
report.
The average survival of the patients receiving
irradiation was 12 months in the San Francisco
study, measured from the time the spread to
bony structures was established. With hormones,
the average survival was 8.8 months — 8.1 months
for patients receiving androgens and 9.7 months
for a smaller group receiving estrogens.
The report also pointed out that the steroid
hormones produced more side effects and that
some cases were considerably aggravated by
therapy. Many of these effects, it added, could
be controlled only by discontinuance of the
hormone.
“In general, unpleasant side effects appear
in about 5 per cent of patients treated with
roentgen rays and in about 25 per cent of those
treated with steroids,” said the report.
Chief among these side effects were edema,
hair growth, voice changes, an abnormally great
rise of blood calcium, increased sex desires and
other complications.
“Whether simultaneous irradiation and steroid
hormone therapy increases or decreases, com-
fortable life has not yet been demonstrated,”
the report continued. “It is our impression
that the two weapons ought to be used serially
in patients with bone metastases and only when
indicated, rather than simultaneously or in
combination.”
Commenting on the report, Dr. Walton Van
Winkle of Chicago, secretary of the Committee
on Research, said:
“The final conclusions must await evaluation
of the studies now in progress. Nevertheless, it
is believed that the data presented will be of
interest and of value in further defining the role
of steroid hormones in the palliation of ad-
vanced mammary carcinoma.
December, 1950
505
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MEMORANDUM TO CONSTITUENT STATE MEDICAL ASSOCIATION SECRETARIES
The collection of American Medical Association flues of $25.00 for the year 1950 must be
significantly increased if the American Medical Association is not to he confronted early in 1951
by a large withdrawal of members. Members who have not paid A.M.A. dues by December 31,
1950, will be considered delinquent and a letter will be sent from this office directly to each
delinquent member during the first week of January 1951.
GEORGE F. LULL, Secretary.
506
The Journal of the Medical Association of Georgia
INDUSTRIAL HEALTH CONGRESS
TO BE HELD IN ATLANTA
Safeguarding of the health of workers will
occupy the spotlight at the eleventh annual
Congress on Industrial Health to he held in
the Biltmore Hotel, Atlanta. Ga., February 26-27,
1051.
The event will be sponsored by the Council
on Industrial Health of the American Medical
Association. Chicago; the Medical Association
of Georgia, the Fulton County Medical Society
of Atlanta and the DeKalb County Medical
Society of Decatur, Ga.
"This will be the first national meeting of its
kind in the South,” said Dr. Anthony J. Lanza
of New York, chairman of the Council on
Industrial Health. "It is a recognition of the
importance of the South as an industrial area.”
The two-day session will stress teamwork as
the key to successful industrial health services.
It also will bring out the interrelation of industry
and agriculture. The importance of industrial
health in civil defense in times of national dis-
aster will be highlighted in panel discussions.
Other panels and round tables will consider
the problems which face workers in various
lines of industry and will review the efforts being
made to find the answers. A panel ' arranged
in cooperation with the Committee on Pesticides
of the A.M.A. will discuss the health problems
created by' new chemicals designed to control
pests.
One morning will be devoted to a panel on
the heart case in industry, to be arranged by
the Georgia Heart Association.
“The meeting will have as speakers and panel
discussants leaders in industrial health, profes-
sional and nonprofessional, from all parts of
the country,” said Dr. Carl M. Peterson of
Chicago, secretary of the Council on Industrial
Health. It will attract medical, industrial, labor,
agricultural and welfare leaders.
The council was established in 1938 to assist
the medical profession in developing and main-
taining a high standard of health in industry.
' MEDICAL STUDENTS PLAN
NATIONAL ORGANIZATION
Delegates representing student bodies in medi-
cal schools of the United States will meet in
Chicago, December 28-29, to draft a constitu-
tion for the Student American Medical Associa-
tion.
“The organization is to be a national associa-
tion of medical students and is to be affiliated
with the American Medical Association,” it was
announced by Dr. George F. Lull, Chicago,
secretary and general manager of the A.M.A.
The meeting will be held in the A.M.A. head-
quarters, 535 North Dearborn Street. To be
eligible to send a delegate, a student body must
be organized along democratic lines and have
duly elected officers, Dr. Lull said. All students
must be eligible to membership.
Dr. Walton Van Winkle, Jr., Chicago, secre-
tary of the A.M.A. Committee on Research, is
serving as temporary executive secretary of the
student association during its pre-organization
period.
Plans for the formation of such a student
group were approved by the A.M.A. House of
Delegates, the association's policy-making body,
at the annual meeting in San Francisco last
June.
INFANTS FARE WELL ON
PLANE FLIGHTS
Mothers worrying about whether or not to
take infants on plane trips can find comfort
in the fact that scientific studies indicate that
the average healthy baby reacts better to flight
conditions than do adults.
Writing on “Information for Mothers” in
the November issue of Today's Health, published
by the American Medical Association, a medical
consultant reports that “ air sickness in infants
is extremely uncommon.”
In the case of the temporary disorder known
as aero-otitis media, infants seem to fare much
better than adults. The consultant explains
it this way:
“In the infant the tube connecting the middle
ear chamber and the throat is still short and
straight. This tends to make its spontaneous
opening and closing easier. In the adult the
tube can be opened by chewing and swallowing
movements, yawning or singing.”
To forestall possible trouble with the infant,
the parent (or attendant) is advised to waken
the child and give him food or a bottle when
the plane begins to descend.
“If the infant has a head cold,” mothers
were cautioned, “advice of the family physician
should be sought. It may be desirable to apply
special treatments to reduce swelling in the
throat tissues.”
During a flight in which altitude changes are
occurring and a pressurized cabin is not pro-
vided, mothers are advised to keep the child
from swallowing as little air as possible when
he eats — frequent “burping” is helpful. The
reason for this is that some gas expansion may
occur in the stomach as high levels are reached.
1951 DUES
The 1951 dues to the Medical Associa-
tion of Georgia will he $15.00 and the 1951
dues to the American Medical Association
will he $25.00.
The State Journal and the American
Medical Association Journal will he includ-
ed in the 1951 dues.
The Medical Association of Georgia M-ill hold its
next annual session at the Bon Air Hotel, Augusta,
April 17-20, 1951.
December, 1950
507
GEORGIA DEPARTMENT OF PUBLIC HEALTH
COXSACKIE VIRUS
Pathogen or Non-Pathogen
Dalldorf, one of the discoverers of the Cox-
sackie viruses, is quoted in discussion of a recent
paper by Huebner and associates1 as follows:
“We are in the anomalous position of having
discovered the cause of a disease before discover-
ing the disease. In New York we have been
intrigued by the association of the Coxsackie
viruses with poliomyelitis. This is a puzzling
problem not yet solved. For example, was the
1947 epidemic of “poliomyelitis” in Wilmington,
Del., actually poliomyelitis, Coxsackie virus in-
fection or both?”
Since the isolation of the first virus of the
Coxsackie group by Dalldorf, Sickles and
associates2 during a small outbreak of polio-
myelitis in Coxsackie, N. Y., it has been shown
that this and the similar viruses now included
in the group are probably widely prevalent para-
sites of man. As implied above, “the possible
causal relationship between infection with these
viruses and the various clinical illnesses pre-
viously associated with them is less well estab-
lished”1.
Recently, Howitt3 has described the isolation
of Coxsackie virus from human sources in Geor-
gia and other southern states. Isolations have
been reported by Howitt and others4 from feces,
throat washings, blood, and tissues taken at
necropsy.
The occurrence, possibly wide spread, of Cox-
sackie infection in Georgia, together with the
interest implicit in this group of viruses for
practicing physicians who have frequently to
deal with, “short, unexplained fevers which
physicians have been inclined in the past to
lump under the undiagnosable respiratory in-
fectious,” makes it worthwhile to report briefly
the present information on Coxsackie virus in
Georgia. Current experience, while fragmentary,
seems to be fairly typical of the experience re-
ported in the rapidly developing literature on
this subject. Huebner and associates1 have re-
viewed this literature in a recent issue of the
Journal of the American Medical Association.
In September 1949 there occurred in Emanuel
County, Georgia, a brief outbreak of acute ill-
ness characterized by severe headache, high
temperature, nausea and intractable vomiting.
Nine patients in whom the disease first occurred
were young males who gave a history of swim-
ming, fishing, or working near the Ohoopee
River. Three of them were hospitalized, one
of them with a provisional diagnosis of polio-
myelitis in Indiana, to which place he had gone
while in the incubation period of the illness,
and two others because of severe dehydration.
The other nine patients in this series were pros-
trated and acutely ill but did not require intra-
venous fluids and were not hospitalized.
A number of other illnesses which occurred
about the same time in the affected area were
included in the series on which follow up in-
vestigations were undertaken. While these in-
vestigations are still continuing, it can be said
that only the first series of cases reveals a con-
sistent pattern and that there has been no
repetition of the outbreak after one year. At
least one suspected case, which was included
in the series before diagnosis could be made,
developed clinical diphtheria which was con-
firmed by cultural findings and a virulence test.
One patient, ill for more than a week without
developing a rash, was found to have murine
typhus when repeated Weil-Felix and comple-
ment-fixation tests were made.
For convenience in referring to the group
under study, the term “Ohoopee Fever” has
been used. It is not intended thereby to imply
that a new disease entity has been established
but only to avoid the use of other descriptive
terms which might be misleading.
Fecal specimens obtained from all but one
of the original series of patients were frozen
immediately and transported to the virus labora-
tory on dry ice. Blood specimens for neutraliza-
tion and complement fixation tests were obtained
from most of the patients, and sent directly to
the laboratory without refrigeration. Since this
work is still in progress and some of the data
of more immediate interest have been included
in publications by U. S. Public Health, Com-
municable Disease Center, Virus Laboratory
personnel, no attempt will be made to describe
in detail the results obtained. The following
tabulation summarizes these findings:
Coxsackie Virus Positive
Clinical Findings
“Ohoopee Fever'’ Group 12
Diphtheria 1
Typhus Fever 1
Encephalitis — type
unknown — 2 / 10/50
Meningitis (H. influenzae
type B) — 3/31/50 1
Unknown 4
Totals 19
3 « ~ o
r g
> hH cu to
5
1
1
2
9 1
From these findings it is clear that Coxsackie
virus is not associated with the “Ohoopee
fever” syndrome alone but apparently occurs
independently in the population. Huebner and
associates in Maryland examined 296 of 308
persons residing in 80 households of the 84 in
Parkwood, a small suburban community, in
which eight persons in five nearly adjacent
households had developed an acute febrile illness
with which a Coxsackie virus was associated.
It was found that 55 per cent (11 persons) were
positive in the households in which clinical
508
The Journal of the Medical Association of Georgia
illness had occurred and that 1.8 per cent (5
persons) were positive in households not known
to be infected. It is not improbable that a
similar study of the considerably more populous
Georgia community affected would have yielded
comparable results.
It is interesting to note that the Parkwood,
Mart land episode and the Emanuel Countv,
Georgia outbreak occurred within two weeks
of each other. In Maryland only two out of
eight patients vomited, although five reported
nausea, whereas vomiting in the Georgia series
was a pronounced symptom. Abdominal and
thoracic pain, stiff neck, sore throat, general
muscle pain and headache occurred in both
series. In Georgia, the headache appears to
have been far more severe than in the Maryland
episode and only one patient had a stiff neck as
compared with 50 per cent of the patients who
manifested this symptom in Maryland.
It has been suggested that “Ohoopee fever”
bears a marked resemblance to the milder forms
of leptospirosis in which jaundice does not occur.
This suggestion is attractive in view of the
apparent relationship of the Emanuel County
episode to water and the Ohoopee River swamp.
Despite the reservations which must be made
with regard to Coxsackie virus as the' etiologic
agent of Ohoopee fever, it should be pointed
out that Huebner and associates1 demonstrated
Coxsackie virus. Group A. tvpe 2 repeatedly
from stools and once from sputum, though not
from urine, throat washings, acute phase blood,
and a biopsy specimen of gastroenemius muscle
in an acutely ill patient. This patient later
manifested a decided rise in serum-neutralizing
antobodies of tvpe 2 virus.
In an earlier episode3, a physician working
with the virus developed a febrile illness of
eight days duration. This was diagnosed as a
'fever of unknown origin". Coxsackie virus was
recovered from his feces and nasopharyngeal
washings during his acute illness, and neutraliz-
ing antibodies first appeared during conval-
escence, reaching a maximum titer on the
forty-third day. Infection of other laboratory
workers has been reported and in each case a
laboratory stain was isolated from throat
washings and stools. Specific antibodies de-
veloped in these patients, with rising titers dur-
ing convalescence.
Another one of the discussants of HuebnerV
paper ( Lennette) has pointed out that healthy
carriers of poliomyelitis virus are known to
exist and that the survey studies of the 193(Ts
showed that 60 to 80 per cent of the normal
population possessed antibodies to poliomyelitis
virus. Despite these facts, “one could hardlv
say that the classic poliomyelitis virus is not
pathogenic". In further discussion, Dalldorf
pointed out that precise etiologic diagnosis is
essential to a solution of the role of Coxsackie
virus in human infection and that this will not
be difficult if stools and throat washings are
taken during the acute phases of the illness.
1 his will make it possible in many cases not
only to recover the virus but also to classify it,
which is highly desirable, since the Coxsackie
group is large and may include viruses that
cause different clinical manifestations.
Specimens of feces and throat washings should
be frozen immediately after taking. Since these
specimens must be shipped on dry ice, it is
usually essential to make specific arrangement
through Health Department channels for trans-
portation and examination of specimens. Un-
fortunately, the facilitiss for virologic studies
are limited and work cannot go beyond examina-
tion of specimens from outbreaks in which the
occurence of a group of similar cases might make
possible the establishment of an association be-
tween a clinical entity and a specific etiologic
agent. Prompt reporting of the presence of multi-
ple cases of unexplained fever is therefore highly
desirable. The problem of Coxsackie infection
can only be solved through the assistance of
clinicians, who alone have the opportunity to
observe the development of conditions which
would make epidemiologic studies productive.
JOHN E. McCROAN, JR.. Ph.D..
Division of Epidemiology.
REFERENCES
1. Huebner, R. J. ; Armstrong. C. ; Beeman. E. A., and
Cole. R. M. : Studies of Coxsackie Viruses. Preliminary
Report on Occurrence of Coxsackie Virus in a Southern Mary-
land Community. J.A.M.A. 144:609 (Oct. 21) 1950.
2. Dalldorf. G.. and Sickles. G. M. : An Unidentified Filt-
erable Agent Isolated from Feces of Children with Paralysis,
Science 108:61-62. 1948. Dalldorf. G. : Sickles. G. M. ;
Plager. H.. and Gifford, R. : A Virus Recovered from
Feces of “Poliomyelitis" Patients Pathogenic for Suckling
Mice, J. Exper. Med. 89:567-582. 1949.
3. Howitt, B. F. : Recovery of the Coxsackie Group of
Viruses from Human Sources. Proc. Exper. Biol. & Med.
73:443-448, 1950.
4. Sulkin. S. E. : Manire. G. P., and Farmer. T. W. :
Cross-neutralization Tests with Coxsackie Viruses. Proc.
Soc. Exp. Biol. & Med. 73:340-341. 1950.
5. Editorial. J.A.M.A. 143:972-793 (July 15) 1950.
Acknowledgements: This preliminary report is based upon
the work of a number of persons, particularly: Dr. Alex-
ander D. Langmuir and Dr. Beatrice Howitt. USPHS.,
Communicable Disease Center. Atlanta: Dr. Randall G.
Brown. Dr. D. D. Smith. Dr. Henry W. Smith, Dr. Cuthbert
E. Powell and Mrs. Emma K. Marshburn. R. N., Swainsboro;
Dr. Leon I. Lanier and Miss Lillian Webster, R.N., Soperton,
and Dr. Grady E. Black. University Hospital. Augusta.
TAKE THE JOURNAL HOME
When you take the bacon home, take The Journal
too if the price of the bacon doesn’t make you forget it.
The little wife never gets to see The Journal as
most of the husbands keep it at their office.
Your State Journal is a credit to any State Association
and would keep any doctor abreast of medicine, medical
legislation and news of his fellow members. But the
wife has more time to read than her busy husband,
so we suggest you take The Journal home and depend
on her to keep you informed. Then she will have an
opportunity to read what the Auxiliary- members are
doing.
Since the Auxiliary- does not have a bulletin all its
own. we will have to depend on our husbands to
bring us The Journal.
MRS. BEN H. CLIFTON, Chairman
Editorials, Homan's Auxiliary".
December, 1950
500
OFFICERS AND COMMITTEES OF THE MEDICAL ASSOCIATION OF GEORGIA
1950-1951
MEDICAL ASSOCIATION OF GEORGIA
Officers and Committees 1950-1951
Officers
President A. M. Phillips, Macon
President-Elect W. F. Reavis, Waycross
First Vice-President Leon D. Porch, Macon
Second Vice-President — T. A. Peterson, Savannah
Parliamentarian .. Jno. W. Simmons, Brunswick
Secretary-Treasurer. Edgar D. Shanks, Atlanta
Delegates to A.M.A.
B. H. Minchew Waycross
Alternate, W. R. Dancy Savannah
Allen H. Bunce
Alternate, Walter W. Daniel
C. H. Richardson
Alternate, C. L. Ayers
Council
W. G. Elliott, Chairman
Marion C. Pruitt, Clerk
Atlanta
Atlanta
Macon
.... .Toccoa
Councilors
Cuthbert
Atlanta
1. Lee Howard
2. C. K. Wall—
3. W. G. Elliott _
4. J. W. Chambers
5. Marion C. Pruitt —
4. H. D. Allen, Jr
7. D. Lloyd Wood
8. Sage Harper
9. W. Bruce Schaefer
10. H. L. Cheves
Savannah
Thomasville
Cuthbert
— . LaGrange
Atlanta
... Milledgeville
__ Dalton
Douglas
Toccoa
.Union Point
V ice-Councilors
1. Chas. T. Brown . Guyton
2. C. H. Watt Thomasville
3. Guy J. Dillard Columbus
4. Clarence B. Palmer
5. David Henry Poer
6. H. G. Weaver
7. M. M. Hagood
8. Alton M. Johnson .
9. D. H. Garrison
Covington
Atlanta
Macon
Marietta
Valdosta
Clarkesville
10. J. Victor Roule Augusta
Executive Committee
A. M. Phillips, President
W. G. Elliott, Chairman, Council
Edgar D. Shanks, Secretary-Treasurer —
Honorary Advisory Board
W. S. Goldsmith President,
Eugene E. Murphey . President,
J. W. Palmer t President,
J. W. Daniel President,
Frank K. Boland President,
C. K. Sharp President,
Wm. R. Dancy . President,
M. M. Head President,
C. H. Richardson President,
Clarence L. Ayers President,
James E. Paullin President,
B. H. Minchew President,
Grady N. Coker President,
J. C. Patterson President,
Allen H. Bunce President,
James A. Redfearn President,
W. A. Selman President,
Cleveland Thompson President,
Ralph H. Chaney President,
Steve P. Kenyon President,
Edgar H. Greene President,
Enoch Callaway President,
Scientific Work
W. C. McGeary, Chairman
Richard Torpin
Thomas J. Ross, Jr
Edgar D. Shanks
Macon
Cuthbert
Atlanta
1915-1916
1917- 1918
1918- 1919
1923-1924
1925-1926
1928- 1929
1929- 1930
1932- 1933
1933- 1934
1934- 1935
1935- 1936
1936- 1937
1938-1939
1940- 1941
1941- 1942
1942- 1943
1943- 1944
1944- 1946
1946- 1947
1947- 1948
1948- 1949
1949- 1950
Madison
...Augusta
Macon
Atlanta
Public Policy and Legislation
C. C. Wen, Chairman \tlanta
Jack C. Norris _ Atlanta
James A. Johnson, Jr Manchester
T. F. Sellers . \tlanta
\. M. Phillips Macon
Edgar D. Shanks \tlanta
Medical Defense
Marion C. Pruitt, Chairman Atlanta
B. H. Minchew Waycross
Marcus Mashburn Gumming
Edgar D. Shanks Atlanta
Advisory State Board of Health
Edgar H. Greene, Chairman Atlanta
C. L. Ridley. Sr. Macon
J. C. Patterson Cuthbert
R. K. Winston Tifton
O. R. Styles Cedartown
J. C. Brim Pelham
J. W. Chambers , LaGrange
C. L. Ayers Toccoa
D. N. Thompson Elberton
B. H. Minchew Waycross
Medical Education and Hospitals
G. Lombard Kelly, Chairman „ Augusta
R. Hugh Wood Emory University
Julian K. Quattlebaum Savannah
Ernest F. Wahl Thomasville
J. A. Thrash •>- Columbus
C. Mark Whitehead ... LaGrange
L. Minor Blackford Atlanta
B. T. Beasley Atlanta
Charles B. Fulghum Milledgeville
John T. McCall, Jr — Rome
A. G. Little, Jr Valdosta
Marcus Mashburn, Jr Cumming
Sam M. Talmadge .... Athens
C. H. Richardson, Sr — Macon
Hervey M. Cleckley Augusta
Albert F. Brawner — Atlanta
Edgar Boling Atlanta
Abner Wellborn Calhoun Lectureship
James E. Paullin, Chairman.—. — — Atlanta
J. R. Broderick Savannah
Eugene E. Murphey ' Augusta
Frank K. Boland ..Atlanta
Guy O. Whelchel ---- Athens
J. Calhoun McDougall ...Atlanta
Memorial Exercises
M. Preston Agee, Chairman — — Augusta
L. D. Porch Macon
J. C. Patterson — Cuthbert
George H. Lang _ ... Savannah
Frank K. Boland Atlanta
M. T. Edgerton ..Atlanta
Medical History of Georgia
J. Calvin Weaver, Chairman Atlanta
Frank K. Boland — Atlanta
Allen H. Bunce Atlanta
T. F. Abercrombie Decatur
Eugene E. Murphey * — .. Augusta
William R. Dancy Savannah
McClaren Johnson Atlanta
Orthopedics
J. Hiram Kite, Chairman Atlanta
Fred G. Hodgson Atlanta
Thomas P. Goodwyn Atlanta
F. Bert Brown . Savannah
John I. Hall Macon
Peter B. Wright Augusta
W. A. Newman Macon
H. Walker Jernigan —Atlanta
C. E. Irwin Warm Springs
510
The Journal of the Medical Association of Georgia
Lawson Thornton -Atlanta
C. G. Henry Vu^usta
Industrial Health
N. Wasden, Chairman — — . Macon
J. Harry Rogers Atlanta
Thomas I’. Goodwyn —Atlanta
T. \ \\ illis Brunswick
L. M. Petrie Atlanta
W. W. Halley - Augusta
Chas. E. Lawrence — Atlanta
W. A. Newman Macon
C. F. Holton ....Savannah
John P. Garner ....Atlanta
J. H. Mull —Rome
Rufus Askew Atlanta
Student Loan Fund
Mrs. Shelley C. Davis, Chairman Atlanta
G. Lombard Kelly — Augusta
R. Hugh Wood - ....Emory University
Scientific Exhibits
Robert B. Greenhlatt, Chairman Augusta
J. Elliott Scarborough Emory University
Marion T. Benson, Jr — - Atlanta
Lee Howard Savannah
Robert C. Pendergrass — Americus
Julian K. Quattlebaum Savannah
J. Hiram Kite — - Atlanta
Max Mass Macon
Clair A. Henderson Savannah
Leila Denmark — Atlanta
M. Fernan-Nttnez Dublin
Medical Preparedness
W. A. Selntan. Chairman - Atlanta
Alternate, L. Minor Blackford Atlanta
A. O Linch Atlanta
Alternate, John W. Turner . Atlanta
Edgar D. Shanks — ... Atlanta
Alternate, Spencer A. Kirkland .Atlanta
Postgraduate Study
R. Hugh Wood, Chairman Emory University
G. Lombard Kelly ...Augusta
R. H. Oppenheimer Atlanta
Thomas L. Ross, Jr Macon
Hollis Hand _. — _ LaGrange
Richard Torpin - - Augusta
Cleveland Thompson Waynesboro
C. H. Richardson, Jr Macon
F. H. Simonton Chickamauga
Vernon E. Powell Atlanta
John Sharpley Savannah
J. M. Byne. Jr Waynesboro
Liaison Committee
Georgia State Medical Association
(Negro)
J. F. Hanson, Chairman Macon
J. R. McCord ...Atlanta
W. E. Storey Columbus
Lee H. Battle. Jr Rome
E. Van Buren Atlanta
H. H. Allen Decatur
Awards
C. H. Richardson, Sr., Chairman Macon
T. Schley Gatewood Americus
G. Lombard Kelly .. Augusta
W. W. Baxley .’. Macon
W. S. Dorough Atlanta
Mason I. Lowance - Atlanta
J. Dean Paschal .Dawson
Cancer Commission
J. Elliott Scarborough, Chairman... ..Emory University
Everett L. Bishop Atlanta
Robert C. Pendergrass Americus
Thomas Harrold _ Macon
Enoch Callaway LaGrange
Lee Howard Savannah
W. F. Jenkins Columubs
J. T. McCall Rome
Hoke Wanunock Augusta
I). M. Bradley - Way cross
John Funke Atlanta
J. J. Collins Thomasville
Max Mass - Macon
Advisory Woman's Auxiliary
Murdock Equen, Chairman ... .Atlanta
L. W. Williams Savannah
J. R. S. Mays Macon
Eustace A. Ulen Atlanta
W. Bruce Schaefer Toccoa
Ralph 11. Chaney \ugii-ta
W. L. Bazemore Macon
J. Harry Rogers Atlanta
W. G. Elliott Cuthbert
Revision of Pharmacopeia of U. S.
Allen H. Bunce, Chairman Atlanta
C. C. Aven Atlanta
Hal M. Davison Atlanta
Prepayment Medical Care Plans
W. S. Dorough, Chairman Atlanta
John L. Elliott _ Savannah
Steve P. Kenyon _. Dawson
Kenneth D. Grace —LaGrange
A. M. Phillips Macon
W. L. Pomeroy Waycross
D. Lloyd Wood Dalton
C. K. Wall Thomasville
H. L. Cheves Union Point
W. Bruce Schaefer Toccoa
Committee to Revise the Constitution
Allen H. Bunce, Chairman Atlanta
C. H. Richardson, Sr. Macon
Marion C. Pruitt Atlanta
W. F. Reavis , Waycross
John A. Dunaway. Attorney for Association Atlanta
A. M. Phillips, President Macon
Edgar D. Shanks, Secretary-Treasurer Atlanta
Liaison Committee of 53 Constituent
State Medical Associations to Coordinate
Educational Program of A.M.A.
Jack C. Norris Atlanta
Group Insurance
John W. Turner, Chairman Atlanta
Kenneth S. Hunt Griffin
James H. Arnold _ New nan
Roy L. Gibson -Columbus
F. H. Sams Reynolds
Frank M. Houser Macon
E. S. Colvin Atlanta
Medical Civilian Preparedness
Edgar M. Dunstan. Chairman \tlanta
Robert W. Candler . Atlanta
Charles E. Dowman ... Atlanta
Joseph S. Skobba _. .Atlanta
Walter M. Bartlett Decatur
Alvin E. Siegel .. Macon
J. H. Pinholster Savannah
W. K. Philrtot Augusta
T. J. Ferrell Waycross
Public Relations Committee
Stephen T. Brown, Chairman Atlanta
Christopher J. McLoughlin Atlanta
W. G. Elliott — - Cuthbert
J. E. Penland Wavcross
W. D. Hall — i — ..Calhoun
Thomas L. Ross, Jr. — Macon
Hartwell Joiner - Gainesville
Ralph H. Chaney Augusta
Emery C. Herman LaGrange
Pediatrics
W. W. Anderson, Chairman Atlanta
Philip A. Mulherin — Augusta
Frank Schley — - Columbus
Edwin R. Watson Macon
M. M. McCord Rome
December, 19S0
511
Howard J. .Morrison
Savannah
W. Charles Boswell
A. M. Johnson
Leila Denmark
. .—Macon
Valdosta
Atlanta
Maternal Care
C. B. Upshaw, Chairman
—Atlanta
T. F. Sellers ......
Richard Torpin
Augusta
E. D. Colvin
John R. McCain
Evelvn Swilling
Tuberculosis
Samuel E. Patton. Chairman
Macon
C. C. Aven .. _ ..
Atlanta
Rufus F. Payne
H. C. Schenck
Robert ( . Maior
.Rome
...Atlanta
Ano-nsta
Faternal Delegates to Other States
Alabama — Enoch Callaway, LaGrange; Roy L. Gib-
son, Columbus; Edwin T. Arnold, Jr., Hogansville;
Harry B. Baxley, Donalsonville.
Florida — TSraswell E. Collins, Waycross; J. L. Camp-
bell. Jr., \aldosta; Rudolph Bell, Thomasville; H. M.
McKemie, Albany.
North Carolina — Thomas J. Hicks, McCaysville; Hart-
well Joiner. Gainesville; B. J. Roberts, Cornelia.
South Carolina — D. R. Thomas, Augusta; Hubert
Milford, Hartwell; Anne Hopkins, Savannah.
Tennessee — F. H. Simonton, Chickamauga; D. Lloyd
ood. Dalton; Ralph N. Johnson, Rome.
State Board of Health* *
First District : James M. Byne, Jr., Waynesboro, Sept.
1, 1951.
Second District: C. K. Sharp, Arlington, Sept. 1, 1951.
Third District: R. C. Montgomery. Butler, Sept. 1, 1954.
Fourth District: M. M. Head, Zebulon, Sept. 1, 1955.
Fifth District: Spencer A. Kirkland, Atlanta, Sept. 1,
1954.
Sixth District: Walter Bramblett, Jr., Forsyth, Sept. 1,
1956.
Seventh District: Fred H. Simonton, Chickamauga,
Sept. 1, 1956.
Eighth District: C. J. Maloy, McRae, Sept. 1, 1956.
Ninth District: Robert L. Rogers, Gainesville, Sept. 1,
1951.
Tenth District: Thos. W. Goodwin, Augusta. Sept. 1.
1955.
State of Georgia at Large**
Georgia Dental Association
J. M. Hawley, Columbus, Sept. 1, 1952.
J. G. V illiams, Atlanta, Sept. 1, 1952.
Georgia Pharmaceutical Association
Preston Sumner, East Point, Sept. 1, 1953.
A. T. McRae, Douglas, Sept. 1, 1956.
‘Nominated by their respective district medical societies
and appointed for six-year terms.
“Nominated by their respective associations.
State Board of Medical Examiners
Edgar H. Greene Atlanta
J. W. Palmer Ailey
Steve P. Kenyon Dawson
Grady N. Coker Canton
R. H. McDonald Newnan
Phil E. Roberson Albany
Fred J. Coleman Dublin
Alexander B. Russell Winder
Rufus A. Askew Atlanta
• W. H. Powell Hazlehurst
The Medical Association of Georgia will hold its
1951 annual session in Augusta. The dates are
April 17, 18, 19 and 20. Bon Air Hotel will be
headquarters, with Partridge Inn participating.
Please make your reservations now.
THE M.D. GOES PR
Continued from Page 502)
years to come.
I know of no better way of concluding this
talk than that of quoting from Dr. Walter C.
Payne of Pensacola, who served as president
of the Florida State Medical Association last
year. His entire address to the the Florida
House of Delegates was devoted to medical pub-
lic relations, something which would have been
unheard of 10 or 20 years ago. In urging im-
provement of medical public relations. Dr.
Payne said:
“The time has arrived for us to analyze the situation
without bias. We must find out why a part of the
public has become dissatisfied, and then do whatever
is necessary to remove the cause or causes of this
dissatisfaction. The public can be divided into two
groups: the distributors of medical care and the con-
sumers of medical care. We as distributors must never
overlook the fact that the consumers are as vitally
interested in health problems as we are.”
I note that the make-up of the open-forum
panel which is to follow later tonight indicates
that this is the philosophy also of the Medical
Association of Georgia.
The public has every right to ask questions
and it is up to us of the medical profession
to supply the answers if we can. I am reminded
in this regard of the story of a man who went
to buy a parrot. The seller said, “It speaks
eight languages.” The buyer said, “Send it out
to the house.” That night the man got home,
and said to his wife, “Did the bird come?”
“Yes, it’s in the oven,” replied the wife. “My
gracious,” said the husband, “that parrot spoke
eighti languages.” The wife’s answer was,
“Well, why didn’t it speak up!”
It is a genuine hope that all of you who
have any questions this evening will speak up
during the forum session. I thank you.
HEALTHGRAMS
Modern public health does not prevent death alone.
It also prevents disease. For every life preserved by
a tuberculosis program, scores of individuals are
saved from invalidism. For every life saved from
malaria, hundreds of individuals are maintained as
active producers in the population. Am. J. Pub.
Health, August, 1950.
* * *
Even after clinical follow-up in minimal tuberculosis
has confirmed the interpretation of the ill-defined x-ray
shadow, the physician is faced with another and per-
haps more serious problem. He must then cope with
the question of the lesion’s significance, and must
decide upon the course of action to be taken in its
management. Will the patient need to undergo hos-
pitalization and surgical procedure? Can the lesion
be managed under a home-care regimen? Or will it
be sufficient to place the patient under long term
observation, imposing only token limitations upon nor-
mal activity? It will be most urgent that these ques-
tions be resolved properly and decisively.
These are but a few of the problems which our
screening survey experiences in communities and hos-
pitals pose for us and for the medical profession gen-
erally. Meeting them directly and fully is the best
assurance of effective tuberculosis control. Robert J.
Anderson, M.D., Journal-Lancet, April, 1950.
512
The Journal of the Medical Association of Georgia
MEDICAL ASSOCIATION OF GEORGIA
County Medical Societies 1950
APPLING COUNTY
Officers
Presidenl Brown, J. B.. Jr.
Vice-President Branch. W. D.
Secretary-Treasurer... Holt, J. T.
Members
Bedingfield, James A., Baxley
Branch, W. D., Baxley
Brown, J. D., Jr., Baxley
Holt. J. T., Baxley
Kennedy, F. D.. Baxley
McCracken, H. C., Baxley
BALDWIN COUNTY
Officers
President.. Gibson, Wallace M.
Vice-President. Leaphart, E. C.
Sec.-Treas. Pursley, Norman B.
Delegate Waller. Robert D.
Alternate Delegate Walker, E. Y.
Censors: Yarbrough, Y. H.; Brad-
ford, R. W., and Wiley, John D.
Members
Allen, E. W„ Milledgeville
Allen, H. D., Jr.. Milledgeville
Bailey, L. A., Milledgeville
Bradford, R. W.. Milledgeville
Chestnutt, T. H., Milledgeville
Clodfelter, Thos. C., Milledgeville
Crichton. Robert B., Milledgeville
Fulghum, C. B., Milledgeville
Fussell, J. K., Milledgeville
Gibson, Wallace M., Milledgeville
Hall. Thomas M„ II. Fairfield State
Hospital, Newtown, Conn.
Leaphart, E. C„ Milledgeville
Peacock, Thos. G., Milledgeville
Pennington, L. E„ Terrell State
Hospital, Terrell. Texas
Pennington, Veronica Murphy, Ter-
rell State Hospital, Terrell, Texas
Pursley, Norman B., Milledgeville
Sikes, Walter A., University Hos-
pital, Augusta
Sikes, Z. S., VA Hospital, Roanoke
17, Va.
Smith, M. E., Milledgeville
Walker, E. Y., Milledgeville
Waller, Robert D„ Milledgeville
Wiley, John D., Milledgeville
Williams, David C., Milledgeville
Woods, 0. C., Milledgeville
Yarbrough, Y. H.. Milledgeville
BANKS COUNTY
Member
Jolley, J. S., Homer
BARTOW COUNTY
Officers
President Quillian, Wm. B., Jr.
Vice-President Bradford, H. B.
Secretary-Treasurer Horton, A. L.
Censors: Howell, S. M.; Quillian,
Wm. B., Jr., and Bradford, H. B.
Members
Bradford, H. B., Cartersville
Ellis, Charles L., Kingston
Horton, A. L., Cartersville
Howell, S. M., Cartersville
Howell, W. Harvey, Cartersville
McGowan, Hugh S., Cartersville
Quillian, Wm. B„ Jr., Cartersville
Stanford, J. W., Cartersville
Wofford, W. E., Cartersville
BEN HILL COUNTY
Officers
President Ward, Francis
Vice-President Cornwell, G. K.
Secretary-Treasurer. Coffee, W. P.
Delegate Johnson, Roy, Jr.
Alternate Delegate . . Ware, D. B.
Censors: Willis, G. W. ; Willcox,
W. D., and Smith, J. E.
Members
Bradiey, T. E., Fitzgerald
Coffee, W. P., Fitzgerald
Cornwell, G. K.„ Fitzgerald
Dismuke, H. L., Ocilla
Harper, A., Wray ( Hon.)
Johnson, Roy, Jr., Fitzgerald
McElroy, S. L., Ocilla
McMillan, J. E., Fitzgerald
Smith, J. E.. Fitzgerald
Ward, Francis, Fitzgerald
Ware, D. B., Fitzgerald
Willcox, W. D„ Fitzgerald
Willis, G. W„ Ocilla
BIBB COUNTY
Officers
President _ Richardson, C. H., Jr.
President-Elect Edenfield, Robt. W.
Vice-President Hall. John I.
Secretary-Treasurer Tift, Henry H.
Delegate Applewhite, J. D.
Delegate... Kay, J. B.
Alternate Delegate Wasden. C. N.
Censor Baxley. W. W.
Members
Aldrich, Fred N., Professional Bldg.,
Macon
Anderson, Carl L., 556 Mulberry
St., Macon
Anderson, J. C., Persons Bldg.,
Macon
Apnlewhite, J. D.. 700 Spring St.,
Macon
Atkinson, H. C., 700 Spring St.,
Macon
Barton, Wm. L., Persons Bldg.,
Macon
Bashinski, Ben, 700 Spring St.,
Macon (deceased)
Baxley, W. W., Persons Bldg.,
Macon
Bazemore, W. L., 553 Walnut St.,
Macon
Benton, Charles C., Professional
Bldg., Macon
Billinghurst, George A., Persons
Bldg., Macon
Blum. Leon J., Warner Robins
Boswell, W. Chas., Persons Bldg.,
Macon
Brannen. Edmund A., 700 Spring
St., Macon
Brown, Roland A., Medical Arts
Bldg., Macon
Bush, W. Holloway, 959 Daisy Park,
Macon
Cary, R. Frank, 815 Hemlock St.,
Macon
Chrisman, W. W., 700 Spring St.,
Macon
Clay, J. Emory, Clinic Hospital,
Macon
Cole, Allan A., 810 Mulberry St.,
Macon
Corn, Ernest, 700 Spring St.. Macon
Dove, W. B., 775 Boulevard, Macon
(Hon. )
DuPree, Geo. W., Gordon
DuPree, John T., Macon Hospital.
Macon
Edenfield, Robert W., 700 Spring
St.. Macon
Farmer, C. Hall, 553 Walnut St.,
Macon
Ferrell. R. G.. Jr., Professional Bldg.,
Macon
Forester, B. W., 700 Spring St.,
Macon
Gallemore, John L.. Perry
Goldstein, J. Jay, Warner Robins
Golsan, W. R., Persons Bldg., Macon
Goodman. Leon J., Bibb Bldg.,
Macon
Goolsby, R. C„ Jr., 700 Spring St.,
Macon
Hall, John I., Bankers Insurance
Bldg., Macon
Hall, T. H.. Grand Bldg., Macon
Hanson, J. F., 3834 The Prado,
Macon
Harrold, Thomas, 700 Spring St.,
Macon
Hatcher, Milford B„ 700 Spring
St., Macon
Haz'ehurst. W. Derrell. 765 Spring
St., Macon
Houser, Frank M.. Grnad Bldg.,
Macon
Hurley, Thos. A., Clinic Hospital.
Macon (Hon.)
James, L. P., 700 Spring St.. Macon
Jarratt. W. D., Jr., 553 Walnut St.,
Macon
Johnson, Geo. L., VA Regional
Office, Montgomery, Ala.
Jones, John P., 853 Hemlock St.,
Macon
Jones, Rudolph W., Jr., 959 Daisy
Park, Macon
Jordan, Wm. K., 700 Spring St.,
Macon
Kay, J. B., Byron
Keen, O. F., Persons Bldg., Macon
King, J. L., Persons Bldg., Macon
Lewis, Wm. E., Persons Bldg.,
Macon
Mass, Max, Macon Hospital, Macon
Massenhurg, G. Y., Clinic Hospital,
Macon
Mays, J. R. S., 700 Spring St.,
Macon
McAllister, Robert W., 700 Spring
St., Macon
December, 1950
513
McFarlane, John W., Professional
Bidg., Macon
-McLaughlin, C. K., Bankers Insur-
ance Bldg., Macon
McMichael, \ . H., Clinic Hospital,
Macon
McMillan, E. C.. Bibb Bldg., Macon
Meriwether, W. W., Persons Bldg.,
Macon
Meserve, F. B., 721 McArthur Blvd.,
Warner Robins
Mobley, W. E., 563 College St.,
Macon (Hon.)
Nathan, Daniel E., Fort Valley
Neal, Jule C.. Jr., Professional Bldg.,
Macon
Neuherg, S. Charlotte, Person Bldg.,
Macon
Newman,
W.
A.,
700 Spring St.,
Macon
Newton,
R.
G.,
Persons Bldg.,
Macon
Olnick, Herbert M., 700 Spring St.,
Macon
Patton, Samuel E., Persons Bldg.,
Macon
Phillips, A. M., Bankers Insurance
Bldg., Macon
Pope, Edgar M., 700 Spring St.,
Macon
Porch, Leon D„ 700 Spring St.,
Macon
Rawls, Lewis L., Persons Bldg.,
Macon
Reifler. R. M., First National Bank
Bldg., Macon
Richardson, C. H., 700 Spring St.,
Macon
Richardson, C. H.. Jr., 700 Spring
St., Macon
Richardson, R. W., Persons Bldg.,
Macon
Ridley, C. L., Macon Hosptial,
Macon
Ridley, C. L., Jr., Persons Bldg.,
Macon
Rogers, T. E., 120 Clisby Place,
Macon (Hon.)
Rogers, T. E., Jr., 700 Spring St.,
Macon
Ross, Thomas L., Jr., 700 Spring
St., Macon
Rubin, Samuel N., Gordon
Rumble, Charles T., 700 Spring St.,
Macon
Rutland, S. C., Ga. Dept, of Public
Health, Atlanta
Siegel, Alvin E., 553 Walnut St.,
Macon
Smith, Horace D., 10519 Ohio Ave.,
Los Angeles 25, Calif.
Smith. J. Allen, 700 Spring St.,
Macon
Stamps. Edward R., Bibb Bldg.,
Macon
Stewart, J. Benham, 700 Spring St.,
Macon
Suarez, Raymond, 553 Walnut St.,
Macon
Swilling, Evelyn, 553 Medical Arts
Bldg., Macon
Thompson, O. R., 700 Spring St.,
Macon
Tift, Henry H., 765 Spring St.,
Macon
Vinson, Frank, Fort Valley
Walker, D. D., 700 Spring St.,
Macon
Ware, Ford, Bankers Insurance
Bldg., Macon
Wasden. C. N.. Bankers Insurance
Bldg., Macon
Watson, Edwin R., 553 Walnut
St., Macon
Weaver, H. G., 700 Spring St.,
Macon
Williams, W. A., 700 Spring St.,
Macon
Woodhall, J. P„ Professional Bldg.,
Macon
Work. Samuel D., Jr., 853 Hemlock
St., Macon
Zackary, J. D., Gray
BLUE RIDGE SOCIETY
(Fanniii-Gilmer-Union Counties)
Officers
President Brooks, Courtney C.
Vice-President O’Daniel, James F.
Secretary-Treasurer Hicks, Thos. J.
Delegate Hicks, Thos. J.
Alternate Delegate .O'Daniel, Jas. F.
Censors: Watkins. Ed W.; O'Daniel,
James F., and Hicks, Thos. J.
Members
Brooks, Courtney C., Blue Ridge
Burdine, James M., Blue Ridge
Hicks, Thos. J., McCaysville
O’Daniel, James F., Ellijay
O’Daniel. John Y., Ellijay
Pettit. James K.. Manheim Garden
Apts., 13-B, Philadelphia 44, Pa.
Shanks, Edgar D., Jr., University
Hospital, Augusta (Asso.)
Tanner, Wra. F., Young Harris
Watkins, Ed W., Ellijay
BROOKS COUNTY
Officers
President Wasden, Harry A.
Vice-President Jones, A. B., Jr.
Sec.-Treas Thwaite, Walter G.
Delegate Smith, L. A.
Alt. Delegate Thwaite, Walter G.
Members
Jelks, E. L., Quitman (Hon.) f de-
ceased)
Jones, A. B., Jr., Quitman
Smith, L. A., Quitman
Thwaite, Walter G., Quitman
Wasden, Harry A., Quitman
BULLOCH-CANDLER-EVANS
COUNTIES
Officers
President Floyd, Waldo E.
Vice-President Hames, Curtis G.
Secretary-Treas. —Griffin, Louie H.
Delegate Griffin, Louie H.
Alt. Delegate Mooney, John, Jr.
Censors: Deal, Ben A.; Simmons,
W. E., Jr„ and Whiteside, J. H.
Members
Daniel, A. B., Statesboro
Daniel, J. W., Claxton
Deal, Albert M., Statesboro
Deal, B. A., Statesboro
Deal, Daniel L., Statesboro
Deal, Helen Read, Statesboro
Fletcher, I. Elizabeth, 160 Pryor
St., S. W., Atlanta
Floyd, W. E., Statesboro
Griffin, Louie H„ Claxton
Hagins, Wm. A., R.F.D., Oliver
Hames, Curtis G., Claxton
Kennedy, R. L., Metter
Lunceford, Kathryn Simmons, Met-
ter
McElveen, J. M., Brooklet
Mooney, John, Jr., Statesboro
Moore, Ed L., Statesboro
Nevil, J. L., Metter
Neville, J. C., Register (Hon.)
Olliff, II. H„ Register
Patrick, J. Z., Pulaski fHon.)
Simmons, W. E., Metter
Stapleton, C. E„ Statesboro
Stewart, Jas. A., Portal
Watkins, E. C., Brooklet
BURKE COUNTY
Officers
President Lowe, W. R.
Vice-President Hillis, W. W.
Sec.-Treas Butterfield, D. L.
Delegate Byne, J. M., Jr.
Alt. Delegate Butterfield, D. L.
Members
Bargeron, E. A., Waynesboro
Bent, H. F., Midville
Butterfield, D. L., Waynesboro
Byne, J. M., Jr., Waynesboro
Green, Charles G., Waynesboro
Hillis, W. W„ Sardis
Lowe, W. R., Midville (deceased)
McCarver, W. C., Vidette
CARROLL-DOUGLAS-
HARALSON COUNTIES
Officers
President Worthy, W. Steve
Vice-President Roberts, O. W.
Secretary-Treasurer Patrick, E. V.
Delegate Denney, Roy L.
Alternate Delegate Reese, D. S.
Censors: Pritchett, J. H., Jr.; Pow-
ell, J. Ernest, Jr., and Reeve,
Thomas E., Jr.
Members
Aderhold, W. A., Carrollton
Allen, C. H., Bremen
Bagley, D. A., Austell
Barker, H. L., Carrollton
Bass, E. C., Carrollton
Berry, Robert L„ Villa Rica
Brock, W. B., 500 Majorea Ave.,
Coral Gables, Fla. (Hon.)
Denney, Roy L., Carrollton
Downey, Wm. P., Tallapoosa
Eaves, B. F., Draketown (Hon.)
Hamilton. R. E., Douglasville
Hogue, W. L., Villa Rica
Holtz, Louis, Carrollton
Hutcheson, E. B., Buchanan (Hon.)
(deceased)
King, O. D., Bremen
Morgan, F. W., Douglasville
Nutt, J. J., Route 1, Bowdon
Patrick, E. V., Carrollton
Powell, B. C„ Villa Rica
Powell, John E., Villa Rica
Powell, J. Ernest, Jr., Villa Rica
Pritchett, J. H., Jr., Bremen
Reese, D. S., Carrollton
Reeve, Thomas E., Jr., Carrollton
Roberts, O. W., Carrollton
Scales, S. F., Carrollton (deceased)
Smith, W. P., Bowdon
Spruell, T. M., Temple (Hon.)
Taylor, Thomas B., Douglasville
Thontasson, W._ E.. Carrollton
The Journal of the Medical Association ok Georgia
514
\ ansant. C. V., Douglasville
Watts, J. W., Bowdon
Wilson, L. E.. Bowdon
Word, J. J., Tallapoosa
Worthy, W. Steve, Carrollton
GEORGIA MEDICAL SOCIETY
(Chatham County)
Officers
President Kandel, H. M.
President-Elect Dunn, L. B.
Vice-President Freedman, L. M.
Sec.-Treas -Youngblood, Sam, Jr.
Delegate Elliott, John L.
Delegate Bowden, Ralph O.
Delegate King, Ruskin
Alternate Delegate Lott, Oscar H.
Alternate Delegate-Smith. Harold M.
Alternate Delegate Pacifici. Joseph
Members
Barfield. Wm. E., 722 Drayton St.,
Savannah
Bedingfield, W. 0., 14 W. Bull St.,
Savannah
Bowden, Ralph 0., 24 W. Gaston
St., Savannah
Broderick, J. R., 125 E. Jones St.,
Savannah
Brown, C. T., Guyton
Brown, F. B„ 22 W. Gaston St.,
Savannah
Brown, Walter E., 14 W. Hull St.,
Savannah
Center, Abraham H., 17-A W. Gor-
don St., Savannah
Charlton, T. J., 220 E. Oglethorpe
Ave., Savannah
Chisholm, J. F., 512 Abercorn St.,
Savannah
Cluxton, Harley E., Jr., Armour
Laboratories, Chicago, 111.
Cluxton, H. Hayes, New Britain Gen.
Hospital, New Britain, Conn.
Cole, W. A., 32 E. Taylor St.,
Savannah
Compton, H. T., 17 E. Jones St.,
Savannah
Cook, Ellison R., Ill, 513 Whitaker
St., Savannah
Coward, Allen W., 17 E. Jones St.,
Savannah
Craig, James B., 19% W. Gordon
St., Savannah
Crawford, W. B., 14 E. Taylor St.,
Savannah
Crawford, W. Barron, Jr., 14 E.
Taylor St., Savannah
Dancy, William R., 102 W. Jones
St., Savannah
Daniel, J. W„ 26 E. 31st St., Savan-
nah (Hon.)
Daniel, John W., Jr., 5 E. Jones St.,
Savannah
deCaradeuc, St. J. R., DeRenne
Apts., Savannah
Demmond, E. C., DeRenne Apts.,
Savannah
Drane, Robert, DeRenne Apts.,
Savannah
Duncan, J. Harry, 116 E. Jones St.,
Savannah
Dunn, L. B., 220 E. Huntingdon St.,
Savannah
Egan, M. J„ 210 E. Liberty St.,
Savannah
Elliott, John L., 212 E. Huntingdon
St., Savannah
Epting, M. J., 722 Drayton St.,
Savannah
Faggart. G. H., 18 W. Oglethorpe
Ave., Savannah
Fillingim, D. B„ 118 E. Jones St.,
Savannah
Fleming, Paul N., 14 W. Taylor
St., Savannah
Freeh. Henry C., Jr., 423 Bull St.,
Savannah
Freedman, L. M., 1% E. Gordon
St., Savannah
Fulmer, Wm. H., 19 E. 34th St.,
Savannah
Gleaton, E. N., 2 E. Jones St.,
Savannah
Goldenstar, Grant W.. 106 E. Jones
St., Savannah
GoUscbalk. Robert B., 123 E. Jones
St., Savannah
Graham, R. E., 212 E. Gaston St.,
Savannah
Ham, O. Emerson, 414 Bull St.,
Savannah
Holloman. A. L.. 119 E. Jones St.,
Savannah
Hobon, C. F., DeRenne Apts.,
Savannah
Honkins, Anne, 22 E. Jones St.,
Savannah
Howard, Lee, DeRenne Apts.,
Savannah
Howard, Lee, Jr., DeRenne Apts.,
Savannah
Iseman. Everette, 103 E. Jones St.,
Savannah (deceased)
Johnson. G. H.. 126 E. Oglethorpe
Ave., Savannah
Jones, Jabez, 11 W. Gordon St.,
Savannah
Kandel. H. M., 432 Abercorn St.,
Savannah
Ka"fer. W. W.. 345 Bull St., Savan-
nah
King, Rudkin, 10 W. Taylor St.,
Savannah
Lang, G. H., 202 E. Liberty St.,
Savannah
Lange, Stephen J., 12 E. Taylor
St., Savannah
Lee, Lawrence, DeRenne Apts.,
Savannah
Lee. Lawrence, Jr., DeRenne Apts.,
Savannah
Le'ington. H. L„ 209 E. Gaston St.,
Savannah
Long, W. V.. Hotel DeSoto, Savan
nah
Lott, Oscar H., Ill E. Jones St.,
Savannah
Lvnn, S. C., 124 E. Jones St.,
Savannah
Maner, E. N., 191 E. 45th St.,
Savannah (Hon.)
Martin, R. V., 18 E. 31st St., Savan-
nah (Hon.)
Massoud, M. A., Pineora (Hon.)
Mazo, Milton M., 8 E. Taylor St.,
Savannah
McGee, H. H., 7 W. Gordon St.,
Savannah
McGoldrick, Thos. A.. Jr.. 15 E.
Gordon St., Savannah
McLean, Jay, 612 Drayton St.,
Savannah
Metts, J. C., 427 Bull St., Savannah
Morrison, Howard J„ 444 Drayton
St., Savannah
Neville, R. L., 11 W. Gordon St.,
Savannah
Nichols, Fenwick R., Jr., 123 E.
51st St., Savannah
Norton, W. A., 105 E. Oglethorpe
Ave., Savannah
Oliver, R. L., DeRenne Apts., Savan-
nah
Olmstead, G. T., 20 E. Taylor St.,
Savannah
Osborne. E. S., 19 E. Jones St.,
Savannah
Osborne, Wm. W., St. Joseph’s Hos-
pital, Savannah
Osteen, W. L., 610 Anderson Ave.,
Savannah
Pacifici, Joseph, 2 E. Taylor St.,
Savannah
Peterson, T. A., 11 W. Jones St.,
Savannah
Pinholster, J. H., 241 Abercorn St.,
Savannah
Porter, J. E., 128 E. Taylor St.,
Savannah
Portman, Henry J., Jr., 9 E. Gor-
don St., Savannah
Powers, L. K., 29 E. Jones St.,
Savannah
Prince, Charles L., 2515 Habersham
St., Savannah
Quattlebaum, J. K., 24 W. Gaston
St., Savannah
Rabhan, L. J., 314 E. Gaston St.,
Savannah
Redmond, C. G., 701 Whitaker St.,
Savannah
Redmond. C. R. A., 530 E. 49th St.,
Savannah
Righton, H. Y., 101 E. Waldburg
St., Savannah
Robinson, David, 104 E. Taylor St.,
Savannah
Rollings, Harry E., 513 Whitaker
St., Savannah
Rosen, E. F., 5 E. Gordon St.,
Savannah
Rosen, Samuel F., 4 E. Jones St.,
Savannah
Rubin, Jacob, 350 Bull St., Savan-
nah
Sax, Charles E., 19 W. Liberty St.,
Savannah
Scardino, Peter L., 2515 Habersham
St., Savannah
Schley, R. L., Jr., 114 W. Gaston
St., Savannah
Schneider, M. M., 12% W. Taylor
St., Savannah
Sharpley, Helen, 109 E. Jones St.,
Savannah
Sharpley, H. F., Jr., DeRenne Apts.,
Savannah
Sharpley, John G., DeRenne Apart-
ments, Savannah '
Shearouse, J. Wm., 14 E. Taylor
St., Savannah
Smith, H. M„ 9 W. Gordon St.,
Savannah
December, 1950
515
Smith, P. H., 3 E. Gordon St.,
Savannah
Stalvey, John K.. Jr., 110 E. Taylor
St., Savannah
Straight, G. W., 202 Gordon St.,
Savannah
Train, J. K.. 1107 Bull St., Savannah
Train. J. K.. Jr., 1107 Bull St.,
Savannah
Upson, E. T„ 201 E. Hall St.,
Savannah
Usher, Charles, 6 E. Uiberty St.,
Savannah
Victor. Jules, Jr., 126 E. Taylor
St., Savannah
Waring, A. J., DeRenne Apts.,
Savannah
Waring, Ruth Moyer, 905 E. Duffy
St., Savannah
Waring. Thomas P., 905 E. Duffy
St., Savannah
Westerfield, C. W.. 101 Garrard
Ave., Gordonston, Savannah
Whelan, E. J., 14 W. Jones St.,
Savannah
Williams, A. F., 127 E. Gordon St.,
Savannah
W'illiams, L. W7., 105 E. Jones St.,
Savannah
Wilson, W. D., 104 W. Waldberg
St., Savannah
Withington, John C., 106 W. Jones
St., Savannah
Youngblood, Sam, Jr., 108 E. Taylor
St., Savannah
Zirkle, John G., 722 Drayton St.,
Savannah
CHATTOOGA COUNTY
Officers
President Allen, John J.
Vice-President Gist, Wm. T.
Sec.-Treas Goodwin. Hugh A.
Delegate Uittle, G. H.
Members
Allen, John J., Trion
Brown, H. D., Summerville
Gist, W7m. T., Summerville
Goodwin, Hugh A., Summerville
Hair, W. B., Summerville (Hon.)
Hyden, Wm. U., Trion
Lawrence, Dan S., Menlo
Little, G. H., Trion
Little, R. N., Summerville
CHEROKEE-PICKENS
COUNTIES
Officers
President Roper, E. A.
Vice-Pres Andrews, Chas. R., Jr.
Sec.-Treas Hendrix, A. M.
Delegate Roper, C. J.
Censors: Coker, Grady N.; Y ansant,
T. J., and Looper, Ben K.
Members
Andrews, Charles R., Jr., Canton
Brooke, George C., Canton
Coker, Grady N., Canton
Hendrix, A. M., Canton
Hendrix, M. G., Ball Ground (Hon.)
Jones, Robert T., Ill, Canton
Looper, Ben K., Canton
Moore, R. M., Waleska (Hon.)
Roper, C. J., Jasper
Roper, E. A., Jasper
Vansant, T. J., Woodstock
CLARKE-MADISON-OCONEE
COUNTIES
Officers
President Neighbors, J. B., Jr.
Vice-President Gerdine, Linton
Sec.-Treas. Bonner. William H.
Delegate ..Hubert, M. A.
Members
Barner, John L., Athens General
Hospital, Athens
Bond, D. T., Danielsville
Bonner, William H., 130 W. Han-
cock Ave., Athens
Brown, W7. W.. City Health Dept.,
Athens
Bryant, C. H., Comer
Burroughs, Wm. F., Danielsville
Byrd, H. G., 1010 Prince Ave.,
Athens
Cabaniss, W. H., Sou. Mutual Bldg.,
Athens
Dover, Tom A., 1010 Prince Ave.,
Athens
Erwin, Goodloe Y., 1010 Prince
Ave., Athens
Florence, Loree, Sou. Mutual Bldg..
Athens
Gall’s. Anthony H.. Georgian Hotel,
Athens
Gerdine, Linton, Sou. Mutual Bldg.,
A’ hens
Goldsmith. L. H., Sou. Mutual
Bldg., Athens
Green, James A., 1010 Prince Ave.,
Athens
Gustin, Ronald M., St. Mary’s
Hospital, Athens
Harris, H. B., 1010 Prince Ave.,
Athens
Harrison. Wr. B., Regional Health
O'Hce, Athens
Holliday, Henry C., Sou. Mutual
Bldg., Athens
Hubert, M. A., 1010 Prince Ave.,
Athens
Hunnicutt, J. A., Sou. Mutual Bldg.,
Athens
Kel’er, A. Paul. Jr., 1010 Prince
Ave., Athens
Kitchens, Wm. C., 130 W. Hancock
Ave., Athens
Maxwell, Edgar J., Jr., Gilbert
Memorial Hospital, Athens
McPherson. J. H. T., Jr., 1010 Prince
Ave., Athens
Meissner, Tom, 1010 Prince Ave.,
Athens
Middlebrooks. C. O.. Holman Hotel,
Athens (Hon.)
YIoss, W7. L.. Jefferson Road. Athens
(Hon.)
Mullins, D. F., Jr., St. Mary’s Hos-
pital, Athens
Neighbors, J. B., Jr., 1010 Prince
Ave., Athens
Patton, Lewis S., Sou. Mutual Bldg.,
Athens
Randolph, R. H., 130 W. Hancock
Ave., Athens
Simpson. John A., 1010 Prince Ave.,
Athens
Stegeman. J. F., 1010 Prince Ave.,
Athens
Talmadge, Harry E., Sou. Mutual
Bldg., Athens
Talmadge, Sam M., 1010 Prince
Ave., Athens
Traylor, J. Bothwell, 455 N. Mil-
ledge Ave., Athens
Veale, E. O., Arnoldsville
Whelchel, Guy O., Sou. Mutual
Bldg., Athens
Whitley, L. L., 234 College Ave.,
Athens
CLA YTON-FA Y ETTE
COUNTIES
Officers
President Robak, J. L.
Y'ice-President. .. W'allis, J. R.
Secretary-Treasurer Busey, T. J.
Delegate Coleman, Y. R.
Members
Busey, T. J., Fayetteville
Campbell. Richard P.. Fayetteville
Coleman, Y. R., Jonesboro
Robak. J. L., Jonesboro
Wallis, J. R., Lovejoy
COBB COUNTY
Officers
President Benson. Wm. H., Jr.
Vice-President Musarra, Elmer A.
Sec.-Treas Garland, C. M., Jr.
Delegate Colquitt, Alfred, Jr.
Alternate Delegate Hagood, M. M.
Censors: Hagood, George F. ; Fow-
ler. A. H., and Garrett, Luke
G„ Jr.
Members
Bannister, C. D., Route 1, Marietta
Benson, Earl B., Marietta
Benson. W7m. H., Jr., Marietta
Burleigh, Bruce D., Marietta
Bu-ch, John F., Marietta
Bussey, J. G., Austell
Butner, J. H., Powder Springs
Cauble, George, Acworth
Clark, F. B., Austell
Colquitt, Alfred, Jr., Marietta
Colquitt, Hugh S., Smyrna
Crawley, Walter G., Marietta
Ellis, J. W., Kennesaw (deceased)1
Fowler, A. H., Marietta
Fowler, R. W7., Marietta
Garland, C. M., Jr., Smyrna
Garrett, Luke G., Jr., Austell
Gober, W. Mayes, Marietta
Hagood, George F., Marietta
Hagood, VI. M., Marietta
Lester, J. E.. Marietta
Levy, M. S., Smyrna
Lindley, F. P., Powder Springs
McCall, M. N., Jr., Acworth
Mitchell, W. C., Smyrna
Musarra, E. A., Marietta
Perkinson, W7. H., Marietta
Teem, Martin Van B., Marietta
COFFEE COUNTY
Officers
President Joiner, H. G.
Vice-President Goodwin, H. J.
Secretary-Treasurer Harper, Sage
Delegate Shellhouse, L. H.
Censor Ricketson, G. M.
Members
Clark, T. H., Douglas (Hon.)
Goodwin. H. J., Douglas
Harper, Sage, Douglas
Jardine, Dan A., Douglas
Johnson, R. L., Douglas
Joiner, H. G., Douglas
Meeks, Cabin S., Jr., Douglas
Oliver. James A., Douglas
516
The Journal of the Medical Association of Georgia
Quillian. B. O.. Douglas
Kicketson. G. M„ Douglas
Shellhouse, L. H., Willacoochee
Wallace. J. W., Douglas
COLQUITT COUNTY
Officers
President Stegall, R. E.
Vice-President McCoy, John F.
Sec.-Treas. Fokes. Robert E., Jr.
Delegate .McCoy, John F.
Uternate Delegate Stegall. R. E.
Censors: Funderburk. A. G. ; Joiner,
R. M., and Holmes, Edgar C.
Members
Baggs, Wade H., Jr., Moultrie
Brannen, Cecil N.. Moultrie
Conger. P. D., Moultrie
Fike. Rupert H.. Moultrie
Fokes, Robert E., Jr.. Moultrie
Funderburk, A. G., Moultrie
Gay. Frank M.. Moultrie
Holmes, Edgar C., Moultrie
Joiner. R. M., Moultrie
Lanier. J. E.. Moultrie I Hon.)
Lawson. E. L.. Moultrie
Loranger. James C., Doerun
McCoy, John F.. Moultrie
McGinty, W. R.. Moultrie
McLeod. John W., Moultrie
Paulk, J. R., Moultrie
Slocumb, C. B., Doerun (Hon.)
( deceased)
Stegall, R. E., Moultrie
Stone, J. C.. Doerun (Hon.)
Whittendale, Wm. H.. Norman
Park (Hon.)
Withers. Samuel M., Moultrie
Woodall. J. B.. Moultrie
COLUMBIA COUNTY
Member
Saggus, John G.. Harlem
COWETA COUNTY
Officers
President ... ..Parks, Joseph W., Jr.
Vice-President St. John, J. O.
Secretary-Treasurer. Glover, N. B.
Delegate Meaders, H. D.
Alt. Delegate . ..Hammond, G. W.
Members
Arnold, J. H., Newnan
Barksdale, C. R., Grantville
Cochran. M. F., Newnan
Elliott, C. C., Sargent
Farmer, C. W.. Jr., Newnan
Glover, H. C., Jr., Newnan
Glover, N. B., Newnan
Hammond, G. W., Newnan
Jackson, Bruce, Route 1, Newnan
Kinnard, George P., Newnan
McDonald, R. H., Newnan
Meaders, H. D., Newnan
Parks, Joseph W., Jr., Newnan
Peniston, J. B., Newman
St. John. J. O., Newnan
Tanner, W. FI., Route 2, Newnan
Tribble, J. M., Senoia
Woodroof. Wm. L., Newnan
CRISP COUNTY
Officers
President McArthur, C. E.
Secretary-Treasurer Gower, 0. T., Jr.
Delegate ... Williams, P. L.
Alt. Delegate ...McArthur, C. E.
Members
Vdams, Charles, Cordele
Dorminy, J. N„ Cordele (Hon.)
Flournoy, H. C., Warwick
Goss, C. C., Ashburn
Gower. 0. T.. Jr., Cordele
McArthur, C. E., Cordele
Whelchel, A. J.. Cordele
Williams, H. J., Cordele
Williams, L. E.. Cordele
Williams, P. L., Cordele
Wootten. L. O., Cordele
DECATUR-SEMINOLE
COUNTIES
Officers
President .Bridges, Henry A.
Vice-President Welch, Carl B.
Secretary-Treasurer Ehrlich, M. A.
Delegate Baxley, Harry B.
Alternate Delegate-Tucker, John P.
Members
Baxley, Harry B., Donalsonville
Bellville, Charles G.. Bainbridge
Bridges, E. C., R.F.D., Attapulgus
Bridges, Henry A., Bainbridge
Chason, Gordon, Bainbridge
Ehrlich, M. A., Bainbridge
Fort, M. A., Bainbridge
Jenke'ns, H. B., Donalsonville
Moseley, E. E.. Donalsonville
Spooner, John I., Donalsonville
(Hon.)
Tucker, John P.. Bainbridge
Welch. Carl B„ Attapulgus
Wheat, R. F., Bainbridge
Wilkinson, W. L.. Bainbridge
Willis, L. W., Bainbridge
DeKALB COUNTY
Officers
President Smoot, Richard H.
Vice-President Ansley, Robert B.
Secretary-Treas Morse, Chester W.
Delegate Evans, J. Rufus
Alt. Delegate Sanders, Floyd R.
Members
Allen, H. Homer, 520 Church St.,
Decatur
Ansley, Robert B., 121 Clairmont
Ave., Decatur
Beck, John E., 356 W. Ponce de
Leon Ave., Decatur
Blincoe, Homer, 1 E. 105th St.,
New York 29, N. Y.
Bloomer, Wm. E., 520 Church St.,
Decatur
Cunningham, C. E., Masonic Tem-
ple Bldg., Decatur
Duncan, G. A., Masonic Temple
Bldg., Decatur
Evans, J. Rufus; Stone Mountain
Joel, Charles, Jr., 2117 N. Decatur
Road, N. E., Atlanta
Kerr, Wm. K., Chamblee
Lee, Howard B., Masonic Temple
Bldg., Decatur
Leslie, John T., 121 Claimont Ave.,
Decatur
Litton, James H„ Tucker
Matthews, Lawrence P., 1282 S.
Oxford Road, N. E., Atlanta
Matthews, W in. A.. 3894 Peachtree
Road, N. E„ Atlanta
McCurdy, Willis T., Stone Moun-
tain
McGeachy, Thomas E., 520 Church
St., Decatur
Mendenhall, W. A., Chamblee
Morse, Chester W., 356 W. Ponce
de Leon Ave., Decatur
Pirkle, Quentin R., 34394 Peachtree
Road, N. E.. Atlanta
Powell, F. C., 319 Church St.,
Decatur
Sanders, Floyd R.. Masonic Temple
Bldg., Decatur
Shinall. Robert P., Jr.. Masonic
Temple Bldg., Decatur
Simmons, M. Freeman, 125 W.
Ponce de Leon Ave., Decatur
Smith, W. P., 319 Church St.,
Decatur
Smoot, Richard H., 215 Church St.,
Decatur
Stewart, Thomas W., Lithonia
Sweet, Mary F., 165 S. Candler St.,
Decatur (Hon.)
Vinson, T. O.. DeKalb County Board
of Health, Decatur
Vogt, Elkin, Lithonia
DOOLY COUNTY
Officers
President Coleman, 0. K.
Sec.-Treas Malloy, Martin L.
Delegate Coleman, O. K.
Alt. Delegate Malloy, Martin L.
Members
Coleman, O. K., Vienna
Daves, V. C., Vienna
Davis, E. B., Byromville
Dean, H. B., LInadilla
Kitchens, O. W'., Byromville
Malloy, Martin L., Vienna
Mobley, H. A., Vienna (Hon.)
DOUGHERTY COUNTY
Officers
President McDaniel, J. Z.
Vice-President Armstrong, E. S.
Sec.-Treas Russell, Paul T.
Delegate Russell, Paul T.
Alt. Delegate McKemie, W. F.
Censors: Barnett, J. M.; Keaton, J.
C., and Redfearn, J. A.
Members
Armstrong, E. S., Albany
Barnett, J. M., Albany
Berg, Joseph L., Albany
Bowman, M. B., Albany
Brown, C. MacKenzie, Albany
Buckner, F. W., Albany
Cook, W. S., Albany
Dixon, J. L., Memorial Hospital of
Martin County, Stanton, Texas
Feild, W. M., Albany
Hilsman, P. L., Albany
Holman, C. M., Albany
Ingram, Lillian, Albany
Irwin, I. W., Albany
James, A. E.. Albany
Kalmon, E. H., Jr., 212 8th St.,
S. W'., Washington, D. C.
Keaton, J. C., Albany
Lucas, I. M., Albany
Mann, D. S., Albany
December, 1950
517
McCall, Charles S., Jr., Albany
McDaniel, J. Z., Albany
McKemie, H. M., Albany
McKemie, W. Frank, Albany
Neill. F. K., Albany
Parrish, Lewis H.. Albany
Redfearn, J. A., Albany
Rhyne, W. P., Albany
Roberson. Phil E., Albany
Russell. Paul T.. Albany
Seymour. Glenn E.. Albany
Sutton, J. M„ Jr., Albany
Thomas, Frank E., Albany
Thomas, N. R., Albany
Tye, J. P.. Albany
Wolfe, David M., Albany
ELBERT COUNTY
Officers
President Johnson, A. S.
Vice-President-Mickel, Carey A., Jr.
Sec.-Treas. O'Neal, John B., Ill
Delegate Thompson, D. N.
Alt. Delegate O'Neal, John B., Ill
Censors: Ward. G. A.; Smith, F. A.,
and Johnson. A. S., Jr.
Members
Bailey, D. V., Elberton
Johnson, A. S., Elberton
Johnson. A. S., Jr., Elberton
Johnson, J. E., Elberton (Hon.)
Johnson, J. F., Jr., Elberton
Johnson, W. A., Elberton
Mattox, B. B., Elberton (Hon.)
Mickel, Carey A., Jr., Elberton
O’Neal, John B.. Ill, Elberton
O’Neal, Phyllis J.. Elberton
Smith, A. C., Elberton
Smith, F. A., Elberton
Thompson. D. N., Elberton
Ward, G. A., Elberton
EMANUEL COUNTY
Officers
President Youmans, S. S.
Vice-President Brown, R. G.
Secretary-Treasurer Smith, H. W.
Delegate ... Smith, D. D.
Alternate Delegate .. Powell. C. E.
Censors: Youmans, S. S.; Brown,
R. G., and Powell, C. E.
Members
Brown, R. G„ Swainsboro
Powell, C. E., Swainsboro
Smith, D. D.. Swainsboro
Smith, H. W., Swainsboro
Youmans, W. W., Swainsboro
FLOYD COUNTY
Officers
President Bosworth, Edward L.
Vice-President Battle, Lee H.. Jr.
Sec.-Treas. Andrews. Russell E., Jr.
Delegate Battle, Lee H., Jr.
Censors: McCall, John T.; Gilbert,
Warren, and McCord, Ralph B.
Members
Andrews, Russell E., Jr., Rome
Banister, W. G., R.F.D. 2, Rome
(Hon.)
Battle, Lee H., Jr., Rome
Black, Robert J., Rome
Blalock. Frank A., Battey State
Hospital, Rome
Bosworth, Edward L., Rome
Brannon, Emmett, Rome
Brooks, Wm. H., Rome
Cagle, W. D., Battey State Hos-
pital, Rome
Chandler, J. L., Rome (Hon.)
Coslett, Floyd, Battey State Hos-
pital, Rome
Crawford, J. M„ Cave Spring
Crenshaw, Fred, Battey State Hos-
pital, Rome
Crow, H. E., Battey State Hospital,
Rome
Davis, Ralph J., Rome
Dawson, Harry, Shannon
Dellinger, Raiden W„ Rome
Elmore, B. V., Rome
Garner, J. S., Jr., U. S. Marines
Garrard, J. L„ Rome
Gilbert, Warren M., Rome
Hackett, Walter G., Rome
Harbin, B. Lester, Rome
Harbin, R. M., Jr., Rome
Harbin. Thomas S„ Rome
Harbin, William P„ Jr., Rome
Jenkins, O. W„ Lindale
Johnson, Ralph N., Rome
Ketchum, Walter H., Battey State
Hospital, Rome
Lewis, Wm. H., Rome
McCall, J. T„ Rome
McCall, J. T., Jr., Rome
McCord, M. M., Rome
McCord, Ralph B„ Rome
Methvin, S. R., Lindale (Hon.)
Moore, C. W. Cary, Rome
Moore, Clifford, Lindale
Moore, Cliff, Jr., Rome
Moss, T. H., Rome
Mull. J. H„ Rome
Norton, John H., Jr., Cave Spring
Norton, Robert F.. Rome
Orton. Sarah P., Battey State Hos-
pital, Rome
Payne, Rufus F„ Battey State Hos-
pital, Rome
Perkins, George E., II, Battey State
Hospital. Rome
Routledge, A. F.. Rome
Sapp, Clarence L, Rome
Sewell. W. A.. Rome (Hon.)
Smith. George B., Rome
Smith, Inman, Rome
Wyatt. C. J.. Jr., Rome
FORSYTH COUNTY
Officers
President ..... Mashburn, Marcus, Jr.
Sec.-Treas Mashburn, James S.
Members
Bramblett, Rupert H., Route 3,
Cumming
Dunn, Wm. Robert, Cumming
Lipscomb, W. E„ Cumming
Mashburn, James S., Cumming
Mashburn, Marcus, Cumming
Mashburn. Marcus, Jr., Cumming
FRANKLIN COUNTY
Officers
President Brown, Stewart D.
Sec.-Treas Poole, E. T.
Delegate Brown, Stewart D.
Alt. Delegate Ridgway, Robert E.
Members
Brown, Stewart D., Royston
Parker, G. M„ Carnesville
Poole, E. T., Lavonia
Ridgway, Robert E., Royston
Smith, B. T., Carnesville
Williams, John Weldon, Jr.,
Lavonia
FULTON COUNTY
Officers
President Linch, A. O.
President-Elect Davison, Hal M.
V -President Strickler, Cyrus W., Jr.
Sec.-Treas — Hobby, A. Worth
Delegate... Linch, A. 0.
Delegate. Brown, Stephen T.
Delegate Davison, Hal M.
Delegate .1 .....Allen, A. E.
Delegate Hobby, A. Worth
Delegate Hamm, William G.
Delegate Norris, Jack C.
Delegate Strickler, Cyrus W., Jr.
Delegate Turner, John W.
Delegate Fowler, Major F.
Delegate Davis, Shelley C.
Delegate Martin, J. D„ Jr.
Delegate Roberts, C. Purcell
Members
Abbott, Osier A., Emory University
Hospital, Emory University
Abercrombie, T. F„ Ga. Dept, of
Public Health, Atlanta (Hon.)
Adams, Charles C., 3075 Peachtree
Rd.. N. E., Atlanta
Adams, C. R.. 840 Gordon St., S.
W., Atlanta
Adams, Guy H.. 85 Merritts Ave.,
N. E., Atlanta
Adams, H. M. S., Candler Bldg.,
Atlanta
Adams, Harold W„ 840 Gordon St.,
S. W., Atlanta
Agnor, Elbert B., Medical Arts
Bldg., Atlanta
Aiken, W. S., First Natl. Bank
Bldg., Atlanta
Akin, John T„ Jr., 35 Fourth St.,
N. E., Atlanta
Alden, Herbert S„ Medical Arts
Bldg., Atlanta
Allen, E. A., Medical Arts Bldg.,
Atlanta
Allgood, Pierce, 478 Peactree St.,
N. E., Atlanta
Allison, Gordon G., Grant Bldg.,
Atlanta
Almand, Claude A., 717 Brookridge
Drive, N. E., Atlanta
Anderson, Robert T.. Coleman Hos-
pital,--Dublin
Anderson, S. A., 36 Sheridan Drive,
N. E., Atlanta
Anderson, W. W., 478 Peachtree
St., N. E., Atlanta
Armstrong, T. B., 1404 North Ave.,
N. E., Atlanta (Hon.)
Armstrong, W. B., 490 Peachtree
St., N. E., Atlanta
Arnold, W. A., Peters Bldg., At-
lanta
Arp, C. Raymond, 478 Peachtree
St., N. E., Atlanta
Arrington, Robt. Glenn, 923 Twelfth
St., Huntington, W. Va. (Asso.)
518
The Journal of the Medical Association ok Georgia
\rteaga. Oliver, 152 Forrest Ave..
N. E.. Atlanta
\rthur, J. F.. 828 Adair Ave., N. E..
Atlanta
\skew. Rufus A.. 10 Pryor St.
Bldg., Atlanta
Askren. E. L., Jr.. 126 Forrest Ave..
N. E.. Atlanta
Vtkins, F. M., 478 Peachtree St..
N. E.. Atlanta
Atwater, John S., 478 Peachtree
St., N. E., Atlanta
Austin, Andrew C., 1218 S. Oxford
Rd., N. E.. Atlanta
Aven, C. C.. Medical Arts Bldg..
Atlanta
Ayer, Guy D., 563 Paces Ferry Road.
N. W„ Atlanta (Hon.)
Ayer, Darrell. Jr.. Crawford W.
Long Mem. Hospital. Atlanta
Vyers, Sanford E., 248 Pharr Rd.,
N. E„ Atlanta
Bachmann. J. George, 478 Peach-
tree St., N. E.. Atlanta
Baggett, L. G., 478 Peachtree St..
N. E.. Atlanta
Bailey, M. K.. Medical Arts Bldg.,
Atlanta
Baird, Janies B„ 62 28th St., N. W.,
Atlanta (Hon.)
Baird, J. Mason. Medical Arts Bldg.,
Atlanta
Baird, Noah W., 541 Lee St., S. W.,
Atlanta
Baker, Luther P., Peters Bldg.,
Atlanta
Baker, W. Pope, 979 Springdale
Rd., N. E„ Atlanta (Hon.)
BaBenger, W. L.. 1302 Emory Road.
N. E., Atlanta
Bancker. E. A., 478 Peachtree St.,
N. E.. Atlanta
Banks, Rafe, Jr., Gradv Mem. Hos-
pital, Atlanta (Asso.)
Barnes, John Jahu. 33 Ponce de
Leon Ave., N. E., Atlanta
Barnett, Crawford F., 478 Peachtree
St., N. E., Atlanta
Barnett, Stephen T.. 26 Linden Ave.,
N. E., Atlanta
Barrow'. Jos. Gordon. 1028 W. Peach-
tree St., N. W„ Atlanta
Bartholomew, R. A., 1259 Clifton
Rd.. N. E„ Atlanta
Bartlett, Walter M., 125 Michigan
Ave., Decatur
Batemen, Gregory W., Grand The-
atre Bldg., Atlanta
Batemen, Needham B., Candler
Bldg., Atlanta
Bateman, Wm. H., Grand Theatre
Bldg., Atlanta (Asso.)
Beard. Donald E.. 490 Peachtree
St St., N. E., Atlanta
Beasley, B. T.. Hurt Bldg., Atlanta
Beeson, Paul B., Grady Mem. Hos-
pital. Atlanta
Bennett, Wm. H., Medical Arts
Bldg., Atlanta
Benson, H. Bagley, 490 Peachtree
St., N. E., Atlanta
Benson, Marion T., Jr., 704 Pied-
mont Ave., N. E., Atlanta
Berger, Louis, 662 W. Peachtree
St., N. W., Atlanta
Berry. Maxwell. 1010 W. Peachtree
St.. \. \\ .. \tlanta
Bishop. Everett L., Medical Arts
Bldg.. Atlanta
Bivings, F. Lee, 20 Fourth St.. N.
W., Atlanta
Bivings, Wm. Troy, 756 Cypress St.,
N. E.. Atlanta (Hon.)
Blackford. L. Minor, 104 Ponce de
Leon Ave., N. E., Atlanta
Blackman, W. W., 418 Capitol Ave.,
S. E., Atlanta (deceased)
Blaine. B. C., 2018 Hollywood Rd..
N. W., Atlanta
Blalock, J. C.. Medical Arts Bldg.,
Atlanta
Blalock. Tully T., 490 Peachtree
St., N. E., Atlanta
Blandford. W. C., Candler Bldg..
Atlanta
Bleich, J. K.. 490 Peachtree St.,
N. E., Atlanta
Bloom. Walter L., 845 Clifton Rd..
N. E„ Atlanta
Blumberg, Max M., 35 Fourth St..
N. E„ Atlanta
Blumberg, Richard W., 33 Ponce
de Leon Ave., N. E„ Atlanta
Boger, Richard E„ 490 Peachtree
St., N. E„ Atlanta
Boland. Charles G., 159 Forrest
Ave., N. E., Atlanta
Boland. Frank K., 478 Peachtree
St.„ N. E., Atlanta
Boland, F. Kells, Jr., 478 Peach-
tree St.. N. E„ Atlanta
Boland. Joseph H„ 478 Peachtree
St., N. E., Atlanta
Boling. Edgar. 490 Peachtree St.,
N. E.. Atlanta
Bondurant. H. Wm.. 478 Peachtree
St., N. E., Atlanta
Bondy, Philip K.. Grady Mem.
Hospital, Atlanta (Asso.)
Bonner-Miller. Lila Morse. 768 Jun-
iper St., N. E.. Atlanta
Bowcock, Chas. M.. Dallas, Texas
( Asso. ) ( deceased )
Bowdoin, C. Dan., Ga. Dept, of
Public Health, Atlanta
Bovd. B. Hartwell. 56 Fifth St.,
N. E., Atlanta
Boyd, Montague L.. 563 Capitol
Ave., S. W., Atlanta
Bovnton, C. E.. P. O. Box 122,
Ponte Vedra Beach. Fla. (Hon.)
Boynton. Estelle P., 105 Pryor St.,
N. E., Atlanta
Brackett. John Gordon, 478 Peach-
tree St.. N. E.. Atlanta
Brawdey, Wm. Gaston, 20 Fourth St.,
N. W., Atlanta
Brawner, Albert F., 478 Peachtree
St., N. E.. Atlanta
Brawner, J. N., 2800 Peachtree Rd.,
N. E„ Atlanta
Brawner. J. N., Jr.. 262 W. Wesley
Rd., N. W., Atlanta
Brewer, Frank B., Area Medical
Officer VA, Atlanta (Asso.)
Bridges, Glenn J., Medical Arts
Bldg., Atlanta
Brown, Charles E.. 21 Eighth St.,
N. E„ Atlanta
Brown, Joseph C., Conyers
Brown, Lester A., 490 Peachtree
St., N. E., Atlanta
Brown. Robert H., 144 Ponce de
Leon Ave., N. E., Atlanta
Brown. Robert L.. Emory University
Hospital. Emory L'niversity
Brown, S. Ross, 1000 Peachtree
Battle Ave., N. W., Atlanta
Brown, Samuel Y., 478 Peachtree
St., N. E., Atlanta
Brown, Stephen T„ Medical Arts
Bldg., Atlanta
Bryan. William W., 490 Peachtree
St., N. E., Atlanta
Buesing, Oliver R.. 106 Physiology
Bldg.. Emory University (Asso).
Bunce, Allen H.. 98 Currier St.,
N. E„ Atlanta
Burch. J. C., 11 Hunter St.. S. W.,
Atlanta
Burge, Dan. 21 Eighth St., N. E.,
Atlanta
Burgess, Taylor S., Medical Arts
Bldg., Atlanta
Burke, B. Russell, 490 Peachtree
St., N. E., Atlanta
Burnett, Stacy W., 56 Fifth St.,
N. E„ Atlanta
Burson. E. Napier, Jr., 34 Seventh
St., N. E., Atlanta
Bush, O. B„ 1996 Bankhead High-
way, N. W., Atlanta
Byers, Kathleen, Piedmont Hos-
pital, Atlanta
Byram, James H., Grand Theatre
Bldg., Atlanta
Byrd. Edwin S., 1207 Oxford Rd.,
N. E., Atlanta (Hon.)
Byrd, L Luther, 478 Peaechtree
St., N. E., Atlanta
Cale, E. F., 33 Ponce de Leon Ave.,
N. E., Atlanta
Calhoun, F. P., 478 Peachtree St.,
N. E., Atlanta
Calhoun, F. P., Jr., 478 Peachtree
St., N. E., Atlanta
Camp, R. T., Fairburn
Campbell, John D., 490 Peachtree
St., N. E., Atlanta
Campbell, Roy E., Grady Mem.
Ho-pital, Atlanta (Asso.)
Campbell, Wm. E., Jr., Medical
Arts Bldg., Atlanta
Candler. Robert W., 490 Peachtree
St., N. E., Atlanta
Carter, A. W.. Jr., Forest Park
Carter, Sandy B., Jr., 34 Seventh
St., N. E., Atlanta
Cason, Wm. M., U. S. Naval Ord-
nance Depot, Pudget Sound, Key-
port, Wash.
Cathcart. Don F., 490 Peachtree St.,
N. E., Atlanta
Catron, 1. T., Candler Bldg., At-
lanta (Hon.)
Chalmers, Rives, 490 Peachtree St.,
N. E., Atlanta
Chambers, Benjamin M.. Grant
Bldg., Atlanta
Champion, W. L., 490 Peachtree
St., N. E., Atlanta (Hon.)
December, 1950
519
Chappell, Amey, 795 Peachtree St.,
N. E., Atlanta
Childs, J. R.. Medical Arts Bldg.,
Atlanta
Christian, Wm. H., Jr., 81 Walton
St., N. W., Atlanta (Asso.)
Christopher, F. E., Hurt Bldg,
Atlanta
Claiborne, T. Sterling, Medical
Arts Bldg., Atlanta
Clark, J. J., 478 Peachtree St.,
N. E., Atlanta
Clarke, M. L. B., Candler Bldg.,
Atlanta
Clifton, Ben H., 478 Peachtree St.,
N. E„ Atlanta
Codington, Arthur B., Medical Arts
Bldg., Atlanta
Cofer, Olin S., 478 Peachtree St.,
N. E., Atlanta
Cohen, Isidore R., 26 Linden Ave.,
N. E„ Atlanta
Cole, G. C., 538 Eight St., N.
W., Atlanta (Hon.)
Coleman, Reese C., Jr., 490 Peach-
tree St., N. E., Atlanta
Coles, Wm. C., 272 Courtland St.,
N. E., Atlanta
Col’ier, T. J., 1781 Peachtree Rd.,
N. E., Atlanta
Collinsworth, A. M., 663 W. Peach-
tree St., N. E., Atlanta
Collinsworth, P. L., Candler Bldg.,
Atlanta
Colvin. E. D., 1259 Clifton Rd., N.
E., Atlanta
Colvin, E. S., Healey Bldg, Atlanta
Combs J. A., 478 Peachtree St.,
N. E., Atlanta
Combs, James M., Candler Bldg.,
Atlanta
Cooke, Virgil C., 3010 Waverly
Ave., Tampa 9, Fla.
Cooper, Fred W., Jr., Emory Uni-
versity Hospital, Emory University
Copeloff, M. B., Mortgage Guaran-
tee Bldg., Atlanta
Coppedge, W. W., 106 N. East
Point St., East Point
Corley, F. L., Peters Bldg., Atlanta
Cousins, W. L., Candler Bldg., At-
lanta
Cowan, Z. S., Clearwater, Fla.,
(Hon.)
Crawford, Clyde L., 652 W. Peach-
tree St., N. W., Atlanta
Crawford, H. C., 478 Peachtree
St., N. E., Atlanta
Crawford, J. H., Grant Bldg., At-
lanta
Crismon, Lester C., Lago Oil &
Transport Co., Ltd., Medical
Dept., Aruba, N.W.I. (Asso.)
Crispell, Raymond S., Area Medi-
cal Officer VA, Atlanta (Asso.)
Cross, John B., Medical Arts Bldg.,
Atlanta
Crowe, Wm. R., 490 Peachtree St.,
N. E., Atlanta
Cruise, Joe S., Medical Arts Bldg.,
Atlanta
Cummings, Martin M., Lawson VA
Hospital, Chamblee (Asso.)
Curtis, Walker L., 104% N. Main
St., College Park
Dabney, W. C., Ocean Springs,
Miss. (Hon.)
Daly, Leo P., Medical Arts Bldg.,
Atlanta
Daniel, Charles H., College Park
( deceased )
Daniel, W. W., 743 W. Peachtree
St., N. E., Atlanta
Daniels, Charles W., 760 W. Peach-
tree St., N. W., Atlanta
Davenport, T. F„ 104 Ponce de
Leon Ave., N. E., Atlanta
Davidson, John K., Ill, Emory Uni-
versity Ho-pital, Emory Univer-
sity (Asso.)
Davis, J. E., Grand Theatre Bldg.,
Atlanta
Davis, M. Bedford, Jr., Lawson VA
Hospital, Chamblee (Asso.)
Davis, Robert Carter, 98 Currier
St., N. E., Atlanta
Davis, Shelley C., 35 Linden St.,
N. E., Atlanta
Davis, W. Ben, 115 S. Main St.,
College Park
Davison, Hal M., 478 Peachtree St.,
N. E„ Atlanta
Davison, T. C., 478 Peachtree St.,
N. E., Atlanta
Dean, Wm. J., Grady Mem. Hospital,
Atlanta (Asso.)
Denham, Samuel W., Jr., Grady
Mem. Hospital, Atlanta (Asso.)
Denmark, Leila D., 5605 Glenridge
Drive, N. E., Atlanta
Dennison, David B„ 478 Peachtree
St., N. E., Atlanta
Denton, J. F., 478 Peachtree St.,
N. E., Atlanta
Dew, J. Harris, 126 Forrest Ave.,
N. E., Atlanta
Dickson, Roger W., 27 Fourth St.,
N. E., Atlanta
Dimmock, Avary M., Hurt Bldg.,
Atlanta
Dixon, Pierce K., Jr., Lawson VA
Hospital, Chamblee
Dobes, Wm. L„ 478 Peachtree St.,
N. E., Atlanta
Dobson, J. L., 27 Fourth St., N. E.,
Atlanta
Dorough. W. S., 478 Peachtree St.,
N. E„ Atlanta
Dougherty, Mark S., 98 Currier St.,
N. E., Atlanta
Dowman, Charles E., 1415 Peach-
tree St., N. E., Atlanta
Dowman, Cordelia K., 3162 Peach-
tree Drive, N. E., Atlanta
Dunbar, Ernest A., Jr., Candler
Bldg., Atlanta
Duncan, John B., 478 Peachtree
St., N. E., Atlanta
Dunlap, E. B., Jr., Medical Arts
Bldg., Atlanta
Dunstan, Edgar M., 478 Peachtree
St., N. E., Atlanta
DuVall, W. B., 26 Linden Ave.,
N. E., Atlanta
Earle, Walter C., 1930 Greystone
Rd., N. E., Atlanta
Eberhart, Charles A., 704 Piedmont
Ave., N. E., Atlanta
Edgerton, M. T., Candler Bldg.,
Atlanta
Edwards, Wm. T., Jr., 490 Peach-
tree St., \E„ Atlanta
Elkin, Dan C., Emory University
Hospital, Emory University
Ellis, John O., Medical Arts Bldg.,
Atlanta
Elmer, Richard A., 35 Linden Ave.,
N. E.. Atlanta
Equen, Murdock, 144 Ponce de
Leon Ave., N. E„ Atlanta
Eskridge, Frank, 736 W. Peachtree
St., N. W., Atlanta
Estes, Edward H„ Jr., Grady Mem.
Hospital, Atlanta (Asso.)
Estes, H. G., 490 Peachtree St.,
N. E., Atlanta
Etheridge, I. H., Peters Bldg., At-
lanta
Evans, Albert L.. 478 Peachtree St..
N. E., Atlanta
Evans, Edwin C., Medical Arts
Bldg., Atlanta
Ezzard, Thomas M., Roswell
Fancher, J. K., 478 Peachtree St.,
N. E., Atlanta
Fanning, O. O., 399 W. Ontario
Ave., S. W., Atlanta (Hon.)
Felber, Ernest, 157 Forrest Ave.,
N. E., Atlanta
Felder, Richard E„ Grady Mem.
Hospital, Atlanta (Asso.)
Ferguson, I. A., 478 Peachtree St.,
N. E., Atlanta
Ferris, Harold A., Candler Bldg.,
Atlanta
Fincher, Edgar F., Emory L[niver-
sity Hospital, Emory University
Fischer, L. C., 35 Linden Ave., N.
E., Atlanta (Hon.)
Fish, John S., 1259 Clifton Rd.,
N. E., Atlanta
Fisher, Wilton M., U. S. Public
Health Service, Atlanta (Asso.)
Fitts, John B„ 31 LaFayette Dr.,
N. E., Atlanta
Florence, Thomas J., 490 Peachtree
St., N. E., Atlanta
Floyd, Earl H., 478 Peachtree St.,
N. E., Atlanta
Foraker, Alvan G., Grady Mem.
Hospital, Atlanta (Asso.)
Fort, Chester A., Jr., Medical Arts
Bldg., Atlanta
Foster, Kimsey E., College Park
Foster, Maude E., 290 Eighth St.,
N. E., Atlanta (Hon.)
Fowler, C. Dixon, 27 Eighth St.,
N. E., Atlanta
Fowler, Major F., 490 Peachtree
St., N. E., Atlanta
Freedman, Milton H., 21 Eighth
St., N. E., Atlanta
Freeman, Thomas R., 513 Whitaker
St., Savannah (Asso.)
Friedewald, Wm. Frank. Grady
Mem. Hospital, Atlanta
Frierson, Norton, Jr., Medical Arts
Bldg., Atlanta
Fuller, George W., 478 Peachtree
St., N. E., Atlanta
Funke, John, 712 Durant Place,
N. E., Atlanta
The Journal of the Medical Association of Georgia
520
Funkhouser. \\ . L„ 33 Ponce de
Leon Ave., N. E., Atlanta
Gabler. Regina. Grant Bldg.. At-
lanta
Galambos, Robert. Memorial Hall,
Cambridge 38. Mass. (Asso.)
Galloway. William 11.. East Atlanta
Bank Bldg.. Atlanta
Galvin, Wm. H.. Emory University
Hospital. Emory University
Gambrell, V . Elizabeth. 795 Peach-
tree St.. N. E.. Atlanta
Garner. John P.. 524 Flat Shoals
Ave., S. E.. Atlanta
Garner. J. R., 794 Springdale Rd.,
N. E.. Atlanta (Hon.)
Gay, Brit B.. Jr.. Lawson \ A Hos-
pital. Chamblee (Asso.)
Gay, J. Gaston. 104 Ponce de Leon
Ave., N. E., Atlanta
Gay. T. Bolling. 27 Eighth St.,
N. E.. Atlanta
Geiser, Frank M.. 663 W. Peach-
tree St.. N. E.. Atlanta
Geist. George A.. 75 Ponce de Leon
Apts., N. E.. Atlanta
Gerling. John J.. 267 E. Paces
Ferry Rd.. N. E., Atlanta
Germain, A. H., Candler Bldg.,
Atlanta
Gershon. Nathan L. 727 W. Peach-
tree St., N. E.. Atlanta
Gibbs, Robert I., Jr.. Lawson VA
Hospital. Chamblee (Asso.)
Gibson. Frank L.. Grady Mem.
Hospital, Atlanta (Asso.)
Gibson. John S.. Ga. Dept, of
Public Health. Atlanta (Asso.)
Giddings, C. G.. 63 28th St., N. W„
Atlanta (Hon.)
Giddings, Glenville. 478 Peachtree
St., N. E., Atlanta
Giddings, Glenville A.. Emory Uni-
versity Hospital, Emory l niversity
(Asso.)
Gillespie. Robert H.. 18 Fourth St.,
N. W., Atlanta
Gillette. Harriet E., 928 Peachtree
St.. N. E., Atlanta
Cinder. David R.. Emory University
School of Medicine, Emory Uni-
versity (Asso.)
Glenn. Wadley R.. 35 Linden Ave.,
N. E.. Atlanta
Glisson. C. Stedman. Jr., Medical
Arts Bldg., Atlanta
Gold, Perry, 54 Sixth St., N. E.,
Atlanta
Golden. Abner, Emory University
Hospital, Emory l niversity
(Asso.)
Goldsmith. W. S.. 36 N. Coates St.,
Daytona Beach, Fla. ( Hon.)
Goodpasture. . C., Medical Arts
Bldg., Atlanta
Goodwin. Franklin H., 478 Peach-
tree St., N. E., Atlanta
Goodwyn. Thomas P., 478 Peachtree
St., N. E., Atlanta
Goodyear, Wm. E., 490 Peachtree
St., N. E., Atlanta
Gordon, Samuel L.. 171 E. Post
Rd., White Plains, N. Y.
Graydon, E. L.. 680 W. Peachtree
St., N. W.. Atlanta
Green. Loula Margaret, 27 Eighth
St., N. E.. Atlanta
Greenberg, Irving L„ Grant Bldg.,
Atlanta
Greene, Edgar H., 478 Peachtree
St., N. E., Atlanta
Gregory, Hugh Hyden. Grady Mem.
Hospital, Atlanta (Asso.)
Griffin. Claude. Medical Arts Bldg.,
Atlanta
Griffin. Eugene L.. 1282 S. Oxford
Rd.. N. E., Atlanta
Grimes, Wm. H., Jr., 1259 Clifton
Rd.. N. E.. Atlanta
Grove, Lon Wr.. Medical Arts Bldg.,
Atlanta
Guilfoil, Paul H., Lawson VA Hos-
pital, Chamblee (Asso.)
Hackney, J. F., Health Dept. City
Hall, Atlanta
Hailey. Howard. 478 Peachtree St.,
N. E., Atlanta
Hailey. Hugh. Medical Arts Bldg.,
Atlanta
Hallum, Alton V., 478 Peachtree
St.. N. E., Atlanta
Hamff. L. Harvey. 478 Peachtree
St., N. E., Atlanta
Hamm, Wm. G.. Medical Arts Bldg.,
Atlanta
Hancock. Robert K.. 663 W. Peach-
tree St. N. E.. Atlanta
Hanes. 0. Eugene. 573 W. Peach-
tree St.. N. E.. Atlanta
Hankey, Daniel D.. Grady Mem.
Hospital. Atlanta (Asso.)
Hanner, James P.. Medical Arts
Bldg., Atlanta
Harper. Byron F., Jr.. 561 Lee St.,
St. W ., Atlanta
Harris, J. Frank, Medical Arts
Bldg.. Atlanta
Hathcock. Wrm. C., Grand Theatre
Bldg., Atlanta
Hauck. Allen E.. 478 Peachtree St.,
N. E„ Atlanta
Havnes, Grady 0., VA Tuberculosis
Hospital. Atlanta (Asso.)
Hearin. David L.. 478 Peachtree St.,
N. E.. Atlanta (Asso.)
Hecht. Emanuel B., 1181 Lee St.,
S. W., Atlanta
Helms. Wm. C„ 490 Peachtree St.,
N. E., Atlanta
Hendry, Wayland M., 478 Peachtree
St., N. E., Atlanta
Henry, Lamont, 30 Prescott St.,
N. E„ Atlanta
Hess, George. 505 McDonough Blvd.,
S. E., Atlanta (deceased)
Hew'ell. Guy C., 33 Ponce de Leon
Ave., N. E., Atlanta
Heyman, Albert, Grady Mem. Hos-
pital, Atlanta
Heyser, D. T., 190 Boulevard, S. E.,
Atlanta
Highsmith, E. D., 622 Moreland
Ave., N. E., Atlanta (Hon.)
Hill, Haywood N., 478 Peachtree
St., N. E., Atlanta
Hill, Wm. H., 478 Peachtree St.,
N. E.. Atlanta
Hilsman. Joseph H., Jr.. 123 Forrest
Ave., N. E., Atlanta
Hines, John H., Roswell
Hobby, A. Worth, 490 Peachtree
St., N. E., Atlanta
Hockenhull, John A., 1014 Hemphill
Ave., N. W., Atlanta
Hodges, Fred B.. Jr., 478 Peach-
tree St., N. E.. Atlanta
Hodges, J. H., Hapeville
Hodges, W:. A., 492 Page Ave.,
N. E., Atlanta (Hon.)
Hodgson. F. G.. Medical Arts Bldg.,
Atlanta
Hoffman. Byron J., 768 Juniper St..
N. E., Atlanta
Holliman, Henry D., Jr.. 490 Peach-
tree St.. N. E.. Atlanta
Holloway, Charles E., 490 Peach-
tree St., N. E„ Atlanta
Holloway, George A., 33 Ponce de
Leon Ave., N. E., Atlanta
Holmes, W'alter R.. 478 Peachtree
St., N. E„ Atlanta
Hope. H. F.. 663 Greenview Ave.,
N. E.. Atlanta
Hopkins, William A., Emory Uni-
versity Hospital, Emory L'niver-
sity
Hoppe, L. D., Medical Arts Bldg.,
Atlanta
Horton. B. E.. Grand Theatre Bldg.,
Atlanta (Hon.)
Howard, Chas. K., 561 Lee St., S.
W., Atlanta
Howard. P. M,. 431 E. John Wres-
ley Ave.. College Park
Howell. Stacy C., 490 Peachtree
St., N. E„ Atlanta
Hrdlicka. George R.. 551 Capitol
Ave., S. W.. Atlanta
Hudson. Paul L.. Trust Co. of Ga.
Bldg., Atlanta
Hughes, David J., Grady Mem. Hos-
pital, Atlanta (Asso.)
Huguley, Charles M., Jr.. Emory
University Hospital. Emory LTni-
versity
Huguley. G. Pope. 126 Forrest Ave.,
N. E., Atlanta
Huie,. Robert E., East Atlanta Bank
Bldg., Atlanta
Hunter, Conway. 770 Cypress St.,
N. E., Atlanta
Hurst. John W., 478 Peachtree St.,
N. E., Atlanta
Hutchins, J. T., 1704 Lakewood
Ave., S. E., Atlanta
Hydrick, Peter, 105 W?. Princeton
Ave., College Park
Inman. John S., Jr., Crawford W.
Long Mem. Hospital. Atlanta
(Asso.)
Ivey, John C., 743 W. Peachtree
St., N. E., Atlanta
Jackson, Zack W., 478 Peachtree
St., N. E., Atlanta
Jacobs, John L., 490 Peachtree St.,
N. E„ Atlanta
James, David F., Emory University
Hospital. Emory University
Jenkins, M. K.. 248 Randolph St.,
N. E., Atlanta
Jennings, James L., 152 Forrest
Ave., N. E., Atlanta
December, 1950
521
Jernigan, H. Walker, 478 Peachtree
St., N. E., Atlanta
Jernigan, Sterling H., 57 Sixth St.,
N. E., Atlanta
Johnson. McClaren, 478 Peachtree
St., N. E., Atlanta
Jones, Charles S., 663 W. Peach-
tree St., N. E., Atlanta
Jones, Eugenia C., 478 Peachtree
St., N. E., Atlanta
Jones, Jack W., Medical Arts Bldg.,
Atlanta
Josephs, Alvin D., 663 W. Peachtree
St., N. E., Atlanta
Kalish, John T.. VA Tuberculosis
Hospital, Atlanta (Asso.)
Kane, Tlios. M., Grand Theatre
Bldg., Atlanta
Kanthak, Frank F., Medical Arts
Bldg., Atlanta
Keller, A. Paul, Jr., Lawson VA
Hospital, Chamhlee (Asso.)
Kelley, L. H.. 478 Peachtree St.,
N. E., Atlanta
Kelley, W. A., 478 Peachtree St.,
N. E., Atlanta
Kelly, Janies D., 2724 Atwood Rd.,
N. E.. Atlanta
Kelly, Robert P„ Jr., Emory Univer-
ity Hospital. Emory University
Kemper, Clifton G., 478 Peachtree
St., N. E., Atlanta
Ke'ron, Hubert W., 2855 Peachtree
Rd., N. W„ Atlanta (Asso.)
Kev, Claud T., 1398 Beecher St.,
S. W.. Atlanta
King, Richard, 478 Peachtree St.,
N. E„ Atlanta
King, James T„ Medical Arts Bldg.,
Atlanta
King, John D., 35 Linden Ave.,
N. E., Atlanta
King, Lewell S., 105 W. Princeton
Ave., College Park
Kirkland, Spencer A., 478 Peach-
tree St., N. E., Atlanta
Kiser, Ellen Finley, 210 Peachtree
Circle, N. E., Atlanta (Asso.)
Kiser, W. H.. Jr., 33 Ponce de
Leon Ave., N. E., Atlanta
Kite, J. Hiram, 490 Peachtree St.,
N. E., Atlanta
Klugh, George F., 736 Piedmont
Ave., N. E., Atlanta
Koff, S. A., 805 Peaechtree Bldg.,
Atlanta
Kraft, FI. N., Candler Bldg., Atlanta
Krantz, Simon, Lawson VA Hos-
pital, Chamblee (Asso.)
Krugman, Philip I., 727 W. Peach-
tree St., N. E., Atlanta
Lahman, Rose A., 795 Peachtree
St., N. E., Atlanta
Lamm, J. Herman, Medical Arts
Bldg., Atlanta
Landham, J. W., 736 Piedmont Ave.,
N. E., Atlanta
Lange, J. Harry, 490 Peachtree St.,
N. E., Atlanta
Langmuir, Alexander D., U. S. Pub-
lic Health Service, Atlanta
(Asso.)
Lawrence, Charles E., Candler Bldg.,
Atlanta
Laws, C. L., Medical Arts Bldg.,
Atlanta
Leadingham, R. S., U. S. VA Hos-
pital, Murfreesboro, Tenn.
Lee, C. A., Citizens & Sou. Natl.
Bank Bldg., Atlanta
Leigh, Ted F., Emory University
Hospital, Emory University
Leonard, Wm. P., 478 Peachtree
St., N. E„ Atlanta
Lester, Wm. M., 1259 Clifton Rd.,
N. E., Atlanta
Letton, A. Id., 478 Peachtree St.,
N. E„ Atlanta
Levin, Harold B.. 662 W. Peachtree
St., N. W., Atlanta
Levin. Jack M., 727 W. Peachtree
St., N. E., Atlanta
Levy, Louis K., 663 W. Peachtree
St.. N. E., Atlanta
Lewis, John R., Jr., 478 Peachtree
St., N. E., Atlanta
Linch. A. O.. 157 Forrest Ave., N.
E., Atlanta
Lineback, Merrill I., Mass. Eye
and Ear Infirmary. Boston. Mass.
(Asso.)
Lipman. B. S., 663 W. Peachtree
St., N. E., Atlanta
Lip comb, Laura, India
Lipton. Harry R.. 490 Peachtree St.,
N. E., Atlanta
Lcgue, R. Bruce, Emory Llniversity
Hospital, Emory University
Lokey, H. M.. Medical Arts Bldg.,
Atlanta
Long, Leonard. Ga. Baptist Hos-
pital, Atlanta
Long, Stewart McL., Medical Arts
Bldg., Atlanta
Longino, D. R., 1344 Lanier Blvd.,
N. E., Atlanta
Longino, Grady E., '11th* Evacuation
Hospital, Ft. Hood, Tex. (Asso.)
Lovell, Woodrow W., Medical Arts
Bldg., Atlanta
Lower, Emory G., 745 Marietta St.,
N. W., Atlanta (deceased)
Lowance, Mason I., 478 Peachtree
St., N. E„ Atlanta
Ludington, Louis G., Ga. Baptist
Hospital, Atlanta (Asso.)
Lunsford, Guy G., 4010 Osborne
Rd., Chamblee
Lyon, Harry C., 677 Ponders Ave.,
N. W., Atlanta
Mabon, Robert, 478 Peachtree St.,
N. E., Atlanta
Maddox, Mr. Robert F., First Na-
tional Bank Bldg., Atlanta (Hon.)
Maholick, Leonard T., U. S. Army,
Washington, D. C. (Asso.)
Main, Emory H., 105 W. Princeton
Ave., College Park
Malone, O. T., 157 Forrest Ave.,
N. E., Atlanta
Mandel, Emanuel E., U. S. Public
Health Service, Chamblee (Asso.)
Manget, J. D., 118 Forrest Ave.,
N. E., Atlanta
Manget, J. D., Jr.. 118 Forrest Ave.,
N. E., Atlanta
Marsh, Lucille Johnson, U. S. Chil-
dren’s Bureau, Atlanta (Asso.)
Martin, Anthony J., 940 W. Peach-
tree St., N. W., Atlanta
Martin, Elisabeth, 56 Fifth St., N.
E., Atlanta
Martin, J. D., Jr., Emory l niversity
Hospital, Emory University
Martin, J. J., Edison
Martin, Wm. B., 1010 W. Peachtree
St.. \. W„ Atlanta
Martin, W. O., Jr., 478 Peachtree
St., N. E., Atlanta
Marvin, Charles P., 1010 W. Peach-
tree St., N. W„ Atlanta
Massee, Joseph C., 21 Eighth St.,
N. E., Atlanta
Matthews, O. H., 735 Piedmont
Ave., N. E., Atlanta
Matthews, Thomas V., 478 Peachtree
St., N. E., Atlanta
Matthews, Warren B., Medical Arts
Bldg., Atlanta
Mauldin, John T., 73 Eleventh St.,
N. E., Atlanta
Maulding, Homer R.. Medical Arts
Bldg., Atlanta
McCain, John R., Medical Arts
Bldg., Atlanta
McClelland, Spence. Medical Arts
Bldg., Atlanta
McClung, R. H., Chamber of Com-
merce Bldg., Atlanta
McClure, Robert E., VA Tubercu-
losis Hospital. Atlanta (Asso.)
McCord, J. R.. 810 E. Fifth St.,
Ocala. Fla. (Hon. I
McDaniel, J. G„ Grand Theatre
Bldg., Atlanta
McDonald, Harold P.. Healey Bldg.,
Atlanta
McDonald, Lewis H.. 490 Peachtree
St., N. E., Atlanta
McDonald, Paul, Bolton
McDougall. J. Calhoun. Medical
Arts Bldg., Atlanta
McDougall, W. L., 478 Peachtree
St., N. E., Atlanta (deceased)
McElroy, Joseph D.. 490 Peachtree
St., N. E., Atlanta
McGarity, William C., Emory Uni-
versity FFospital. Emory Univer-
sity (AssV>.)
McGee, Ro^\ W., 160 Pryor St.,
S. W., Atlanta
McGinty, A. Park. 762 Cypress St.,
N. E., Atlanta
McLain, Ernest K., VA Tubercu-
losis Hospital, Atlanta (Asso.)
McLoughlin. Christopher J., Medi-
cal Arts Bldg., Atlanta
McMillan, J. C., 115 S. Main St.,
College Park
McNiece, Estelle, 11 Seventeenth
St., N. E., Atlanta
McRae, Floyd W., Medical Arts
Bldg., Atlanta
Merren, David D., 53 Sixth St.,
N. E„ Atlanta
Merrill, Arthur J., 35 Fourth St.,
N. E., Atlanta
Mestre, Ricardo, VA Area Medical
Office, Atlanta (Asso.)
Michael, Max, Jr., Lawson VA Hos-
pital, Chamblee (Asso.)
Miles, F. C., Grand Theatre Bldg.,
Atlanta
The Journal of the Medical Association of Georgia
>22
.Miller. Mai C.. 478 Peachtree St.,
N. E.. Mlanta
Miller. Linus J.. 21 LaFayette Via\.
N. W„ Atlanta
Mills. C’arence W., Jr.. Medical
\rts Bldg.. Atlanta
Mims, F. C., Route 1, Lakemont
( Hon.)
Minnieh. Fredric R.. 490 Peachtree
St., N. E., Atlanta
Minnieh, Wm. R., Medical Arts
Bldg., Atlanta
Minor. Henry .. 157 Forrest Ave.,
N. E.. Atlanta
Mitchell, Charles H.. Army Medical
Center, Washington, D. C.
( Asso.)
Mitchell. Marvin A.. 490 Peachtree
St., N. E.. Atlanta
Mitchell, Wm. E.. Medical Arts
Bldg., Atlanta
Moncrief, W. M.. Jr., 151 Ponce
de Leon Ave.. N. E.. Atlanta
Monfort, J. M.. 478 Peachtree St..
N. E.. Atlanta
Moore. Lewis W.. Peoples Bank
Bldg., b inder
Moore. Wm. W„ Jr., 490 Peachtree
St.. N. E., Atlanta
Morris. A. L., Fairburn
Morris, J. L., Alpharetta
Morris. S. L., Jr.. 15 Fourth St.,
N. E., Atlanta
Moseley, Thomas H., Crawford W.
Long Mem. Hospital. Atlanta
( Asso.)
Mosley. Hugh G.. 663 W. Peachtree
St.. N. E., Atlanta
Mnrohv. Michael A .. Jr.. 21 Eighth
St.. N. E., Atlanta
Murphv, m. J.. 12 Capitol Square,
S. W„ Atlanta
Murray. Samuel D.. Standard Bldg..
Atlanta
Muse, L. H.. Medical Arts Bldg.,
N. E.. Atlanta
Mvers, Martin T.. Medical Arts
Bldg., Atlanta
Nabors. Dewey T.. 490 Peachtree
St.. N. E., Atlanta
Nardine, Gene. Oak Grove Rd.,
Route 2, Atlanta
Nardone. August J., St. Joseph's
Infirmary, Atlanta (Asso.)
Neelv. F. Levering. Medical Arts
Bldg., Atlanta
Nellans, C. T.. 105 Pryor St., N. E..
Atlanta
Nelson. Richard M.. 618 Cresthill
Ave.. N. E., Atlanta (Hon).
Nico'son, Wm. Perrin, Jr., 478
Peachtree St.. N. E., Atlanta
Niles. George A., Jr., 18 Fourth St.,
N. W., Atlanta
Nippert. Philip H., 478 Peachtree
St., N. E., Atlanta
Noel. Malcolm E.. 300 Capitol Ave.,
S. E., Atlanta
Norris. Jack C.. 490 Peachtree St..
N. E.. Atlanta
Norwood, Samuel W., 564 Lee St.,
S. W.. Atlanta
Olds, Bomar A., 138% Main St.,
College Park
O'Neal. Buford L., 478 Peachtree
St., N. E., Atlanta
Oppenheiiner, R. H.. 36 Butler St.,
S. E„ Atlanta
Osborne, \ . W., 427% Moreland
Ave., N. E.. Atlanta
Owenshy. N. M.. Medical Arts Bldg.,
Atlanta
Paine. C. H., 123 Forrest Ave.,
N. E., Atlanta
Parham, Leroy G„ Medical Arts
Bldg., Atlanta
Parks, Harry, Candler Bldg., At-
lanta
Pate, Julien C., Jr., First Natl.
Bank Bldg., Tampa, Fla. (Asso.)
Patterson, John L.. Jr., 1302 Emory
Rd., N. E„ Atlanta
Patterson, Joseph 1L. 104 Ponce de
Leon Ave., N. E., Atlanta
Paullin, James E., Medical Arts
Bldg., Atlanta
Paullin. William L., Jr.. Medical
Arts Bldg., Atlanta
Peacock, Lamar B., 478 Peachtree
St., N. E„ Atlanta
Pendergrast, Wm. J.. 478 Peachtree
St.. N. E., Atlanta
Pentecost. M. P.. 478 Peachtree
St., N. E., Atlanta
Perry, Samuel W., 490 Peachtree
St., N. E., Atlanta
Person, W. E.. Candler Bldg., At-
lanta
Pe<ers. Margaret Polk. 614 E. Ponce
de Leon Ave.. Decatur
Petrie, Lester M.. Ga. Dept, of
Public Health, Atlanta
Phillips, H. S.. 1738 Homestead
Ave., N. E., Atlanta
Phyrdas, Irene A., YA Regional
Office, Atlanta (Asso.)
Pierotti. Ju'ius V., 478 Peachtree
St., N. E., Atlanta
Pilkington. Joseph W.. 204 Second
St., N., St. Petersburg, Fla.
(Asso.)
Pinson, C. H.. Alpharetta I Hon.)
Pittman. James L., 478 Peachtree
St.. N. E.. Atlanta
Poer. David Henry, Medical Arts
Bldg., Atlanta
Poliakoff. Samuel R.. 26 Linden
Ave.. N. E., Atlanta
Powell, Vernon E„ 763 Juniper St.,
N. E., Atlanta
Pratt. Caroline K.. 879 Glen Arden
Way, N. E., Atlanta
Price, Harry J., Lawson VA Hos-
pital, Chamblee (Asso).
Priviteri, Charles A., VA Hospital,
Buffalo, N. Y. (Asso.)
Proctor. W. H„ Jr., Lawson VA
Hospital, Chamblee
Pruce, Arthur M., 890 W. Peachtree
St., N. W., Atlanta
Pruce, Marta, VA Regional Office,
Atlanta (Asso.)
Pruitt. M. C.. Medical Arts Bldg.,
Atlanta
Quigley. Thomas A.. Jr., Gulfport,
M iss. (Asso.)
Quillian, G. W., 1216 N. Rolfe St.,
Arlington, Va. (Hon.)
Quillian, W. E.. Medical Arts Bldg.,
Atlanta
Ragan. W. E„ Jr., 25 Third St.,
N. E„ Atlanta
Raiford, Morgan B., 144 Ponce de
Leon \ve., N. E., Atlanta
Rankin. Joseph L., Medical Arts
Bldg., Atlanta
Rankine, C. A. N„ 3997 Peachtree
Rd., Brookhaven
Ransmeier, John C., Lawson VA
Hospital, Chamblee (Asso.)
Rapp. Edwin W., VA Tuberculosis
Hospital, Atlanta (Asso.)
Rasmussen, Earl, Medical Arts
Bldg., Atlanta
Rauber, Albert P.. 490 Peachtree
St., N. E., Atlanta
Rauiszer. Hubert, Candler Bldg.,
Atlanta
Rayle. Albert A.. 478 Peachtree
St., N. E., Atlanta
Rayle. Albert A., Jr.. 36 Butler St.,
S. E.. Atlanta
Read, Ben S., Medical Arts Bldg.,
Atlanta
Read. Joseph C.. Medical Arts Bldg..
Atlanta
Redd, S. C., 645 Lee St., S. W„
Atlanta
Reed, Clinton, Candler Bldg., At-
lanta
Reed. John Hamilton, Jr., Grand
Theatre Bldg., Atlanta
Reider. Reuben F„ U. S. Public
Health Service, Atlanta (Asso. I
Rhodes, C. A.. 126 Forrest Ave.,
N. E.. Atlanta
Rice. Guy V., Ga. Dept, of Public
Health. Atlanta
Rice. Keith C., Medical Arts Bldg.,
Atlanta
Richardson, Jeff L.. 1028 W. Peach-
tree St.. N. W., Atlanta
Ridley, H. W.. Grant Bldg., Atlanta
Ridley. John H., Medical Arts Bldg..
Atlanta
Rinser. Charles, 819 Cypress St.,
N. E., Atlanta
Reith. Paul I... Medical Arts Bldg.,
Atlanta
Riley, Julian G., 490 Peachtree St.,
N. E., Atlanta
Roach. George, 144 Ponce de Leon
Ave., N. E., Atlanta
Roberts, C. Purcell, 762 Cypress
St., N. E., Atlanta
Roberts, M. Hines, 33 Ponce de
Leon Ave.. N. E., Atlanta
Robertson. Rov L., Grady Mem.
Hospital. Atlanta (Asso.)
Robinson, R. L.. 1944 Bankhead
Ave., N. W., Atlanta
Rogers. J. Harry. 490 Peachtree St.,
N. E., Atlanta
Rosborough, Wm. Daniel. VA
Tuberculosis Hospital. Atlanta
(Asso.)
Rosenberg, Albert A.. 53 Sixth St.,
N. E„ Atlanta
Rosenberg, H. J., 478 Peachtree
St., N. E., Atlanta
Roughlin, L. C.. First Natl. Bank
Bldg., Atlanta
December, 1950
523
Rudder, Fred F., 490 Peachtree St.,
N. E., Atlanta
Rumble, Lester, Jr., St. Joseph’s
Infirmary, Atlanta (Asso.)
Rushin. C. E., 478 Peachtree St.,
N. E., Atlanta
Russell. David A., Jr., Grand The-
atre Bldg., Atlanta
Sage, Dan V., Medical Arts Bldg.,
Atlanta
Sanchez, A. S., 84 Marietta St.,
Atlanta
Sanders, A. S., 118 Forrest Ave.,
N. E., Atlanta
Sandison, J. Calvin, 478 Peachtree
St., N. E., Atlanta
Scarborough, J. Elliott, Emory
University Hospital, Emory Uni-
versity
Scheinbaum, C. N., 1019 W. Peach-
tree St., N. E., Atlanta
Schenck, H. C., Ga. Dept, of Public
Health, Atlanta
Schneider, J. F.. First Natl. Bank
Bldg., Atlanta
Schroder, J. Spalding, Emory Uni-
versity Hospital, Emory University
Schroeder. Paul L., 490 Peachtree
St., N. E., Atlanta
Scott, Wilbur M„ Grady Mem.
Hospital, Atlanta (Asso.)
Sealey. R. M., Medical Arts Bldg.,
Atlanta
Sellers, T. F., Ga. Dept, of Public
Health, Atlanta
Selman. W. A., 157 Forrest Ave.,
N. E., Atlanta
Servians, James H.. 34 Seventh St.,
N. E., Atlanta
Shackleford, B. L., Medical Arts
Bldg., Atlanta
Shanks, Edgar D., 478 Peachtree
St., N. E., Atlanta
Shea, Patrick C., Jr., Grady Mem.
Hospital, Atlanta (Asso.)
Sheldon, Walter H., Grady Mem.
Hospital, Atlanta
Shepard. V. Duncan, 663 W'. Peach-
tree St., N. E., Atlanta
Simpson, James R., 490 Peachtree
St„ N. E., Atlanta
Sims, Marshall R.. 157 Forrest Ave.,
N. E., Atlanta
Sinkoe, S. J., Candler Bldg., Atlanta
Skiles, W. Vernon. Jr., 56 Fifth
St., N. E., Atlanta
Skobba, J. S., 490 Peachtree St.,
N. E., Atlanta
Slade, Helen Benedict, 409 Collier
Rd., N. W., Atlanta (Asso.)
Slade, John deR., 768 Juniper Sr.,
N. E., Atlanta
Sloan, W. P., Candler Bldg., At-
lanta
Sloan, W. P., Jr. Candler Bldg.,
Atlanta
Smith, Carter, Medical Arts Bldg.,
Atlanta
Smith. Charles W., 57 Sixth St.,
N. E„ Atlanta
Smith, Joel Perry, 26 Uinden Ave.,
N. E., Atlanta
Smith, Linton M., 427)4 Moreland
Ave., N. E., Atlanta
Smith, M. F., 918 Bankhead Ave.,
N. W., Atlanta
Smith, Randolph, 478 Peachtree St.,
N. E„ Atlanta
Smith, W. A., Medical Arts Bldg.,
Atlanta
Spier, Eugene, Piedmont Hospital,
Atlanta
Stampa, Samuel, Candler Bldg., At-
lanta
Staton, T. R., 478 Peachtree St.,
N. E., Atlanta
Steadman, Henry E., 3021 Stewart
Ave., Hapeville
Stelling, Henry G„ 3076)4 Roswell
Rd., N. W., Atlanta
Stephens, A. Leslie, Jr., 478 Peach-
tree St., N. E., Atlanta
Stephenson, Robert H., 490 Peach-
tree St., N. E., Atlanta
Stewart. Calvin B., 478 Peachtree
St., N. E., Atlanta
Stillerman, Hyman B., 26 Linden
Ave., N. E., Atlanta
Stoddard, S. D., Ga. Institute of
Technology, Atlanta
Stone, Chas. F., Jr., Medical Arts
Bldg., Atlanta
Stoneburner, Lawson W., Lawson
VA Hospital, Chamblee (Asso.)
Stoner, Cyrus H., Candler Bldg.,
Atlanta
Strickland, Maurice A., 106 N.
East Point St., East Point
Strickler, C. W., 123 Forrest Ave.,
N. E., Atlanta
Strickler, Cyrus W„ Jr., 123 Forrest
Ave., N. E., Atlanta
Stubbs, George M., Grady Mem.
Hospital, Atlanta (Asso.)
Sturdevant, Clinton E., Healey
Bldg., Atlanta
Sunderman, F. W., U. S. Public
Health Service, Atlanta (Asso.)
Supan, Peter C., U. S. Naval Air
Dispensary, Healey Bldg., Atlanta
(Asso.)
Swanson, Cosby, 478 Peachtree St.,
N. E., Atlanta
Swanson, Homer, S., Emory Univer-
sity Hospital, Emory University
Tabb, William G., Jr., Medical Arts
Bldg., Atlanta
Tankesley, Robert M., 478 Peach-
tree St., N. E., Atlanta
Tanner, James C., Jr., Crawford
W. Long Mem. Hopital, Atlanta
(Asso.)
Taranto, Morris B., Mortgage Guar-
antee Bldg., Atlanta
Tarplee, Scott L., 29 Twelfth St.,
N. E., Atlanta
Taylor, W'. J., 1677 Sylvan Rd., S.
W., Atlanta
Teate, Hentz L., Jr., 104 Ponce de
Leon Ave., N. E., Atlanta
Teplis, Paul, 826 Sherwood Rd.,
N. E., Atlanta (Asso.)
Thebaut, Ben R., Candler Bldg.,
Atlanta
Thomason, C. Griggs, 106 N. East
Point St., East Point
Thomason, W. L., 157 Forrest Ave.,
N. E., Atlanta
Thompson, D. O., 478 Peachtree St.,
N. E., Atlanta
Thompson, Edgar A., El Centro,
Calif. (Asso.)
Thompson, F. IL, Crawford W'.
Long Mem. Hospital. Atlanta
( Asso.)
Thompson, John W., 27 Eighth St.,
N. E., Atlanta
Thompson, Ralph M., VA Regional
Office, Atlanta (Asso.)
Thompson, Wm. R., 73 Eleventh
St., N. E., Atlanta
Thornton, Lawson, 478 Peachtree
St., N. E., Atlanta
Thoroughman, James C., 2888 Hab-
ersham Rd.. N. W., Atlanta
Tidmore, T. L., Piedmont Hospital,
Atlanta
Timberlake, G. B., Candler Bldg.,
Atlanta
Timberlake, Lloyd F., 35 Fourth
St., N. E., Atlanta
Tootle, George S., Grady Mem.
Hospital, Atlanta (Asso.)
Treusch, Herbert L., 1745 Harvard
St., N. W., Washington, D. C.
(Hon.)
Trimb'e, W. H., 478 Peachtree St.,
N. E., Atlanta
Trincher, Irvin H., Pinehurst, N. C.
Tucker. Robert P., 100)4 N. Main
St., East Point
Turk, L. N., Jr., Candler Bldg.,
Atlanta
Turner, August B., Grady Mem.
Hospital, Atlanta (Asso.)
Turner, Edwin W.. 100)4 N. Main
St., East Point
Turner, John W.. 151 Ponce de
Leon Ave.. N. E., Atlanta
Turrentine, Paul E„ 478 Peachtree
St., N. E„ Atlanta
Upchurch, W. E., Healey Bldg.,
Atlanta
Upshaw, C. B., 18 Fourth St., N. W.,
Atlanta
Us^er. Glen S„ U. S. Public Health
Service, Atlanta (Asso.)
Van Ruren. E., 768 Juniper St.,
N. E„ Atlanta
Van Dvke, A. H.. Grant Bldg.,
Atlanta
Varner. John B., 478 Peachtree St..
N. E., Atlanta
Veatch, Jesse W., Jr., 490 Peach-
tree St., N. E., Atlanta
Velkoff. Abraham S., 490 Peachtree
St., N. E., Atlanta
Vella, Paul D.. 1010 W. Peachtree
St., N. E., Atlanta
Vinson, C. D., 72 Anniston Ave.,
S. E., Atlanta
Vinton. Luther M., 478 Peachtree
St., N. E., Atlanta
Visanska, Samuel A., 1021 St.
Charles Ave., N. E., Atlanta
(Hon.)
Vonderlehr. R. A., 1409 Fairview
Rd., N. E., Atlanta (Asso.)
Wagar, Anne W., 1280 Peachtree
St., N. E., Atlanta
Wagnon, George N., Medical Arts
Bldg., Atlanta
Walker, Exum, 490 Peachtree St.,
N. E., Atlanta
524
The Journal of the Medical Association of Georcia
Walker. J. Frank, Lawson YA Hos-
pital. Chamblee (Asso.)
Walker. John R.. 922 W. Peachtree
St.. N. W., Atlanta
Wall. Hilton F., 21 Eighth St.,
N. E., Atlanta
Walton, John M., 418 Capitol Ave..
S. E., Atlanta
\\ aid. Emmett, Medical Vrts Bldg.,
Atlanta
Ward, Wm. Cleveland, 36 Butler
St.. S. E., Atlanta
Warner, W. P., Jr.. 478 Peachtree
St.. N. E., Atlanta
Warnock, C. Murray, 478 Peach-
tree St., N. E., Atlanta
Warren, James V., Emory Univer-
sity Hospital, Emory University
( Asso.)
Warren. Win. C., Jr., 478 Peachtree
St.. N. E., Atlanta
Waters. Wm. C., Jr., 663 W. Peach-
tree St., N. E., Atlanta
Watters, Julian Q.. Medical Arts
Bldg., Atlanta
Weaver, J. C., 78 Ellis St., N. E.,
Atlanta (Hon.)
W eens, H. S.. Grady Mem. Hospital,
Atlanta
Weinberg, James I.. 490 Peachtree
St., N. E., Atlanta
Weinherg, S. P., 704 Piedmont Ave.,
N. E., Atlanta
Weinstein, A. A.. 663 W. Peachtree
St., N. E., Atlanta
Weitz, Frank, 780 Juniper St., N. E.,
Atlanta
West, C. M., Candler Bldg., Atlanta
West, Edward M., Crawford W.
Long Mem. Hospital, Atlanta
( Asso.)
Whipple, Robert L., Jr., Medical
Arts Bldg., Atlanta
Whitaker, William G., Jr., 490
Peachtree St., N. E., Atlanta
White, James R., 478 Peachtree St.,
N. E., Atlanta
Whorton, Carl W., Grady Mem.
Hospital, Atlanta (Asso.)
Wilker, Irving. Ft. McPherson, Lee
St., S. W., Atlanta (Asso.)
Wilkins, S. A., Jr., Emory Univer-
sity Hospital. Emory University
Williams, George A., Medical Arts
Bldg., Atlanta
Williams, Thomas H., Grady Mem.
Hospital, Atlanta (Asso.)
Willingham, T. L, 56 Fifth St.,
N. E., Atlanta
Will is, Augusta Elizabeth, Lawson
VA Hospital, Chamblee (Asso.)
Wilmer, John Grant, Medical Arts
Bldg., Atlanta
Wilson, Joseph S„ Grady Mem.
Hospital, Atlanta (Asso.)
Wilson, Richard B., 490 Peachtree
St., N. E., Atlanta
Winstead, George A., Grady Mem.
Hospital. Atlanta (Asso.)
Woddial, Joseph D., Grand Theatre
Bldg., Atlanta
Wolff, Bernard P., Medical Arts
Bldg., Atlanta
Wood. R. Hugh, Emory l niversity
School of Medicine, Atlanta
Woolley, Lawrence F., 490 Peach-
tree St.. N. E., Atlanta
Worth, Jack J.. Jr., 478 Peachtree
St., N. E., Atlanta
Wright, E. S„ Medical Arts Bldg.,
Atlanta
Yampolsky, Joseph, 478 Peachtree
St., N. E., Atlanta
Yarn, Charles P., Lawson VA Hos-
pital, Chamhlee (Asso.)
York. Jesse H„ Medical Arts Bldg.,
Atlanta
GLYNN COUNTY
Officers
President ...Willis, T. V.
Vice-President Moore, H. L.
Secretary-Treasurer Johnston, T. H.
Delegate Collier, Thomas W.
Alternate Delegate.-McDaniel, S. P.
Censors: Kirchman, Herbert; Tow-
son, Ira G.; and Valente, Louis A.
Members
Avera, J. B., Brunswick
Brawner, L. E., St. Simons Island
Burford, Robert S., Brunswick
Coe, H. M., Brunswick
Collier, Thomas W., Brunswick
Greer, C. B., Brunswick
Harris, B. W., Memphis, Tenn.
Hicks, James M., Brunswick
Johnston, Thomas H., Brunswick
Kirchman, Herbert, Brunswick
McDaniel, S. P., Brunswick
Mitchell, Frank B.. Jr., Brunswick
Moore, Haywood L., Brunswick
Muse, Jesse Phillip, Brunswick
Rohben, Francis J., Brunswick
Simmons, James O., Woodbine
Simmons, J. W., Brunswick
Towson, Ira G., Sea Island
Valente, Louis Anthony, Darien
Willis, Tom Vann, Brunswick
Wilson, C. A., Jr., Brunswick
Winchester, M. E., Brunswick
GORDON COUNTY
Officers
President Billings, J. E.
Vice-President Walter, R. D.
Secretary-Treasurer. Lang, Lewis R.
Delegate Hall, W. D.
Alternate Delegate. Billings, J. E.
Members
Acree, M. A., Calhoun
Banks, George T„ Fairmount (Hon.)
Barnett, W. R., Calhoun (Hon.)
Billings, J. E., Calhoun
Hall, W. D., Calhoun
Lang, Lewis R., Calhoun
Richards, Charles K., Calhoun
Steele, Byron Harold, Fairmount
Walter, R. D., Calhoun
GRADY COUNTY
Officers
President Reynolds, A. B.
Secretary-Treasurer Rogers, J. V.
Delegate Rogers, J. V.
Members
Arline, T. J., Cairo (Hon.)
Beale, George L., 14800 Bay Shore
Drive, Maderia Beach, St. Peters-
burg, Fla.
Hancock, Sidney Lanier, Cairo
Rehberg, A. W„ Cairo
Reynolds, A. B., Cairo
Reynolds. 11. M„ Cairo
Rogers. J. V., Cairo
Rogers, J. V., Jr.. Grad} Mem.
Hospital, Atlanta
Walker, W. A., Cairo (Hon.)
Warnell, J. B., Cairo
GREENE COUNTY
Officer
President Killam. F. H.
Members
Etheridge, Wm. N., Greensboro
Killam, F. H., Greensboro
McGuire, Thomas Howard, Houston,
Texas
GWINNETT COUNTY
Officers
President.. Chastain, J. R.
Vice-President Hutchins, W. J.
Sec.-Treas Smith, Reuben E.
Delegate ... Puett, W. W.
Alternate Delegate Mason, M. H.
Members
Chastain. Jos. Robert, Buford
Ezzard, W. P„ Lawrenceville
Cain, Sylvester, Jr., Norcross
Hinton, Samuel Herbert, Lawrence-
ville
Hutchins, Harry, Buford
Hutchins, W. J., Buford
Kelley, D. C., Lawrenceville
Mason, Miles Herbert, Duluth
Puett, W. W., Norcross
Sims. Fayette Alfred, Jr., Lawrence-
ville
Smith, Reuben E., Buford
Williams, Andrew D.. Lawrenceville
HABERSHAM COUNTY
Officers
President Garrison, D. H.
Vice-President Hardman, C. T.
Sec.-Treas. Nicholson, George T.
Delegate Walker, J. L.
Alt. Delegate... Nicholson. George T.
Censors: Arrendale, Joe J.; and
Roberts, B. J.
Members
Arrendale, Joe J., Cornelia
Barrett, Clara, Ga. Dept, of Public
Health, Atlanta
Brabson, T. H., Cornelia
Garrison, D. H., Clarkesville
Hardman, C. T., Tallulah Falls
Nicholson, George T„ Cornelia
Roberts, B. J., Cornelia
Tolhurst, George Monroe, Cleveland
Walker, J. L., Clarkesville
HALL COUNTY
Officers
President Hardman. Billy S.
Vice-Pres Nalley, Wm. Benjamin
Sec.-Treas Whitworth, C. W.
Delegate Hardman, Billy S.
Alt. Delegate McCrum, Barton A.
Censors: Sirmons, Derrell C.; Gar-
ner. W. Raleigh, and Whitworth,
C. W.
December, 1950
525
Members
Burns, J. K., Jr., Gainesville
Burns, John Knox, III, Gainesville
Butler, C. G., Gainesville
Cheek, Pratt, Gainesville
Chandler, B. B., Gainesville
Davis, Bradley B., Gainesville
Garner, W. Raleigh. Gainesville
Gilbert. Ben P., Gainesville
Grove, E. W.. Gainesville
Hardman, Billy S„ Gainesville
Howard, Marcus L., Dahlonega
Hulsey, John M., Jr., New Holland
Joiner. Hartwell, Gainesville
Lancaster. H. H.. New Holland
McCarver, W. C., Jr., Gainesville
McCrum, Barton A., Gainesville
Meeks, Jesse L., Gainesville
Nalley. William Benjamin. Helen
Neal. L. G., Cleveland
Neal. L. G., Jr., Cleveland
Rogers. R. L., Gainesville
Sirmons. Derrell C., Dahlonega
Smith, J. Gregg, Gainesville
Titshaw, H. S„ Gainesville
Valentine, Herbert Edward, Jr.,
Gainesville
Ward. Eugene L., Gainesville
Whelchel, C. D.. Gainesville
Whitworth. C. W., Gainesville
HANCOCK COUNTY
Officers
President Darden, Horace
Vice-President Jernigan, C. S.
Secretary-Treasurer Earl, H. L.
Delegate Jernigan, C. S.
Members
Darden, Horace, Sparta (Hon.)
(deceased)
Earl, H. L., Sparta
Elam, Lincoln Patrick, Sparta
Hutchings, Ernest H.. Sparta
Jernigan. C. S., Sparta
HART COUNTY
Officers
President Harper, George T.
Sec.-Treas Cacchioli, Louis G.
Delegate Milford, J. Hubert
Members
Cacchioli, Louis, G., Hartwell
Harper, G. T., Dewy Rose
McCurry, W. E.. Hartwell (Hon.)
Milford, J. Hubert, Hartwell
HENRY COUNTY
Officers
President Brandon, R. V.
Vice-President Foster, G. R.. Jr.
Secretary-Treasurer Ellis, H. C.
Members
Brandon, R. V., McDonough
Ellis, H. C., McDonough (Hon.)
Foster, Gordon R., Jr., McDonough
HOUSTON-PEACH COUNTIES
Officers
Sec.-Treas Hendrick, A. G.
Delegate Marshall, A. Smoak
Alt. Delegate Hendrick, A. G.
Members
Hendrick, A. G., Perry-
Marshall, A. Smoak, Fort Valley
JACKSON-B ARROW
COUNTIES
Officers
President Rogers, A. A., Jr.
Vice-President Randolph. W. Q.
Sec.-Treas. Etheridge, Edwin H.
Delegate Russell, Alex B.
Alt. Delegate. Rogers, A. A., Jr.
Members
Allen, M. B„ Hoschton
Bowdoin. W. H.. Statham
Etheridge, Edwin Holt. Winder
Harris, E. R.. Winder
Lord, C. B., Jefferson
McDonald, E. M„ Winder
Pittman, 0. C., Commerce
Randolph, W. Q.. Winder
Randolph, W. T.. Winder
Rogers, A. A., Commerce
Rogers, A. A., Jr., Commerce
Russell, Alex B.. Winder
Scoggins, P. T.. Commerce
Stovall. J. T., Jefferson
JASPER COUNTY
Officers
President Belcher, F. S.
Vice-President Fisher, Albert. Jr.
Sec.-Treas... Lancaster. E. M.
Delegate Belcher. F. S.
Members
Belcher, F. S., Monticello
Fisher, Albert. Jr., Monticello
Lancaster, E. M., Shady Dale
JEFFERSON COUNTY
Officers
President Revell, Walter J.
Vice-President Williams, C. Roy
Sec.-Treas Pilcher, James W.
Delegate Williams, C. Roy
Alternate Delegate . Lewis. John R.
Members
Bryant, V. L., Wadley
Lewis, J. R., Louisville
Pilcher, John J., Wrens
Pilcher, James W., Louisville
Revell. Walter J.. Louisville
Wiliams, C. Roy, Wadley
JENKINS COUNTY
Officers
Sec.-Treas. ..Thompson, Cleveland
Delegate Lee, H. G.
Alt. Delegate Simmons, Wm. G.
Members
Hawkins, Katrine Rawls, Sylvania
Lee, H. G„ Millen
Mulkey, A. P., Millen
Mulkey, Q. A., Millen
Simmons, William G., Sylvania
Thompson, Cleveland, Waynesboro
LAMAR COUNTY
Officers
President Jackson. J. H.
Vice-President Pritchett. D. W.
Sec.-Treas Traylor. S. B.
Delegate Corry, J. A.
Members
Corry, J. A., Barnesville
Crawford, John B., Barnesville
Jackson, J. H., Barnesville
Pritchett, D. W„ Barnesville
Traylor. S. B., Barnesville
LAURENS COUNTY
Officers
President Fernan-Nunez, M.
Vice-President Hodges, Chas. A.
Secretary-Treasurer. Cheek, 0. H.
Delegate Cobb. Tyrus R., Jr.
Alt. Delegate Hodges, Chas. A.
Censors: Coleman, A. T. ; Moye,
G. C.; Barton. J. J.: and Dodd,
Wm. A.
Members
Barton, J. J., Dublin (Hon.)
Bell, John A.. Jr., Dublin
Bloise, Francis I., VA Hospital,
Dublin (Asso.)
Brandes, Peter. \ A Hospital, Dublin
( Asso.)
Brantley, J. G.. Wrightsville
Bush, James L.. Dublin
Carter, J. G., Scott
Cheek, 0. H.. Dublin
Cheney, Fred D.. VA Hospital. Dub-
lin (Asso.)
Claxton, E. B., Dublin
Cobb. Tyrus R., Jr., Dublin
Coleman, A. T., Dublin
Coleman, Fred J.. Dublin
Coyle, Joseph A., \ A Hospital,
Dublin (Asso.)
Cullen, Milton L.. \ A Hospital,
Dublin (Asso.)
Dodd, William Asa. Wrightsville
Fernan-Nunez. M., Dublin
Hodges, C. A., Dublin
Karpat, Robert, VA Hospital, Dub-
lin (Asso.)
Lanier, L. I., Soperton
Moye, C. G., Brewton
Mullins, Glenn. VA Hospital. Dub-
lin (Asso.)
Quinn. David E., VA Hospital. Dub-
lin (Asso.)
Singer, S. B., \ A Hospital. Dublin
(Asso.)
Stapleton, James V .. \ A Hospital,
Dublin (Asso.)
Ware, A. D., Toomsboro
MACON COUNTY
Officer
Sec.-Treas Adams, Thos. M.
Members
Adams. J. Fred, Montezuma
Adams, Thos. M., Montezuma
Derrick, H. C., Oglethorpe
Frederick, D. B., Marshallville
(Hon.)
McDuffie county
Member
Riley, B. F.. Jr., Thomson
MERIW ETHER-HARRIS
COUNTIES
Officers
President Jackson, H. C.
Vice-President Raper. Stuart
Secretary-Treasurer. Gilbert, R. B.
Delegate Irw-in, C. E.
Alternate Delegate.. ... Raper, Stuart
Members
Allen, W. P., Woodbury
Bennett, Robert L., Warm Springs
Bennett, V. H.. Gav
Ellis, W. P., Chipley
Gilbert, R. B„ Greenville
Irwin, C. E., W arm Springs
526
The Journal of the Medical Association of Georgia
Jackson, Henry Calvin, Manchester
Jackson, T. W., Manchester (Hon.)
Johnson, J. A., Manchester
Johnson, James A.. Jr., Manchester
Kirkland, W. P„ Manchester
Raper, Stuart, Warm Springs
MITCHELL COUNTY
Officers
President Howard, C. L.
Vice-President Stevenson, C. A.
Secretary-Treasurer— .Belcher, D. P.
Delegate Brim, J. C.
Alternate Delegate William, M. W.
Members
Belcher, D. P.. Pelham
Brim, J. C., Pelham
Crovatt, J. G., Camilla
Howard, C. L., Pelham
McNeill, A. A., Jr., Camilla
Pirkle, James C., Pelham
Roles, C. L., Camilla
Stevenson, C. A., Camilla
Walker, Edwin Mercer, Pelham
Williams, M. W„ Camilla
MONROE COUNTY
Officers
President-. Alexander, George H.
V.-Pres Bramblett, A. Walter, Jr.
Sec.-Treas. Lane, George M.
Delegate Alexander, George H.
Members
Alexander, George H., Forsyth
Bramblett, A. Walter, Jr., Forsyth
Goolsby, R. C., Sr., Forsyth (Hon.)
Hodges, Thomas Lumpkin, Jr., U.
S. Naval Hospital, Oakland, Calif.
Lane, George Mitchell, Thomson
MONTGOMERY COUNTY
Officers
President . Moses, W. M.
Vice-President Hunt, J. E.
Secretary -Treasurer— -Palmer, J. W.
Delegate Kusnitz, Morris, Jr.
Members
Moses, W. M., Uvalda
Palmer, J. W., Ailey
Hunt. J. E., Box 143, Bynum, Ala.
Kusnitz, Morris, Jr., Alamo
MORGAN COUNTY
Officers
President Nicholson, J. H.
Secretary-Treasurer.-McGeary, W. C.
Delegate McGeary, W. C.
Alt. Delegate Nicholson, J. H.
Members
Dickens, C. H., Madison
McGeary, W. C., Madison
Nicholson, J. H., Madison
Porter, J. L., Rutledge (Hon.)
White, Edward Olin, Madison
MUSCOGEE COUNTY
Officers
President Wolff, Luther H.
Vice-President -Love, William G.
Sec.-Treas... Hughston, Jack C.
Delegate Hutto, George M.
Delegate Love, William G.
Alternate Delegate Storey, W'. E.
Alternate Delegate Murray, G. S.
Censors: Berman, Dave; Boy ter,
Henry H., and Schuessler, George
Members
Beach. Bessie Mae, Martin Bldg.,
Columbus
Berman, Dave, Doctors Bldg., Colum-
bus
Berry, Arthur N., Medical Arts
Bldg., Columbus
Bickerstaff, H. J., Medical Arts
Bldg., Columbus
Blanchard, Mercer, 204 Eleventh
St., Columbus
Blanchard, Mercer Carl, 204 Elev-
enth St., Columbus
Bovter, Henry H., 204 Eleventh St.,
Columbus
Brannen, O. C., Murrah Bldg., Co-
lumbus
Bush, John, 1340 Fourth Ave.,
Columbus
Butler, Clarence C., Medical Arts
Bldg., Columbus
Cain. Elisha J., Medical Arts Bldg.,
Columbus
Carter, Curtis B., 1545 Third Ave.,
Columbus (Hon.)
Chipman, R. A., Swift Bldg., Co-
lumbus
Comstock, George W.. U. S. Public
Health Service, Columbus
Conner. George R.. 1229 Second
Ave., Columbus
Cook. Wm. C., Swift Bldg., Colum-
bus
Cooke,' W. L., Doctors Bldg., Colum-
bus (Hon.)
Cosby, F. L., Doctors Bldg., Colum-
bus
Curtiss, Edgar J.. Doctors Bldg..
Columbus (Hon.)
DiHard. Guy J.. Medical Arts Bldg.,
Columbus
Durden, John G., Jr., 1327 Third
Ave., Columbus
Dykes, A. N., 1229 Second Ave.,
Columbus
Edwards. Franklin D.. 1344 Second
Ave., Columbus
Elder. Ivan R., 1229 Second Ave.,
Columbus
Elkins. James A., 1327 Third Ave.,
Columbus
Fletcber, H. Quigg, Jr.. 1327 Third
Ave., Columbus
Fox. Brent, Medical Arts Bldg.,
Columbus
Freeman. Edward R.. 1340 Fourth
Ave., Columbus (deceased)
Gibson. R. L., Murrah Bldg., Colum-
bus
Gilliam, O. D., Doctors Bldg.,
Columbus
Graffagnino. Peter C., Medical Arts
Bldg., Columbus
Henderson. Charles W„ Swift Bldg.,
Columbus
Hughston. Jack C., Medical Arts
Bldg., Columbus
Hutto, George M., Medical Arts
Bldg.. Columbus
Jenkins, W. F., 1444 Fourth Ave.,
Columbus
Jones, Wm. R., Doctors Bldg.,
Columbus
Jordan, W. P., 1119 Fourth Ave..
Columbus
Jordan, W. P., Jr., 1119 Fourth Ave.,
Columbus
Land, Polk S., Doctors Bldg., Colum-
bus
Love, William G., Medical Arts
Bldg., Columbus
Mayher, J. W., 1344 Second Ave.,
Columbus
Mayher, Will E., 1344 Second Ave.,
Columbus
McDuffie, J. H„ Jr., 1120 Third
Ave., Columbus (deceased)
McWhorter, M. R„ 1338 Fourth
Ave., Columbus
Monaco, A. Ralph, City Hospital,
Columbus
Moses, Alice, 1413 Second Ave.,
Columbus
Munn, E. K., Murrah Bldg., Colum-
bus
Murray, G. S., Swift Bldg., Colum-
bus
Peeples, Wm. J., Linwood Clinic,
Columbus
Rhea. James W., Swift Bldg., Colum-
bus
Roberts, Luther J., Martin Bldg.,
Columbus
Schley, Frank B., 303 Eleventh St.,
Columbus
Schuessler, George, 1437 Second
Ave., Columbus
Smith, Charles R., VA Hospital,
Downey, 111.
Snelling. W. R., 1315 Fourth Ave.,
Columbus
Stapleton, J. L., 307 Eleventh St.,
Columbus
Stewart, John S., Medical Arts
Bldg., Columbus
Storey, W. E., 1312 Third Ave.,
Columbus
Thompson, John B., Medical Arts
Bldg., Columbus
Thrash, J. A, City Hospital, Colum-
bus
Theatte, Bruce, 204 Eleventh St.,
Columbus
Tillery, Bert, Medical Arts Bldg.,
Columbus
Turner, Henry H., Martin Bldg.,
Columbus
Venable, D. R., 1722 Stark Ave.,
Columbus
Walker, John E.. 1223 Third Ave.,
Columbus
Waller. Roy M., Jr., Murrah Bldg.,
Columbus
Willis, J. N., Swift Bldg., Colum-
bus
Winn. J. H., Swift Bldg., Columbus
Wolff, Luther H., Medical Arts
Bldg., Columbus
Wooldridge, J. C., Murrah Bldg.,
Columbus (Hon.)
Youmans, J. R., Doctors Bldg.,
Columbus (Hon.)
NEWTON COUNTY
Officers
President Huson, W. J.
Sec.-Treas Palmer, Clarence B.
Delegate - Sams, J. R.
Alternate Delegate Huson, W. J.
Members
Huson, W. J., Covington
Mitchell, J. B., Jr., Porterdale
Nesbit, F. C., Covington
December, 1950
527
Palmer. Clarence B., Covington
Sams, J. K.. Covington
Swann. W. K.. Knoxville, Tenn.
Waites, S. L., Covington
Willson, Pleas. Newborn
OCMULGEE COUNTY
( Bleckley-Dodge-Pulaski
Counties)
Officers v
President. Baker, W. R.
Vice-President.. Smith, Richard L.
Sec.-Treas. . Thomson, James L.
Delegate.. .. Smith, Richard L.
Alt. Delegate Jones, Edward G.
Members
Arnold, M. F., Hawkinsville
Baker, W. R.. Hawkinsville
Batts, A. S., Hawkinsville
Bush, Albert R.. Hawkinsville
Harp, S. L.. Cochran
Holder, F. P„ Jr., Eastman
Jones, Edward G., Eastman
Long, H. W., Eastman
Massey, W. F„ Chester
Smith, J. M., Cochran (Hon.)
Smith. Richard L., Cochran
Thomson. James L.. Eastman
Whipple, R. L., Cochran
POLK COUNTY
Officer
President Griffith. J. E.
Vice-President. Blanchard, W. H.
Secretary-Treasurer Lucas, W. H.
Delegate Lucas, W. H.
Alternate Delegate .. Griffith, J. E.
Members
Blanchard. W . H„ Cedartown
Chapman, W. A.. Cedartown (Hon.)
Chaudron, P. O., Cedartown
Elliott, Cecil B.. Cedartown
Goldin. Harold W., Rockmart
Good, John W., Cedartown
Griffith, J. E., Rockmart
Hagan. James H., Rockmart
Lucas, W. H„ Cedartown
McBryde, T. E., Rockmart
McGehee, John M., Cedartown
Spanjer. Raymond F., Cedartown
Styles, 0. R., Cedartown
White, George M., Rockmart
RABUN COUNTY
Members
Dover, J. C., Clayton
Heaton, Samuel A., Jr., Clayton
RANDOLPH-TERRELL
COUNTIES
Officers
President Daniel, Ernest F.
V-President .... Martin, Robert B., Ill
Secretary-Treasurer Elliott, W. G.
Delegate Martin, Robert B„ III
Alt. Delegate..... Quattlebaum, R. B.
Censors: Tidmore, J. C.; Sims, A.
R., and Rogers, F. S.
Members
Arnold, J. T.. Parrott
Daniel, Ernest F., Dawson
Elliott. W. G., Cuthbert
Goss, W oodrow, Ashburn
Harper, T. F., Coleman
Kenyon, J. M., Richland (Hon.)
Kenyon, S. P., Dawson
Martin, F. M., Shellrnan
Martin. Robert B., Ill, Cuthbert
Paschal J. Dean, Harvard Medical
School, Boston, Mass.
Patterson, J. C., Cuthbert
Quattlebaum, R. B., Fort Gaines
Rogers, F. S., Coleman
Sims, A. R., Richland
Tidmore, Joseph C., Dawson
RICHMOND COUNTY
Officers
President Mulherin, Charles McL.
President-Elect Goodwin, Thos. W.
Vice-President Thurmond, Allen G.
Sec.-Treas Klemann, Gilbert L.
Delegate McGahee, Robert C.
Delegate Thomas, David R., Jr.
Delegate Martin, John M.
Alternate Delegate Harrison. F. N.
Alternate Delegate Miller, John M.
Alternate Delegate Roule, J. Victor
Members
Agee, M. P., 753 Broad St., Augusta
Bailey, Thomas E., 315 Tenth St.,
Augusta
Bell, Jack E., 1242% Greene St.,
Augusta
Bernard, G. T., 204 Thirteenth St.,
Augusta
Blanchard, George C., Sou. Finance
Bldg., Augusta
Bowen, J. B., 842 Greene St.,
Augusta
Boyd, Wm. S., 1020 Greene St.,
Augusta
Brittingham, John W’., 1345 Greene
St., Augusta
Brown, Stephen W, Sou. Finance
Bldg., Augusta
Brown, Thomas P., Route 5, Thom-
asville
Bryans, C. L. 967 Meigs St., Augus-
ta (Hon.)
Burdashaw, James F., 2571 Mt.
Auburn Ave., Augusta (Hon.)
Chandler, J. L., Jr., University Hos-
pital, Augusta
Chaney, Ralph H., 1445 Harper St.,
Augusta
Chaney, Ralph H., Jr., La. State
Board of Health, Pineville, La.
Clary, Thomas L., Jr., 1345 Greene
St., Augusta
Cleckley, Hervey M., University
Hospital, Augusta
Corbitt, Melvis O., 1309 Holden St.,
Augusta
Cranston, W. J., 1345 Greene St.,
Augusta
Davis, Abe J., 1302 Wilson St.,
Augusta
Davis, David A., University Hospital,
Augusta
DeVaughn, N. M., 124 Seventh St.,
Augusta
Ellison, Robert G., 2321 King W'ay,
Augusta
Estes, Marion M., Medical College
of Georgia, Augusta
Everett, Theodore, University Hos-
pital, Augusta
Fuller, Wm. A., 1345 Greene St.,
Augusta
Goodwin, Thomas W., Sou. Finance
Bldg., Augusta
Gray, J. D., 842 Greene St., Augusta
Greenblatt, Robert B., Medical Col-
lege of Georgia, Augusta
Harper, Harry T., Marion Bldg.,
Augusta
Harrison, F. N., 2733 Milledgeville
Rd., Augusta
Henry, C. G., 842 Greene St.,
Augusta
Hensley,’ E. A., Gibson
Hock, Charles W., University Hos-
pital, Augusta
Holmes, L. P., Sou. Finance Bldg.,
Augusta
Hummel. John E., 1345 Greene St.,
Augusta
Johnson, E. M., Oliver Gen. Hos-
pital, Augusta
Johnson, Robert W., 1229 Greene
St., Augusta
Kelly, Alex R., Jr., Trudeau Sani-
torium, Saranac Lake, N. Y.
Kelly, Gordon M., University Hos-
pital, Augusta
Kilpatrick, Charles M., Sou. Finance
Bldg., Augusta
Klemann, Gilbert L., Sou. Finance
Bldg., Augusta
Leonard, Robert E., 1001 Greene
St., Augusta
Lewis, S. J., Sou. Finance Bldg.,
Augusta
Lokey, Julian L., University Hos-
pital, Augusta
Martin, John M., 407 Seventh St.,
Augusta
Martin, Walter D., 501 Greene St.,
Augusta
Massengale, Leonard R., 1211
Greene St., Augusta
Mathews, W. E., Sou. Finance Bldg.,
Augusta
McGahee, Robert C., 1345 Greene
St., Augusta
McGinty, Howard C., 19 Lakemont
Dr., Augusta
Mettler, Fred A., Columbia Univ.
College of Physicians and Sur-
geans. New York, N. Y.
Miller, John M., 842 Greene St.,
Augusta
Milligan, King W., 942 Greene St.,
Augusta
Mulherin, Charles McL., 1345
Greene St., Augusta
Mulherin, F. X., 1345 Greene St.,
Augusta
Mulherin, Philip A., 1211 Greene
St., Augusta
Norvell, J. T., 1240 Greene St.,
Augusta
Palmer, John R., Jr., 1020 Greene
St., Augusta
Perkins, H. R., Sou. Finance Bldg.,
Augusta
Persall, John T., Jr., Sou. Finance
Bldg., Augusta
Philpot, W. K., 1345 Greene St.,
Augusta
Pinson, Harry D., Sou. Finance
Bldg., Augusta
The Journal of the Medical Association of Georgia
528
Price. \\ . T.. Leonard Bldg., Augus-
ta
Fund, Edgar K.. Medical College
of Georgia. Augusta
Rhodes, R. L.. Sou. Finance Bldg.,
Augusta
Risteen, W. \.. I Diversity Hospital,
Augusta
Roule. J. Victor, Sou. Finance
Bldg., Augusta
Sanderson, E. S.. Medical College
of Georgia. Augusta
Schmidt, Henry L., Medical College
of Georgia. Augusta
Shepeard, Walter L., University Hos-
pital, Augusta
Tessier, Claude E., Masonic Bldg.,
Augusta
Thigpen, Corbett H„ University Hos-
pital, Augusta
Thomas, David R.. Jr.. Sou. Finance
Bldg., Augusta
Thurmond, Allen G.. 623 Greene
St., Augusta
Thurmond, J. W., 623 Greene St.,
Augusta
Timmons, C. C., 415 Milledge Rd.,
Augusta
Wammock. Hoke, Medical College
of Georgia, Augusta
Ward. Charles D., 842 Greene St.,
Augusta (deceased)
Watson, W. G., 623 ' Greene St.,
Augusta
Weeks. J. L., Harlem (Hon.)
Weeks. Richard B., Sou. Finance
Bldg., Augusta
White, William 0., 1345 Greene St.,
Augusta
Wilcox, Everard A., P. 0. Box 615,
Beaufort, S. C. (Hon.)
Wilkes, W. A., L'niversity Hospital,
Augusta
Williams, David C., Jr., 1345 Greene
St., Augusta
Winter, Wallace E., Orange Mem.
Hospital, Orlando, Fla.
Wright, George W.. 1345 Greene
St., Augusta
Wright, Peter B., 1345 Greene St.,
Augusta
4 ates, T. M., 1113 Fairview Drive,
Columbia, S. C.
ROCKDALE COUNTY
Member
Griggs. H. E„ Conyers
SOUTH GEORGIA MEDICAL
SOCIETY
( Berrien-Clinch-Cook-Echols-
Lanier and Lowndes Counties)
Officers
President Smith, J. R.
Vice-President Mixson, Harry
Secretary-Treasurer ...Parrott, Jesse
Delegate =._.Little, A. G., Jr.
Alt. Delegate Clements, Fred N.
Censor Peters, James S., Jr.
Members
Austin, G. J., Jr., Valdosta
Burns, D. L., Valdosta
Campbell, James L., Jr., Valdosta
Clements, Fred N., Adel
Clements, H. W., Adel
Eldridge, F. G., Valdosta
Gibson, Ira Malcolm, Valdosta
Giddens, I. S., Lakeland
Hutchinson, L. R.. Adel
Johnson, A. M., Valdosta
Little. Alex G., Jr., Valdosta
McKey. Earle S., Jr., Valdosta
Mixson, E. Harry, Valdosta
Mixson, J. F„ Valdosta
Mixson. Joyce F., Jr., Valdosta
Morrow, John Gordon, Jr., Hahira
Oliphant. Jones R.. Adel
Owens, B. G., Valdosta
Parrott, Jesse. Hahira
Perry, Robert E.. Jr., Valdosta
Peters, James S., Jr., Nashville
Quillian, E. P., Clyattville
Robbins, Allen Isaac, Homerville
Saunders, A. F„ Valdosta
Sherman. Henry T., Valdosta
Smith, E. J., Hahira
Smith, J. R., Hahira
Smith, Tom H., Valdosta
Stump, Robert L., Jr., Valdosta
Thomas, F. H„ Valdosta
Thompson, E. F., Valdosta
Turner, J. D., Nashville
Turner, W. W., Nashville
Waugh, William C., Nashville
Williams, T. C., Valdosta
SPALDING COUNTY
Officers
President Stuckey, Ann
Vice-President Floyd, T. J., Jr.
Sec.-Treas..- Williams, Virgil B.
Delegate Hunt, Kenneth S.
Alternate Delegate ... Smaha, T. G.
Censors: Walker, George L. ; Giles,
J. T., and Jones, Alex P.
Members
Austin, J. L., Griffin
Brown, George W., Griffin
Clouse, John E., Jr., Griffin
Copeland, H. J., Griffin
Copeland, H. W„ Griffin (Hon.)
English. R. E. L„ Griffin (Hon.)
Floyd, T. J., Jr., Griffin
Forrer, D. A., Griffin (Hon.)
Frye, Augustus II.. Jr., Griffin
Giles, J. T., Griffin
Hammond. Robert L.. Jackson
Head, D. L., Zebulon
Head, M. M„ Zebulon
Hicks, Wright Grant, Jackson
Howard, I. B.. Williamson (Hon.)
Hunt, Kenneth S., Griffin
Jones, Alex P., Griffin
King, Harry Crawford, Griffin
King, William R., Jr., Griffin
Miles, W. C„ Griffin (Hon.)
Oshlag, Abraham M., Griffin
Smaha, T. G., Griffin
Stuckey, Ann, Griffin
Walker, Geo. L., Griffin ,
Williams, Virgil B., Griffin
STEPHENS COUNTY
Officers
President „ -McNeely, H. H.
Vice-President Henry, Charles M.
Secretary-Treasurer C. L. Ayers
Delegate Shiflet. Robert E.
Alt. Delegate Singer, Arthur G.
Censors: Chaffin, E. F. ; McNeely,
H. H., and Henry, Charles M.
Members
Ayers, C. L., Toccoa
Chaffin. E. F., Toccoa
Edge, J. H., 356 Home Park Ave.,
N. E.. Atlanta (Hon.)
Good. Wm. H., Jr., Toccoa
Heller, W. B., Lakemont (Hon.)
Henry, Chas. M., Toccoa
Isbell, J. E. D., Toccoa
McNeely, H. H., Toccoa
Schaefer, W. Bruce, Toccoa
Shiflet, Robert E., Toccoa
Singer. Arthur G., Toccoa
SUMTER COUNTY
Officers
President- Fenn, Henry R.
Vice-President McMath, Wm. B.
Sec.-Treas. Durham, Bon M.
Delegate - Fenn, Henry R.
Alternate Delegate McMath, Wm. B.
Censors: Fenn. Henry R.; McMath,
Wm. B., and Durham. Bon M.
Members
Boyette, L. S., Ellaville
Cheves, Langdon C.. Jr., Montezuma
Collins, Robert A., Jr., Montezuma
Durham. Bon M., Americus
Enzor, R. H.. Smithville (Hon.)
(deceased)
Fenn, Henry R„ Americus
Gatewood, T. Schley, Americus
Logan, J. Colquitt, Plains
McMath. Wm. Bates, Americus
Pendergrass, R. C., Americus
Primrose, A. C., Americus
Robinson, John H., Ill, Americus
Savage, C. P., Montezuma
Seay, E. Faxton, Marshall ville
Smith, Herschel A., Americus
Thomas, Russell B., Americus
Wilson, Frank Adams, III. Leslie
Wise, B. Thad, Americus
Wood, Kenneth, Leslie
TATTNALL COUNTY
Officers
President Hughes, J. M.
Vice-President . Strickland, L. V.
Sec.-Treas Pinkston, A. G., Jr.
Delegate Pinkston, A. G., Jr.
Censors: Pinkston, A. G., Jr.; Col-
lins, J. C. ; and Jelks, L. R.
Members
Collins, J. C., Collins
Colson, A. C., Glennville
Hughes, J. M., Glennville
Jelks, L. R., Reidsville
Pinkston, A. G.. Jr., Glennville
Strickland, L. V., Cobbtown
TAYLOR COUNTY
Officers
President Sams, F. H.
Vice-President Montgomery, R. C., II
Secretary-Treasurer Whatley, E. C.
Delegate- Montgomery, R. C.
Censors: Beason, Lewis; and Mont-
gomery, R. C.
Members
Beason, Lewis, Butler
Montgomery, R. C., Butler
Montgomery, Robert C., II, Butler
Sams, F. H., Reynolds
Whatley, Edwards C., Reynolds
December, 1950
529
TELFAIR COUNTY
Officers
President Mann, F. R., Jr.
Vice-President Smith, F. A., Jr.
Secretary-Treasurer Mann, F. R., Sr.
DelegateM Parkerson, S. T.
Alternate Delegate Maloy, C. J.
Censors: Mann, F. R., Sr.; Born,
W. H., and Maloy, C. J.
Members
Born. W. H.. McRae
Jones, A. J., Jacksonville (Hon.)
Maloy, C. J., McRae
Maloy, D. W. F., Milan (Hon.)
Mann, F. R., McRae
Mann, F. R., Jr., RcRae
McMillan. Thos. J., Milan
Parkerson, S. T., McRae
Smith, F. A., Jr., McRae
THOMAS COUNTY
Officers
President . . Pepin, Henry S., Jr.
Vice-President ...Baldwin, Marion A.
Secretary-Treasurer Shepard, Kirk
Delegate Bell. Rudolph
Alternate Delegate .Mobley, John W.
Censors: Watt, Charles H.; Moore,
Henry M.; and Mobley, John W.
Members
Baldwin, Marion A., Thomasville
Bell, Rudolph, Thomasville
Bellhouse, Helen W., 12 Captiol
Sq., S. W., Atlanta
Cheshire, Howard L„ Thomasville
Collins, J. J.. Thomasville
Daniel, Frank C., Pavo
Dillinger, Geo. R., Thomasville
Erickson. Mary J.. Thomasville
Foushee, John Caldwell, Thomas-
ville
F rid dell . William F., Boston (Hon. I
Futch, T. Allen. Jr., Thomasville
Garrett, J. A., Meigs
Hill. Arthur W., 374 Ordnance Bat-
talion. Camp McCoy, Wis.
Isler, J. N.. Meigs (Hon.)
Jones, Henry, Coolidge (Hon.)
King, J. T.. Thomasville
Levy, Tracy, USPH Outpatient
Clinic. 4th and D St., S. W.,
Washington, D. C.
Little, Frank A., Thomasville
Lundy, L. L„ Boston
McCollum, William, Thomasville
Mobley, J. W'., Jr., Thomasville
Moore. H. M., Thomasville
Morton, John Buck, Thomasville
Murphy, Fred E., Jr., Thomasville
Palmer. J. I., Thomasville
Pepin, Henry S., Jr.. Thomasville
Readling. Herbert F., Thomasville
Reid. James W., Thomasville
Sanchez, S. E., Jr., Barwick
Saye, E. B.. Thomasville
Shepard. Kirk. Thomasville
Stillwell, John D., Thomasville
Stinson, Roy F.. Thomasville
Wahl, Ernest F„ Thomasville
Wall, C. K., Thomasville
Wasden, Howell A., Jr., Pavo
Watt, C. H., Thomasville
Wine, Mervin B., Thomasville
TIFT COUNTY
Officers
President Winston, Richard K.
Vice-President . .. Jones, Robert E.
Sec.-Treas. Edmonson, Tom L.
Delegate Flowers, Eugene M.
Members
Andrews, Agnew, Tifton
Andrews, Ella F., Tifton
Edmondson, Tom L., Tifton
Evans, E. L„ Tifton
Flowers, Eugene M., Tifton
Harrell, D. B., Tifton
Jones, Robert E„ Tifton
Lucas, Paul W., Tifton
Pittman. Carl S., Tifton
Pittman, C. S., Jr., Tifton
Webb, M. L.. Tifton
Winston, Richard K., Tifton
Zimmerman. Charles E., Tifton
Zimmerman, W. F., Tifton
TOOMBS COUNTY
Officers
President. Mercer, J. E.
Sec.-Treas Dejarnette, R. H.
Delegate Youmans, H. D.
Alt. Delegate McArthur, J. D.
Members
Aiken, W .W., Lyons
Bedingfield, W. H., Vidalia
Conner, Herbert 1., Vidalia
Darby, V. Lee, Vidalia
Dejarnette, R. H., Vidalia
Findley, C. W., Vidalia
Gross, O. S., Vidalia
McArthur, J. D., Lyons
Mercer, J. E., Vidalia
Youmans, H. D., Lyons
TRI-COUNTY
(Calhoun-Early-Miller
Counties)
Officers
President Baxley, W. C.
Vice-President Crowdis, Ja6. H., Jr.
Sec.-Treas Merritt, H. J.
Delegate Standifer, J. G.
Alternate Delegtae Sharp, C. K.
Censors: Martin, James B. ; Martin,
James W., Jr., and Wall. W. H.
Members
Baxley, W. C., Blakely
Beard, J. S., Edison
Bridges, R. R., Leary
Crowdis, James H., Jr., Blakely
Hattaway, J. C., Edison
Hays, W. C., Colquitt
Holland. S. P., Blakely
Houston, W. H., Colquitt
Martin, James B., Edison
Merritt, Hinton J.. Colquitt
Merritt, James W., Jr., Colquitt
Rentz, Turner W., Colquitt
Sharp. C. K.. Arlington
Shepard. J. L., Damascus
Shepard, W. O., Bluffton
Standifer, J. G., Blakely
Wall, W. H„ Blakely
TRI-COUNTY
(Liberty-Long-Mclntosh
Counties)
Members
Armistead, I. G., Townsend
Middleton, 0. D., Ludowici
TROUP COUNTY
Officers
President Freeman, Thos. N., Jr.
Vice-President Molyneaux, Evan W'.
Secretary-Treasurer. Foster, H. A.
Delegate ...... Whitehead, C. Mark
Alt. Delegate Molyneaux, Evan W.
Censors: Molyneaux, Evan W.;
Freeman, Thos. N., Jr., and Foster,
H. A.
Members
Arnold, E. T., Jr., Hogansville
Avery, R. M., LaGrange
Calhoun, Samuel J., Langdale, Ala.
Callaway, Enoch, LaGrange
Caswell, Doyle F., Franklin
Chambers, James W„ LaGrange
Clark, W. H„ LaGrange
Cowart, Charles Thornton, La-
Grange
Easley, Curran S„ Jr.. LaGrange
Fackler, William B., Jr., LaGrange
Foster, H. A., LaGrange
Freeman, Thos. N„ Jr., LaGrange
Grace, Kenneth D., LaGrange
Grady, Henry W., LaGrange
Hadaway, W. H., LaGrange
Hammett, H. H., LaGrange
Hammett, H. H., Jr., LaGrange
Hand, Benjamin H., LaGrange
Harvey, C. W., Hogansville
Hendricks, Willis M., LaGrange
Herault, Pierre C., Jr., LaGrange
Herman, E. C., LaGrange
Holder, J. S., LaGrange
Hutchinson, Wm. Lane, LaGrange
Jones, H. T., West Ponit
Lewis, James Willard. LaGrange
Little, William F., Jr., West Point
McCall. W. R„ LaGrange
McCulloh, Hugh, Jr., West Point
Molyneaux, Evan W., Hogansville
Morgan, D. E., LaGrange
Morgan, J. C., West Point
Morgan, J. C., Jr., West Point
Muldoon, Edward J.. West Point
Norman, Lewis G„ Jr., West Point
O'Neal. R. S.. LaGrange
Phillips. W. P.. LaGrange
Prescott, Eustace H., LaGrange
Taylor, John L., Franklin
Whitehead, C. Mark, LaGrange
Williams, C. 0., West Point
TURNER COUNTY
Member
Baxter, J. H.. Ashburn (Hon.)
UPSON COUNTY
Officers
President Carter, Robert L.
Vice-President Head. Douglas L., Jr.
Sec. -Treasurer Tyler, Herbert D.
Delegate Garner, John E.
Alt. Delegate Tyler. Herbert D.
Members
Adams, B. C., Thomaston (deceased)
Barron. H. A., Thomaston (Hon.)
Blackburn, Jno. D., Thomaston
Bridges, B. L., Thomaston
Carter, Robert L., Thomaston
Dallas, R. E., Thomaston
Garner, John E., Thomaston
Girardeau, Ivylyn, Thomaston
Gower, Wm. J., Jr., Thomaston
Grubbs, J. H., Molena
Harris, C. A., The Rock
Head, Douglas L., Jr., Thomaston
The Journal of the Medical Association of Georgia
530
Kellum. J. M.. Thomaston
McKenzie, J. M., Thomaston
Sappington, T. A., Thomaston
Tyler. Herbert D., Thomaston
Woodall, Frank M.. Thomaston
Woodall. James A., Thomaston
Woodall, Wm. Pruitt, Thomaston
W ALKER-CATOOSA-DADE
COUNTIES
Officers
President Derrick, Howard C., Jr.
Vice-President Hoover, John IT
Sec.-Treas Alexander, L. LeBron
Delegate - Simonton, Fred H.
Alt. Delegate O’Connor, Frank L.
Censors: Simonton, Fred H.; Kitch-
ens, S. B„ and O’Connor. Frank
L.
Members
Alexander, L. LeBron, Rossville
Cochran, T. A., Ringgold
Cornett, Dennis M., LaFayette
Derrick, Howard C., Jr., LaFayette
Hoover, John P., Rossville
Kitchens, S. B.. LaFayette
Middleton, D. S., Rising Fawn
(Hon.)
O’Connor, Frank L., Rossville
Pope, Roy, Jr., Chickamauga
Shepard, Richard C., LaFayette
Shields, H. F., Chickamauga
Simonton. Fred H., Chickamauga
Stephenson, Chas. W., Ringgold
Vassey, G. C., Rossville
WALTON COUNTY
Officers
President .—. Anderson, M. W.
Vice-President.. Huie, Lynn M.
Sec.-Treas Nunnally, Harry B.
Delegate Floyd, Chas. S.
Alt. Delegate. DeFreese, Samuel J.
Members
Anderson, M. W., Social Circle
DeFreese, Samuel J., Monroe
Floyd, Chas. S., Logansville
Gerdine, John, Jersey (deceased)
Head, Homer, Monroe
Huie, Lynn M., Monroe'
Nunnally, Harry B., Monroe
Stewart, Philip R., Monroe
Thompson, Ernest, Monroe
WARE COUNTY
Officers
President Hendry, W. A.
Vice-President Calhoun, W. C.
Sec.-Treas Smith, Leo
Delegate Pomeroy, W. L.
Alternate Delegate Smith, Leo
Censors: Seaman, H. A.; Hendry,
W. A., and Flanagin, W. M.
Members
Adkins, H. T., Waycross
Avera, Bertram P., Jr., VA Hospital,
Dublin
Bates, W. B., Jr., Waycross
Bradley, D. M., Waycross
Bussell, B. R., Waycross
Calhoun, W. C., Waycross
Clayton, Malcolm D., Jr., Waycross
Collins, Braswell E., Waycross
Davis, Floyd, Waycross
DeLoach, A. W.. Waycross
Ferrell. T. J.. Waycross
Flanagin, W. M., Waycross
Fleming, A., Folkston
Gay. Joseph R., Waycross
Goldman, Benj., Hazlehurst
Goldwasser, Fred L, Alma
Hafford, W. C., Waycross < de-
ceased)
Hawkins, L. M., Blackshear
Hendry, G. T., Blackshear
Hendry, Katherine M., Blackshear
Hendry, Wm. A., Blackshear
Jackson, Joseph M., Folkston
Johnson, R. L.. Waycross (Hon.)
Knight, A. M., Jr.. Waycross
Lee, Walter E., Jr., Waycross
Massey, Clayton M., Waycross
Mauldin, John W„ Alma
McCollum, R. Roy, Jr.. Kingsland
McCoy, W. R.. Folkston
Minchew, B. H., Waycross
Mixson, W. D„ Waycross (Hon.)
Muecke, H. W„ Waycross
Oden, John W., Blackshear (Hon.)
Oden, Lewis H., Jr., Tyndall Field,
Panama City. Fla.
Oden. T. E., Blackshear
Parker, Charles 0., Jr., U. S. Navy,
USS Consolation (Asso.)
Penland, J. E„ Waycross
Pierce, Lovick W.. Waycross
Pomeroy, W. L.. Waycross
Reavii; W. F., Wavcross
Schneider, W. J., Folkston
Seaman, Henry A.. Waycross
Sharpe, W. W., III. Alma
Shuman. Vilda, Waycross
Smith. Clyde, Jefferson-Hillman Hos-
pital, Birmingham. Ala. (Asso.)
Smith. Leo, Waycross
Stephens, John A., Ware County
Hospital. Wavcross (Asso.)
Terry, D. B., Homerville
Trulock, Albert S., Jr., VA Hos-
pital, Bav Pines. Fla.
Youmans, C. R., Hazelhurst
WARREN COUNTY
Officers
President Carson, H. B.
Secretary -Treasurer Daves, A. W.
Delegate Carson, H. B.
Alternate Delegate Ware, F. L.
Members
Carson, H. B., Warrenton
Davis, A. W.. Warrenton
Kennedy, H. T., Warrenton
Ware, F. I,., Warrenton
WASHINGTON COUNTY
Officers
President . Newsom, N. J.
Vice-President Newsome, Emory G.
Sec.-Treas. .... McElreath, F. T„ Jr.
Delegate ... Rawlings, William
Alt. Delegate Newsome, Emory G.
Censors: Rogers, 0. L. ; Hilton, B.
L., and Taylor, R. L.
Members
Dillard, J. B., Davisboro (Hon.)
Helton, B. L., Sandersville
Hurt, Marion West, Sandersville
Lennard, 0. D., Sandersville
Lever, Joseph E., Sandersville
.McElreath, Farris T., Jr., Tennille
Newsom, N. J., Sandersville
Newsome, Emory C„ Sandersville
Overby, N„ Sandersville
Rawlings, William, Sandersville
Rogers, 0. L., Sandersville (Hon.)
Taylor. Halph L., Davisboro
WAYNE COUNTY
Officers
President. Yeomans, J. W.
Vice-President Leaphart. J. A.
Secretary-Treasurer Harper, F. M.
Delegate.. Pumpelly, Robert A.
Alternate Delegate Harper. F. M.
Members
Harper, Fred M., Jesup
Leaphart, J. A., Jesup
Pumpelly, Robert A., Jr.. Jesup
Bitch, T. G., Jesup
Tyre, J. Lawton, Screven
Yeomans, James W„ Jesup
Yeomans, Una Ritch, Jesup
WHITFIELD COUNTY
Officers
President Whitfield, Truman W.
Vice-President Rosen, E. A.
Secretary-Treasurer Aidt, H. J.
Delegate Broaddrick, G. L.
Alternate Delegate Bradley, Paul L.
Censors: Whitfield, Truman W.;
Bradford, J. E., and Whitley,
James R.
Members
Ault, H. J.. Dalton (Hon.)
Baldwin, Robert E.. Lawson VA
Hospital, Chamblee (Asso. t
Boozer, Albert M„ Dalton
Bradford, J. E., Spring Place
Bradley, Paul L., Dalton
Bradley, R. H., Chatsworth
Broaddrick, G. L., Dalton
Carson, Willard P., Chatsworth
Dickie, E. H., Chatsworth
Erwin, H. L., Dalton (Hon.)
Mullins, James N., Chatsworth
Ragland, Fred B.. Dalton
Rollins, J. C., 1211 W'. Rugby, Col-
lege Park (Hon.)
Rosen, E. A., Dalton
Sams, Henry L., Dalton
Starr, Trammell, Dalton
Summerour, Brooke F., Dalton
Venable, John H., Dalton
Whitfield, Truman W., Dalton
Whitley, James R., Dalton
Wood, D. Lloyd, Dalton
Wood, Jay G., Vinings
W ILCOX COUNTY
Officers
President Harris, V. L.
Vice-Presdient— Durham, Wm. P.
Secretary-Treasurer Owens, J. D.
Delegate Harris, V. L.
Alternate Delegate Estes, J. M.
Censors: Owens, J. D.. and Bussell,
J. A.
Members
Bussell, J. A., Rochelle (Hon.)
Dorsey, Homer A., Pitts (Hon.)
Durham, Wm. P., Abbeville
Estes, J. M., Abbeville
Harris, V. L., Rochelle (Hon.)
Owens, J. D.. Rochelle
December, 1950
53 1
WILKES COUNTY
Officers
President Nash, T. C.
Vice-President W ills, C. E., Jr.
Secretary-Treasurer. Duggan, A. D.
Delegate. LeRoy, A. G.
Alternate Delegate Adair. M. C.
Censors: Casteel, L. R„ and Simp-
son, A. W., Sr.
Members
Adair, M. C., Washington
Casteel, L. R., Washington (Hon.)
(deceased)
Cheves, Harry L„ Union Point
Duggan, A. D., Washington
Gibson. F. N., Thomson
Harriss, H. T„ Washington (lion.)
LeRoy, A. G„ Thomson
Middlebrooks, Tracy W., Union
Point
Nash, T. C.. Philomath
Simpson, A. W., Washington (Hon.)
Simpson, A. W., Jr., Washington
Sims, Lewis S., Jr., Naval Air Dis-
pensary, Box 8, Jacksonville, Fla.
Smith, R. H., Lincolnton
Stephens, R. G., Washington
Wills, C. E., Washington
Wills, Charles E., Jr., Washington
Woods, O. S., Washington
WORTH COUNTY
Officers
President Tracy, J. L.
Secretary-Treasurer Davis, H. C., Jr.
Members
Bell, Peyton E., Sylvester (Hon.)
Crowe, Norman J., Sylvester
Davis, If. G.. Jr., Sylvester
Greer, Zack E„ Macon-Bibb Health
Center, Macon
Jefford, T. C., Sylvester (Hon.)
Stoner, W. P., Sylvester
Sumner. G. S., Sylvester
Tracy, J. 1.., Jr., Sylvester
IMPORTANT NOTICE
The Committee on Constitution and By-Laws of the
Medical Association of Georgia will hold a meeting
at the Hotel Dempsey, Macon, Georgia on January 10,
1951 at two o’clock in the afternoon. Members of
the Association are cordially invited to present their
views to the committee either in person or by letter.
ALLEN H. BUNCE, Atlanta, Chairman
C. H. RICHARDSON, SR., Macon
MARION C. PRUITT, Atlanta
W. F. REAVIS, Waycross
JOHN A. DUNAWAY, Atlanta, Attorney
for the Association
A. M. PHILLIPS, Macon, President
EDGAR D. SHANKS, Atlanta, Secty-Treas.
NEWS ITEMS
Albany Crippled Children's Clinic held its third
clinic since its founding in the pediatric section of the
Phoebe Putney Hospital, Albany, October 13. One
hundred and forty-six children from 24 South Georgia
Counties were invited to attend the clinic, officials
said. The clinic was staffed by State workers from
Albany and Atlanta, and Dr. Edgar Dunlap, Atlanta,
Emory Hospital, and Dr. Fred Murphy, Thomasville.
The clinic is sponsored by the Crippled Children’s
Division of the Department of Welfare and is partially
supported by the State and partially by interested
Albany citizens. Children were examined and fitted with
braces and appliances to assist them in better use of
their limbs.
* * *
The American College of Surgeons at its 36th Convo-
cation held in Symphony Hall, Boston, October 27, ai
the end of its annual Clinical Congress which opened
October 23, received into fellowship 978 initiates, the
largest elass since 1914. Five honorary fellowships
were also conferred. Dr. Arthur W. Allen, Boston,
Chairman of the Board of Regents, presented the
initiates following a colorful procession in which they
and the officers, Regents, Governors and honored
guests of the College wore the royal blue and scarlet
Fellowship robes. The fellowships were conferred by
the president. Dr. Henry W. Cave, New York. The
fellowship address, “Quo Vadimus,” was delivered by
the Director of the College, Dr. Paul R. Hawley of
Chicago. Georgia 1950 initiates are: Drs. Donald E.
Beard, Atlanta; Robert B. Gottschalk, Savannah; C.
Richard King, Atlanta; Robert B. Martin, III, Cuth-
bert; Charles P. Marvin, Atlanta; Lewis H. McDonald,
Atlanta; James L. Pittman, Atlanta; Leon Douglas
Porch, Macon; William Houser Proctor, Jr., Chamblee;
Rivington H. Randolph, Athens; Richard E. Smoot,
Decatur; Ben R. Thebaut, Atlanta, and William G.
Whitaker, Jr., Atlanta.
* * *
The Appling County Medical Society held its first
fall meeting in the Public Health Office, Baxley,
October 17. Dr. J. B. Brown, Jr., Baxley, read a
paper entitled, “Cortisone and Adrenocorticotropic
Hormones.’’ Dr. J. T. Holt, Baxley, was in charge of
the November program.
* * * *
Dr. Russell Andrew's, Dr. Ralph Johnson and Dr.
Robert Norton, all of Rome, participated in the
medical forum broadcast over The News-Tribune
Station WLAQ, Rome, October 12. They discussed in
detail the proposed national health insurance plan
and went into details of the cost of the plan should it
become law, and the effect of national health insur-
ance on the people of Great Britain. They also dis-
cussed an alternate program sponsored by the physi-
cians of the country.
* * *
The Athens Medical Center, located on the corner
of Prince Avenue and Chase Street, Athens, was opened
October 23. The ultra-modern, efficiency-equipped
Medical Center will house the offices of 12 physicians,
tw'o dentists and one druggist. The center will offer
x-ray and general laboratory facilities, including equip-
cent to give electrocardiograms and basal metabolism
tests. Physicians of the corporation who have offices
in the center include Drs. Paul Keller, Tom Meissner,
Goodloe Y. Erwin, J. B. Neighbors, Jr., John F.
Stegeman, James A. Green, Sam M. Talmadge, Herschel
B. Harris, Thomas A. Dover, Marion A. Hubert,
Holmes G. Byrd and John A. Simpson.
* * *
The Atlanta Federation of Trades and the Atlanta
Tuberculosis Association, through its Industrial Hygiene-
Division, recently sponsored the third health education
dinner forum held in Atlanta. Heart disease and high-
blood pressure were discussed. Dr. Carter Smith,.
Atlanta, spoke on “Heart Disease”, emphasizing pre-
ventive medicine, regular check-ups, and danger signals.
Dr. Vernon Powell, Atlanta, discussed “High Blood'
Pressure.” Dr. L. M. Petrie and Dr. Randolph Smith,
both of Atlanta, discussed health problems, illustrated
with slides. Other diseases, including tuberculosis,
cancer, and polio, will be discussed in the coming
weeks. Each physician has kept in mind that he is
speaking to layrpen, and that they do not understand
technical language.
* * *
Dr. L. Minor Blackford, Atlanta physician, and
associate in medicine at Emory University School of
Medicine, addressed the Southern Medical Association
at its annual meeting in St. Louis, November 16, on
“Certain Public Health Aspects of Heart Disease.”
The Cardiac Clinic at Grady Hospital provides ser-
vices ranging from diagnosis and treatment of all kinds
of heart diseases to help with the heart patient’s
financial and domestic problems, Dr. Blackford said.
He said a social worker and her assistant were “impor-
tant members” of the clinic staff. “They visit the
home,” he reported, “help the family adjust to the
situation and perhaps help with the family budget.
They suggest ways and means of entertaining the patient
to keep him quiet . . . They may secure toys if the
patient is a child. Sometimes they find the larder bare-
(Continued on Page 540)
The Journal of the Medical Association of Georcia
The Journal
of the
Medical Association
INDEX
Volume XXXIX
January-December, 1950
PUBLICATION COMMITTEE
Cleveland Thompson, M.D.
Edgar D. Shanks, M. D.
EDITOR
Edgar D. Shanks, M.D.
ASSOCIATE EDITORS
T. C. Davison, M.D.
Daniel C. Elkin, M.D.
Spencer A. Kirkland, M.D.
Jack C. Norris, M.D.
Edgar D. Shanks, Jr., M.D.
C. B. Upshaw, M.D.
BUSINESS MANAGER AND
EXECUTIVE SECRETARY
Viola Berry
December, 1950
533
INDEX
A
Addison’s Disease
Carbohydrate Studies in Patients with
Addison’s Disease Treated with Testo-
sternone Propionate and Cortisone.
October 1950. Harley E. Cluxton, Jr.,
Savannah
Adenocarcinoma
Adenocarcinoma of the Colon and Rectum.
September 1950. D. F. Mullins, Jr.,
Athens
Analgesic Agents
Clinical Impressions of Some of the Newer
Analgesic Agents. February 1950. John
M. Brown and Perry P. Volpitto, Augusta
Antabuse
The Use of Antabuse in the Treatment of
Alcoholism. November 1950. James N.
Brawner, Jr., and Albert F. Brawner,
Smyrna
B
Bicornate Uteri
Bicornate Uteri: Obstetric Complications.
February 1950. T. Schley Gatewood,
Americus
Births
The Two-Fold Problem of Premature
Births. May 1950. Helen W. Bellhouse,
Atlanta
Blood
The Color of Feces Following the Instilla-
tion of Citrated Blood at Various Levels
of the Small Intestine. October 1950.
J. H. Hilsman, Atlanta
Brain Tumors
Early Signs and Symptoms of Brain Tum-
ors. November 1950. Charles E. Dow-
man, Atlanta
Breech Presentation
Breech Presentation: Is Fetal Extension an
Etiologic Factor? February 1950. Guy
L. Calk, anad Richard Torpin, Augusta .
Burns
Burns. January 1950. J. D. Martin, Jr.,
Richard Caudle, and J. M. B. Bloodwood,
Jr., Atlanta
Burns: Their Effects and Treatment. July
1950. Berry Bowman, Jr., Albany
Bursitis
Roentgen Therapy for Bursitis of the Shoul-
der. May 1950. David Robinson, Savan-
nah
C
Cancer
The Routine Use of Exfoliative Cytologic
Examinations for the Detection of
Asymptomatic Cancer of the Cervix
Uteri. July 1950. H. E. Nieburgs, and
S. Bamford, Augusta
SUBJECTS
Right Thoracic Approach in Combination
with Laparotomy for Resection of Can-
cer of the Esophagus at the Level of the
Arch of the Aorta. January 1950. Rich-
ard King, Atlanta ... 30
Carcinoma
Carcinoma of the Stomach. June 1950. T.
C. Davidson, and A. H. Letton, Atlanta 243
Carotid Sinus
Carotid Sinus Syndrome. May 1950. C.
Raymond Arp, Hal M. Davison, and John
S. Atwater, Atlanta .. ... . 196
Casarean Section
Today’s Indications for Cesarean Section.
August 1950. M. M. Schneider, Savannah 313
D
Diabetes
Diabetes in Pregnancy. February 1950.
John R. McCain, and William M. Lester,
Atlanta 57
Doctor
Mind, Matter and the Doctor. June 1950.
H. B. Jenkins, Donalsonville .. 246
Doctors and the Public. November 1950.
John E. Drewry, Athens 459
Duodenal Obstruction
Congenital Intrinsic Duodenal Obstruction.
January 1950. Lon Grove, and Earl Ras-
mussen, Atlanta 1
E
Editorials
Advise Extreme Caution in Use of Newer
Insecticides, October 1950 . .. 422
A.M.A. Clinical Session, October 1950.. 421
A.M.A. Council Summarizes Research on
Vitamin E Therapy, March 1950 ... 116
A.M.A. Council Warns of Need for In-
formation About Pesticides, February
1950 76
A.M.A. Journal Refutes Medical Education
Criticism, March 1950 114
A.M.A. Membership Not Compulsory for
Enrollment in Local Groups, January
1950 34
A.M.A. Meets in Cleveland December 5-8,
October 1950 423
A.M.A. President Receives Letter, February
1950 74
A.M.A. President Speaks, July 1950 302
Are We Neglecting Skin Tumors?, Janu-
ary 1950 36
Army Authorizes Appointment of Women
Doctors as Reserve Corps Officers,
October 1950 424
Attribute Relief from Shaking Palsy to
Psychotherapy, January 1950 35
Aureomycin Reduces Childbirth Infection
Possibilities, July 1950 304
Awards, 1950, May 1950 214
Awards, Macon Session, 1950, June 1950.... 256
TO
408
364
63
449
54
216
402
443
51
10
269
205
287
534
The Journal of the Medical Association of Georgia
Beware of Ticks This Spring, American
Medical Association Says, May 1950 215
Calls Family Doctor Guide in Old Age
November 1950 463
' Cites Desirability of Breast Feeding of
Babies, April 1950 _ 173
Civil Defense a Civilian Responsibility,
July 1950 303
Compound F Reported Effective Against
Rheumatic Arthritis, September 1950 386
Constitution and By-Laws of the Medical
Association of Georgia, 1950, March 1950 128
Diabetic Doctors Prove One Can Live Long
and Remain Active, November 1950 462
Doctor Blames Eyes for 25 Per Cent of
Headaches, November 1950 — 463
Doctor Draft Law, October 1950 420
Egyptian Drug Produces Good Results in
Heart Disease, June 1950 .... 256
Electron Microscope Proving Big Aid in
Medical Research, April 1950 174
Enjoy Yourself: It is Later Than You
Think, June 1950 254
Federal Income Tax Laws Unfair to Pro-
fessions, Says Economist, May 1950 214
Find Blood Test for Cancer Not Suitable
for Diagnosis at Present, April 1950 173
Find Chloramphenicol Useful Against
Bacillary Dysentery, September, 1950— 388
Find Ethyl Alcohol Unsatisfactory Disin-
fectant for Wounds, April 1950 174
Find 50,000 in Los Angeles- Area Have
Been Infected With Q Fever, April 1950.. 173
Find Mental Deficiency More Likely in
Children Born tc Mothers Over 40, July
1950 303
Finds Persons with Blue Eyes Susceptible
to Cancer Caused by Sunlight, July 1950 307
Georgia Physicians Who Have Practiced
Medicine Fifty Years or More, March
1950 134
Good Public Relations, July 1950 306
Have a Cold? Keep it to Yourself, Advises
Doctor, November 1950 464
High Standard of Veteran Care Credited to
Medical Leadership, September 1950 388
Industrial Health Conference to be Held
in Atlanta, December 1950 506
Infants Fare Well on Plane Flights,
December 1950 506
In Memoriam, March 1950 126
Lack of Calcium Is Common Dietary De-
ficiency, March 1950 115
Links High Blood Pressure to the American
Way of Life, October 1950 424
Link Lung Cancer to Prolonged Tobacco
Smoking, June 1950 256
Macon Session, 1950, May 1950 212
Medical Dues, 1950, January 1950 34
Medical Opinion Is Needed Before Contact
Lenses Are Worn, February 1950 79
Medical Students Plan National Organiza-
tion, December 1950 506
Medicine’s Role in Civil Defense to Be Dis-
cussed, April 1950 174
Mysterious Virus Disease in Medical Spot-
light, November 1950 462
Name of Hygia, Health Magazine, to be
Changed to Today’s Health, January 1950 36
New Eye Instrument May Help Prevent
Blindness, May 1950 .... 215
New Officers of the Association and Dele-
gates to the A.M.A., May 1950 212
New Test for Stomach Cancer Devised by
New York Doctors, September 1950 ... 388
New Ulcer Drug Seen as Preventive of
Surgery, August 1950 ..... . 343
No Preventative of Gray Hair Says Medi-
cal Authority, April 1950 ... 174
Officers and Committees of the Medical
Association of Georgia, March 1950 120
Officers of the Medical Association of Geor-
gia, March 1950 117
One-Day Aureomycin Treatment for Gonor-
rhea Reported, July 1950 304
Overeating Attributed to Environment and
Emotions, September 1950 387
Physicians for the Armed Forces, August
1950 343
Portrait of Dr. Fischer Unveiled at the
Crawford Long Hospital, January 1950 . 37
Program for the 100th Annual Session of
the Medical Association of Georgia,
March 1950 124
Program of the 100th Annual Session,
March 1950 114
Recommends Eai’ly Treatment for Children
Who Stutter, July 1950 307
Report Early Treatment Prevents Painful
Foot Deformities Later, February 1950 78
Report of Delegates to the American Medi-
cal Association, August 1950 343
Report New Test for Cancer of Uterus,
February 1950 76
Reports Poisoning from Use of Insecticide,
February 1950 79
Report Successful Use of ACTH in Treat-
ment of Gouty Arthritis, February 1950.. 76
Reports X-Ray Superior Therapy in Breast
Cancer Complications, December 1950 504
Roster of the Association, December
s 1950 504
San Francisco Meeting of the American
Medical Association, August 1950 342
Scientific Exhibits, March 1950 127
Seven Types of Infantile Drivers Believed
to Cause Traffic Accidents, September
1950 389
Skin Disease Attacks Florida Swimmers,
February 1950 79
Statement by James E. Paullin, M.D., on
H.R. 6000. Submitted to the Senate Com-
mittee on Finance, April 1950 170
December, 1950
535
Surgeons Tattoo Eyeball in Newer Sight-
Giving Operation, March 1950 116
Survey of Physicians’ Incomes, April 1950 170
Synthesis of Active Portion of ACTH
Seen as Possible, May 1950 214
Technical Exhibits, March 1950 127
Telegram re A.M.A. Dues, December 1950_ 505
Terramycin Reported Effective Against
Two Types of Pneumonia, September
1950 389
The Alleged Shortage of Physicians, Febru-
ary 1950 74
The Amazing Year of 1949, February 1950 77
The Challenge . . . Public Relations, June
1950 252
Theory Suggests Prevention of Cancer by
Artificial Feeding of Babies, February
1950 79
‘Tired Feeling’ is Major American Disease,
January 1950 — 35
Toward Effective Cancer Control, April
1950 175
Treat Scarlet Fever With Human Blood
Fraction, February 1950 — 79
United States Pharmacopeia, June 1950.. 253
Urges Immediate First-Aid Training in
Care of Atomic Bomb Casualties, Sep-
tember 1950 386
Use Aureomycin Against Inffuenzal Men-
ingitis, April 1950 , 176
Use Penicillin to Prevent Rheumatic Fever
Recurrence, March 1950 115
U. S. Ranks With Leading Nations in Pre-
venting Infant Deaths, April 1950 174
What is the Health Future of Your Child?
October 1950 424
Where Are Our Large Families? July
1950 304
Whooping Cough Yield to Antibiotic Drug,
January 1950 34
William Farrell Reavis, M.D., May 1950 213
Worry, January 1950 35
Edward Campbell Davis
Edward Campbell Davis, M.D., July 1950.
Isabella Arnold Bunce, Atlanta 299
Encephalitis
A Case of Post-Vaccinal Encephalitis Treat-
ed with Chloromycetin. June 1950. David
S. Mann, and Frank E. Thomas, Albany. 242
Endometriosis
Endometriosis: The Urgency for Eaidy
Diagnosis and Treatment. July 1950.
Edgar H. Greene, Atlanta 283
Eye
The Eye in the Advancing Years. Febru-
ary 1950. Morgan B. Raiford, Atlanta .... 66
Feet
F
Treatment of Flat Feet in Children. August
1950. J. H. Kite, and W. W. Lovell,
Atlanta 335
Fractures
The Treatment of Fractures of the Middle
Third of the Face. November 1950.
Frank F. Kanthak, Atlanta 441
Intramedullary Nailing of Fractures of
Long Bones. June 1950. J. C. Patterson,
Cuthbert .. 232
G
Gastrointestinal
Gastrointestinal Allergy. October 1950.
John L. Jacobs, Atlanta 405
Gastrointestinal Allergy in Children. April
1950. Harold W. Muecke, Waycross 150
The Diagnosis of Obstructive Lesions of
the Gastrointestinal Tract of the New-
born Infant. August 1950. M. Hines
Roberts, Atlanta 320
Gastric Disorders
The Gastroscope as a Diagnostic Aid in
Gastric Disorders, September 1950. John
S. Atwater, Atlanta 359
Goiter
Goiter: Hashimoto Type. January 1950.
T. C. Davison and A. H. Letton, Atlanta 19
H
Heart
Use of the Oral Mercurial Diuretics in
Advanced Congestive Heart Failure. July
1950. J. Gordon Barrow and Clayton R.
Sikes, Atlanta 276
Stab Heart Repair. June 1950. Cecil B.
Elliott, Cedartown 249
Vocational Rehabilitation of Cardiac Pa-
tients. December 1950. Joseph C. Massee,
Atlanta 495
Hemorrhoids
The Injection Treatment of Hemorrhoids.
July 1950. Fred B. Hodges, Jr., Atlanta 279
Hernia
Diaphragmatic Hiatus Hernia. September
1950. Sandy B. Carter, Atlanta 374
History
History of the Medical Association of
Georgia, 1881-1949. March 1950. Frank K.
Boland, Atlanta 89
Hospital
Integrated Hospital Service. February
1950. Tully T. Blalock, Atlanta 72
Hypnosis
Hypnosis in Therapy. December 1950.
Richard M. Nelson, and Corbett H. Thig-
pen, Augusta 473
Hypothyroidism
Masked Hypothyroidism as a Basis for
Symptoms. April 1950. W. Edward
Storey, Columbus 156
I
Insecticides
Organic Phosphorus Insecticides. February
1950. Lester M. Petrie, Atlanta
83
The Journal of the Medical Association of Georgia
536
Intussusception
An Analysis of Fifteen Cases of Intus-
susception. September 1950. John W.
Turner, and August B. Turner, Atlanta 369
K
Key
Presentation of the President’s Gold Key
to Enoch Callaway, M.D., September
1950. David Henry Poer, Atlanta 371
L
Legislation
Legislation. February 1950. Enoch Calla-
way, LaGrange -
73
M
Medical Services
Medical Services in the Department of De-
fense. June 1950. Richard L. Meiling,
Washington, D. C. 231
Medicine
Medicine and Freedom. May 1950. Ernest
E. Irons, Chicago 185
Medicine Versus Politics. March 1950.
Enoch Callaway, LaGrange 113
Methemoglobinemia
Methemoglobinemia Caused by Nitrate Pol-
lution in Drinking Water. June 1950.
Gilbert R. Frith, Atlanta ... .t: 258
N
Neck
Neck Dissections. April 1950. Milford B.
Hatcher, Macon 145
Nerve
The Relief of Distressing Pain By Inter-
rupting Nerve Pathways. November
1950. Exum Walker, Atlanta 446
Nipple Discharge
The Significance of Nipple Discharge.
July 1950. B. T. Beasley, Atlanta 281
Nurse
Nurse Midwife Service in Walton County,
Georgia. June 1950. Ernest Thompson,
Monroe 238
O
Obstructive Lesions
Some Obstrucitve Lesions in the Newborn.
June 1950. J. Dudley King, Atlanta 250
Opportunities
New Opportunities and Responsibilities.
April 1950. Enoch Callaway, LaGrange 169
Diagnostic and Therapeutic Block for the
Treatment of Pain. May 1950. C. Mac-
Kenzie Brown, Albany 207
Pancreatic Disease
Chronic Pancreatic Disease. September
1950. Charles W. Hock, Augusta 361
Acute Pancreatitis. January 1950. William
G. Whitaker, Jr., Atlanta 26
Papanicolaou Smear
The Papani'colaou Smear: In Retrospect
and Future. April 1950. Jack C. Norris,
Atlanta 168
Peritoneal
Peritoneal Drainage. October 1950. J. Ben-
ham Stewart, Macon 399
Pilonidal
Pilonidal Cyst and Sinus. April 1950. Need-
ham B. Bateman, William H. Bateman,
Gregory W. Bateman, and Joseph D.
Woddail, Atlanta 148
Plastic Surgery
Horizons of Modern Plastic Surgery.
November 1950. John R. Lewis, Jr., At-
lanta ... ...... .... 438
Poliomyelitis
Diagnosis and Early Management of Acute
Poliomyelitis. August 1950. Marvin L.
Davis, Atlanta ... 327
President’s Address
President’s Address. September 1950. Wal-
ter C. Payne, Pensacola, Fla. 379
Psychiatric Practice
Sudden Death in a Psychiatric Practice.
December 1950. Joseph D. McElroy, At-
Atlanta 479
Public Relations
The M.D. Goes PR. December 1950. Law-
rence W. Rember, Chicago 498
Public Relations: Good and Bad. January
1950. Enoch Callaway, LaGrange 33
R
Rehabilitation
Rehabilitation of the Crippled Child. Aug-
ust 1950. Harriet E. Gillette, Atlanta 332
Ith Factor
The Clinical Implications of the Rh Factor.
July 1950. E. B. Saye, Thomasville 292
S
Syndrome
The Adrenogenital Syndrome. December
1950. Ralph Hill Chaney, and Robert B.
Greenblatt, Augusta ... ... 482
Syphilis
Abulatory Treatment of Syphilis with
Aureomycin. June 1950. C. H. Chen, R.
B. Dienst, and R. B. Gleenblatt, Augusta 237
The Prevention of Congenital Syphilis.
January 1950. Rudolph W. Jones, Jr.,
Atlanta 38
T
Traumatic Rupture
Management of Traumatic Rupture and
Stricture of the Membranous Urethra
Complicating Fracture of the Pelvis.
November 1950. James H. Semans, At-
lanta 435
Tuberculosis
Tuberculosis: Suggestions for Improved
December, 1950
537
Control. Septemoer 1950. H. C. Schenck,
Atlanta 390
Tumors
The Common Tumors of the Genito-urinary
Tract Clinical Aspects. December 1950.
Robert W. McAllister, Macon. 487
Typhus
Biologic Activities of the Georgia Typhus
Control Program. July 1950. Roy J.
Boston, Atlanta - 308
U
Ulcer
The Choice of Operation in Gastric and
Duodenal Ulcer. September 1950. C. H.
Richardson, Jr., Macon ... 366
V
Virus
Newcastle Virus Disease. April 1950. Ed-
win R. Watson, and Marvin M. Harris,
Macon 154
Coxsackie Virus. December 1950. John E.
McCroan, Jr., Atlanta 507
W
Welfare
The Welfare State Versus the Welfare of
the State. May 1950. Enoch Callaway,
LaGrange 191
INDEX OF AUTHORS
A
Arp, C. Raymond, Atlanta
Davison, Hal M., Atlanta
Atwater, John S., Atlanta
Carotid Sinus Syndrome. May 1950 196
Atwater, John S., Atlanta
Arp, C. Raymond, Atlanta
Davison, Hal M., Atlanta
Carotid Sinus Syndrome. May 1950 196
Atwater, John S., Atlanta
The Gastroscope as a Diagnostic Aid in
Gastric Disorders. September 1950 359
B
Bamford, S., Augusta
Nieburgs, H. E., Augusta
The Routine Use of Exfoliative Cytologic
Examinations for the Detection of
Asymptomatic Cancer of the Cervix
Uteri. July 1950 287
Barrow, J. Gordon, Atlanta
Sikes, Clayton R., Atlanta
Use of the Oral Mercurial Diuretics in
Advanced Congestive Heart Failure. July
1950 276
Bateman, Needham B., Atlanta
Bateman, William H., Atlanta
Bateman, Gregory W., Atlanta
Woddail, Joseph D., Atlanta
Pilonidal Cyst and Sinus. April 1950 ... 148
Beasley, B. T., Atlanta
The Significance of Nipple Discharge. July
1950 281
Bellhouse, Helen W., Atlanta
The Two-Fold Problem of Premature
Births. May 1950 216
Blalock, Tully T., Atlanta
Integrated Hospital Service. February 1950 72
Bloodwcrth, J. M. B„ Jr., Atlanta
Martin, J. D., Jr., Atlanta
Caudle, Richard, Atlanta
Burns. January 1950 10
Boland, Frank K., Atlanta
History of the Medical Association of Geor-
gia, 1881-1949. March 1950 89
Boston, Roy J., Atlanta
Biologic Activities of the Georgia Typhus
Control Program. July 1950. 308
Bowman, Berry, Jr., Albany
Burns: Their Effects and Treatment. July
1950 - 269
Brawner, James N., Jr., Smyrna
Brawner, Albert F„ Smyrna
The Use of Antabuse in the Treatment of
Alcoholism. November 1950 . 449
Brown, C. MacKenzie, Albany
Diagnostic and Therapeutic Block for the
Treatment of Pain. May 1950 207
Brown, John M., Augusta
Volpitto, Perry P., Augusta
Clinical Impressions of Some of the Newer
Analgesic Agents. February 1950 63
Bunce, Isabella Arnold, Atlanta
Edward Campbell Davis, M.D., July 1950 299
C
Calk, Guy L., Augusta
Torpin, Richard, Augusta
Breech Presentation: Is Fetal Extension an
Etiologic Factor? February 1950
Callaway, Enoch, LaGrange
Legislation. February 1950
Medical Versus Politics. March 1950
New Opportunities and Responsibilities.
April 1950
Public Relations: Good and Bad. January
1950
The Welfare State Versus the Welfare of
the State. May 1950
Carter, Sandy B., Atlanta
Diaphragmatic Hiatus Hernia. September
1950
51
73
113
169
33
191
374
Caudle, Richard, Atlanta
Martin, J. D., Jr„ Atlanta
Bloodworth, J. M. B., Jr., Atlanta
Burns. January 1950 - I9
Chaney, Ralph H., Augusta
Greenblatt, Robert B„ Augusta
The Adrenogenital Syndrome. December
1950 482
Chen, C. H„ Augusta
Dienst, R. B., Augusta
Greenblatt, R. B., Augusta
Ambulatory Treatment of Syphilis with
Aureomycin. June 1950 — 237
538
The Journal of the Medical Association of Georgia
CHixton, Harley E„ Jr., Savannah
Carbohydrate Studies in Patients with Ad-
dison’s Disease Treated with Testosterone
Propionate and Cortisone. October 1950 408
D
Davis, Marvin L., Atlanta
Diagnosis and Early Management of Acute
Poliomyelitis. August 1950 327
Davison, Hal M., Atlanta
Arp, C. Raymond, Atlanta
Atwater, John S., Atlanta
Carotid Sinus Syndrome. May 1950 196
Davison, T. C., Atlanta
Letton, A. H., Atlanta
Carcinoma of the Stomach. June 1950 243
Goiter: Hashimoto Type. January 1950 19
Dienst, It. B., Augusta
Chen, C. H„ Augusta
Greenblatt, R. B., Augusta
Ambulatory Treatment of Syphilis With
Aureomycin. June 1950 .... 237
Dowman, Charles E., Atlanta
Early Signs and Symptoms of Brain Tum-
ors. November 1950 ... 443
Drewry, John E„ Atlanta
Doctors and the Public. November 1950 459
E
Elliott, Cecil B., Cedartown
Stab Heart Repair. June 1950 ... 249
F
Frith, Gilbert R., Atlanta
Methemoglobinemia Caused by Nitrate
Pollution in Drinking Water. June 1950 258
G
Gatewood, T. Schley, Americus
Bicornate Uteri: Obstetric Complications.
February 1950 ... 54
Gillette, Harriet E., Atlanta
Rehabilitation of the Crippled Child.
August 1950 332
Greenblatt, R. B., Augusta
Chen, C. H., Augusta
Dienst, R. B„ Augusta
Ambulatory Treatment of Syphilis with
Aureomycin. June 1950 237
Greenblatt, Robert B., Augusta
Chaney, Ralph H„ Augusta
The Adrenogenital Syndrome. December
1950 482
Greene, Edgar H., Atlanta
Endometriosis: The Urgency for Early
Diagnosis and Treatment. July 1950 283
Grove, Lon, Atlanta
Rasmussen, Earl, Atlanta
Congenital Intrinsic Duodenal Obstruction.
January 1950 1
H
Harris, Marvin M., Macon
Watson, Edwin R., Macon
Newcastle Virus Disease. April 1950 ... 154
Hatcher, Milford B., Macon
Neck Dissections. April 1950 145
Hilsman, J. H., Atlanta
The Color of Feces Following the Instilla-
tion of Citrated Blood at Various Levels
of the Small Intestines. October 1950 402
Hock, Charles W., Augusta
Chronic Pancreatic Disease. September
1 950 361
Hedges, Fred B.. Jr., Atlanta
The Injection Treatment of Hemorrhoids.
July 1950 .. 279
I
Irons, Ernest E., Chicago
Medicine and Freedom. May 1950 185
J
Jacobs, John L., Atlanta
Gastrointestinal Allergy. October 1950 405
Jenkins, H. B., Donalsonville
Mind, Matter and the Doctor. June 1950 ... 246
Jones, Rudolph W., Jr., Atlanta
The Prevention of Congenital Syphilis.
January 1950 38
K
Kan.thak, Frank F., Atlanta
The Treatment of Fractures of the Middle
Third of the Face. November 1950 441
King, J. Dudley, Atlanta
Some Obstrutive Lesions in the Newborn.
June 1950 250
King, Richard, Atlanta
Right Thoracic Approach in Combination
with Laparotomy for Resection of Cancer
of the Esophagus at the Level of the
Arch of the Aorta. January 1950 30
Kite, J. H., Atlanta
Lovell, W. W., Atlanta
Treatment of Flat Feet in Children. August
1950 — 335
L
Letton, A. H., Atlanta
Davison, T. C., Atlanta
Carcinoma of the Stomach, June 1950 243
Goiter: Hashimoto Type. January 1950 19
Lester, William M., Atlanta
McCain, John R., Atlanta
Diabetes in Pregnancy. February 1950-._ 57
Lewis, John R., Jr., Atlanta
Horizons of Modern Plastic Surgery.
November 1950 438
Lovell, W. W., Atlanta
Kite, J. H., Atlanta
Treatment of Flat Feet in Children. August
1950 335
M
Mann, David S., Ablany
Thomas, Frank E., Albany
A Case of Post-Vaccinal Encephalitis
Treated with Chloromycetin. June 1950 242
December, 1950
559
Martin, J. I)., Jr., Atlanta
Caudle, Richard, Atlanta
Bloodworth, J. M. B., Jr., Atlanta
Burns. January 1950 . 10
Massee, Joseph C., Atlanta
Vocational Rehabilitation of Cardiac
Patients. December 1950 495
McAllister, Robert W., Macon
The Common Tumors of the Genito-Urinary
Tract Clinical Aspects. December 1950 487
McCain, John R., Atlanta
Lester, William M., Atlanta
Diabetes in Pregnancy. February 1950 . . 57
McCroan, John E., Jr., Atlanta
Coxsackie Virus. December 1950 . 507
McElroy, Joseph D., Atlanta
Sudden Death in Psychiatric Practice.
December 1950 479
Meiling, Richard L., Washington, D. C.
Medical Services in the Department of De-
fense. June 1950 231
Muecke, Harold W., Waycross
Gastrointestinal Allergy in Children. April
1950 150
Mullins, D. F., Jr., Athens
Adrenocarcinoma of the Colon and Rectum.
September 1950 364
N
Nelson, Richard M., Augusta
Thigpen, Corbett H., Augusta
Hypnosis in Therapy. December 1950 473
Nieburgs, H. E., Augusta
Bamford, S., Augusta
The Routine Use of Exfoliative Cytologic
Examinations for the Detection of
Asymptomatic Cancer of the Cervix
Uteri. July 1950 287
Norris, Jack C., Atlanta
The Papanicolaou Smear: In Retrospect
and Future. April 1950 168
P
Patterson, J. C., Cuthbert
Intramedullary Nailing of Fractures of
Long Bones. June 1950 232
Payne, Walter C., Pensacola, Fla.
President’s Address. September 1950 379
Petrie, Lester M., Atlanta
Organic Phosphorus Insecticides. February
1950 81
Poer, David Henry, Atlanta
Presentation of the President’s Gold Key
to Enoch Callaway, M.D., September
1950 _ 377
R
Raiford, Morgan B., Atlanta
The Eye in the Advancing Years. February
1950 66
Rasmussen, Earl, Atlanta
Grove, Lon, Atlanta
Congenital Intrinsic Duodenal Obstruction.
January 1950 , 1
Rember, Lawrence W., Chicago
The M.D. Goes PR. December 1950 498
Richardson, C. H., Jr., Macon
The Choice of Operation in Gastric and
Duodenal Ulcer. September 1950 366
Roberts, M. Hines, Atlanta
The Diagnosis of Obstructive Lesions of
the Gastrointestinal Tract of the New-
born Infant. August 1950 320
Robinson, David, Savannah
Roentgen Therapy for Bursitis of the
Shoulder. May 1950 205
S
Saye, E. B., Thomasville
The Clinical Implications of the Rh Factor.
July 1950 292
Schenck, H. C., Atlanta
Tuberculosis: Suggestions for Improved
Control. September 1950 390
Schneider, M. M., Savannah
Today’s Indications for Cesarean Section.
August 1950 313
Semans, James H., Atlanta
Management of Traumatic Rupture and
Stricture .of the Membranous Urethra
Complicating Fracture of the Pelvis.
November 1950 435
Sikes, Clayton R., Atlanta
Barrow, J. Gordon, Atlanta
Use of the Oral Mercurial Diuretics in
Advanced Congestive Heart Failure.
July 1950 276
Stewart, J. Benham, Macon
Peritoneal Drainage. October 1950 399
Storey, W. Edward, Columbus
Masked Hypothyroidism as a Basis for
Symptoms. April 1950 156
T
Thigpen, Corbett H., Augusta
Nelson, Richard M., Augusta
Hypnosis in Therapy. December 1950 . 473
Thomas, Frank E., Albany
Mann, David S., Albany
A Case of Post-Vaccinal Encephalitis
Treated with Chlormycetin. June 1950 „ 242
Thompson, Ernest, Monroe
Nurse Midwife Service in Walton County,
Georgia. June 1950 „ ... 238
Torpin, Richard, Augusta
Calk, Guy L., Augusta
Breech Presentation: Is Fetal Extension
an Etiologic Factor? February 1950 ... 51
Turner, John W., Atlanta
Turner, August B., Atlanta
An Analysis of Fifteen Cases of Intus-
susception. September 1950 .. 369
V
Volpitto, Perry P., Augusta
Brown, John M„ Augusta
Clinical Impressions of Some of the Newer
Analgesic Agents. February 1950 63
W
Walker, Exum, Atlanta
The Relief of Distressing Pain by Inter-
The Journal ok the Medical Association of Georgia
5 10
*
rupting Nerve Pathways. November
1950 - 446
Watson, Edwin R., Macon
Harris, Marvin M., Macon
Newcastle Virus Disease. April 1950 154
Whitaker, William G., Jr., Atlanta
Acute Pancreatitis. January 1950 26
Woddail, Joseph D., Atlanta
Bateman, Needham B„ Atlanta
Bateman, William H., Atlanta
Bateman, Gregory W., Atlanta
Pilonidal Cyst and Sinus. April 1950 148
NEWS ITEMS
(Continued from Page 531)
and may have to call on some social agency for help.”
Dr. Blackford said he hoped Georgia some day would
have a “convalescent home-school for our children
crippled by heart disease so that their education will
be interrupted as little as possible. '
The Atlanta physician pointed out that some 20
other physicians in the Atlanta area donate part of
their time to assisting at the Cardiac Clinic. He ex-
plained that six visiting nurses, specially trained in
heart disease, carry many services of the clinic directly
to the patients’ homes. He attributed the success of
the Cardiac Clinic to the cooperation of the supporting
agencies, including Grady Memorial Hospital, Emory
University School of Medicine, the Fulton County De-
partment of Health, the Georgia Heart Association and
the American Heart Association.
Other Georgia physicians on the program were:
Section on General Practice: “The Management of
Whooping Cough,” Dr. Richard W. Blumberg, Atlanta.
Discussion opened by Dr. Albert Rauber, Atlanta.
Section on Medicine: Dr. Carter Smith, Atlanta, Vice-
Chairman; “Effect of Cortisone on Various Bacterial
Infections” (Lantern Slides), Dr. Max Michael, Jr.,
Atlanta; “A Simplified and Practical Vectorial Method
of Electrocardiographic Interpretation” (Lantern
Slides), Dr. J. Willis Hurst, Emory Llniversity. Section
on Neurology and Psychiatry: “Spontaneous Thrombosis
of Internal Carotid Artery,” Dr. Homer S. Swanson,
Emory Llniversity; Discussion opened by Dr. Rives
Chalmers, Atlanta. Section on Pediatrics: Dr. Wm. L.
Funkhouser, Atlanta, Chairman; Chairman’s Address:
“The South’s Service to the Crippled Child” (Lantern
Slides), Dr. Wm. L. Funkhouser. Section on Radi-
ology: Dr Robert C. Pendergrass, Americus, Secre-
tary; “Problems in Diagnosis of Carcinoma of the Lung”
(Lantern Slides), Dr. Stephen W. Brown, Augusta.
Section on Dermatology and Syphilology: “A Simplified
Method of Cryotherapy for Acne Vulgaris,” Dr. William
L. Dobes, Atlanta; “Ringworm of the Scalp; Treat-
ment with Spergon, Clinical and Laboratory Analysis,”
Drs. Joseph L. Rankin, William L. Dobes, Jack W.
Jones and Herbert S. Alden, Atlanta. Section on Allergy:
Dr. Mason I. Lowance, Atlanta, Chairman; Chairman’s
Address: “A Plea for Standardization of Skin Testing
Material” (Lantern Slides), Dr. Mason I. Lowance,
Atlanta; “Some Suggestions on the Dermatologic Care
of the Atopic Patient" (Lantern Slides), Dr. Herbert
S. Alden, Atlanta. Section on Industrial Medicine
and Surgery: "Health Maintenance for Small Plants”
( Lantern Slides), Dr. Lester M. Petrie, Atlanta. Section
on Surgery: Dr. David Henry Poer, Atlanta, Chair-
man ; Discussion of “Sarcoma of the Breast,” Dr. Enoch
Callaway, LaGrange; Discussion of paper, “Indications
for Procedure in Plastic Surgery of the Nose,” Dr.
William G. Hamm, Atlanta; “Chairman’s Address:
“Carcinoma of the Infra-ampullary Portion of the
Duodenum” (Lantern Slides), Dr. David Henry Poer,
Atlanta. Section on Orthopedic and Traumatic Surg-
ery; Dr. Charles E. Irwin, Warm Springs, Chairman;
Chairman’s Address: “The Calcaneous Foot” < Lantern
Slides), Dr. Charles E. Irwin, Warm Springs; "Fatigue
Fractures of the Tibia” (Lantern Slides), Dr. Robert
P. Kelly, Emory University, and Dr. Fred E. Murphy,
Thomasville. Section on Urology: Dr. Harold P. Mc-
Donald, Atlanta, Secretary; “Transurethral Resection
of the Bladder Neck in Treatment of Congenital Ab-
normalities in Children” (Lantern Slides), Dr. J.
Robert Rinker, Augusta; Discussion of paper “The
Neglected Female Urethra,” Dr. Willis P. Jordan, Jr.,
Columbus; Discussion of paper “Ordinary Problems
Met Within Electrosurgery of the Bladder Neck and
Their Solution,” Dr. Reese C. Coleman, Jr.,Atlanta;
Discussion of paper "Melanoma of the Organs of the
Urinary Tract with Particular Reference to the Prostate
Gland,” Dr. Rudolph Bell, Thomasville. Section on
Proctology: “Oil Soluble Anesthetics in Proctology,”
Dr. A. M. Phillips, Macon. Section on Ophthalmology
and Otolaryngology : “Practical Therapeutics in
Otolaryngology,” Dr. William C. Warren, Jr., Atlanta.
Section on Anesthesiology: Dr. Perry P. Volpitto,
Augusta, Chairman; Dr. David A. Davis, Augusta,
Secretary. Section on Public Health: Dr. T. F. Sellers,
Atlanta, Chairman; Chairman's Address: “The Rela-
tion of Public Health to Medical Practice,” Dr. T. F.
Sellers, Atlanta; “The Georgia Plan of Multiphase
Testing,” Dr. C. D. Bowdoin, Atlanta: “Certain Public
Health Aspects of Heart Disease, " Dr. L. Minor
Blackford, Atlanta. American College of Chest Psysi-
cians, Southern Chapter: "Bacteriologic Diagnosis in
Tuberculosis,” Dr. Martin M. Cummings, Atlanta; “The
Surgical Treatment of Asthma Emphysema, Bullae and
Blebs” (Lantern Slides), Dr. Osier A. Abbott, Atlanta.
Scientific Exhibits: “Bentyl Hydrochloride: A New
Antispasmodic,” Dr. Charles W. Hock, Augusta;
“Agents of Tinea Capitis in the United States,” U. S.
Public Health Service, Communicable Disease Center,
Mycology Uint, Atlanta; "The Role of Hormones in
Carcinogenesis and Therapy,” Dr. H. E. Nieburgs,
Augusta. Motion Pictures: “Vaginal Hysterectomy,”
Drs. Olin S. Cofer and Albert L. Evans, Atlanta;
“Uterine Cancer: Pathogenesis Detection and Diag-
nosis,” Drs. H. E. Nieburgs, E. R. Pund and S. Bamford,
B.S., Augusta. Other physicians attending the above
named meeting were: Dr. Olin S. Cofer, Atlanta, repre-
senting Georgia as a member of the Council; Drs. C. C.
Aven, B. T. Beasley, James N. Brawner, Sr., Edgar M.
Dunstan, Murdock Equen, Howard Hailey, John R.
Lewis. Jr„ W. A. Selman, John W. Turner and R. Hugh
Wood, all of Atlanta.
* * *
Dr. Frank K. Boland, Atlanta, physician and pro-
fessor of clinical surgery, Emory University School
of Medicine, spoke at the Emory Hospital Auditorium,
October 25. His subject was the title of his recent
book, “The First Anesthetic, the Story of Crawford
Long.” This was the first of three lectures on major
historical advances in medicine contemplated for the
fall quarter at Emory. The public was invited.
* * *
Dr. Ralph O. Bowden, Savannah physician, recently
was guest speaker at the meeting of the Junior Chamber
of Commerce held at the Hotel Savannah. Dr. Bowden
discussed the need for a new 250-bed hospital in
Savannah.
* * *
Dr. Richard P. Campbell, formerly of Rockmart,
announces the opening of his office in the Hollings-
worth Building, Fayetteville, for the practice of medi-
cine. Dr. Campbell is a graduate of Llniversity of
Georgia School of Medicine, Augusta. He served a
15-month internship at the Jersey City Medical Center
and later was a medical officer aboard the cruisers
Fresno and Albany for two years. He recently com-
pleted a residency at the Crawford W. Long Memorial
Hospital, Atlanta.
December, 1950
541
The Chatham-Savannah Health Council met in
Jenkins Hall of Armstrong College, Savannah, October
16. Dr. Albert J. Kelley, president of the council, pre-
sided. Colonel Frank A. Kopf, Atlanta, Civil Defense
Coordinator for Georgia, was guest speaker, and spoke
on ‘‘Civilian Defense. ’ He also showed a film, "The
Atom Strikes,” depicting the bombing of Hiroshima
and Nagasaki. National authorities are alarmed that
preparation for civilian defense has lagged and are
urging each and every community to take steps to
rectify this as soon as possible.
* * *
Dr. Abe J. Davis, Augusta, Health Commissioner
for Richmond County, recently spent a week in St.
Louis, Mo., where he attended a meeting of the
American Public Health Association.
Dr. Davis recently spoke on “Tuberculosis, a Com-
munity Problem,” at a luncheon meeting of the Woman's
Auxiliary to the Richmond County Medical Society held
in the Crystal Room of the Boa Air Hotel, Augusta.
* * *
Emory University School of Medicine, Atlanta, is
accepting applications for scholarships recently estab-
lished in honor of Di. James E. Paullin. Dean R. Hugh
Wood recently announced. Dean Wood said financial
need and scholastic standing will be considered in
awarding the scholarships. The first awards will be
given for the 1951-52 school session. They are planned
largely to assist students during their second and third
years in medical school. Dr. Paullin. professor emeritus
of clinical medicine, retired from Emory faculty last
years after 42 years of service.
* * *
Dr. R. H. Fike, Moultrie, radiologist of V ereen
Memorial Hospital, spends each Wednesday afternoon
at the Mitchell County Hospital. Camilla, interpreting
x-ray films and doing fluoroscopy. In cases of emer-
gency he is available at all times. Before moving to
Moultrie, Dr. Fike was head of Steiner Clinic, Atlanta,
for 25 years. Dr. Fike is a major asset to the hospitals
at Moultrie and Camilla.
* * *
Dr. Ralph W. Fowler, Marietta physician, was recently
appointed the ninth member of the Kenne tone Hos-
pital Authority by Marietta City Council. Dr. howler
is the first nonbusinessman selected for the five-month-
old hospital’s administrative authority.
* * *
The Fulton County Medical Society held its semi-
monthly dinner meeting at the Academy of Medicine,
Atlanta, November 2. Scientific program: Dr. Mason
I. Lowance, moderator. “Medical Care Today: Are
We Using It to the Best Advantage?”, Dr. McClaren
Johnson; "Patients and Physicians in the Modern
Hospitals”, Mr. Edwin B. Peel; “Insurance Companies’
Part in Voluntary Prepaid Medical Care Plans”. Mr.
Lambert G. Schulze. The National Health Week
program was open to the public.
* * *
The Eighth District Medical Society held its semi-
annual meeting at the King and Prince Hotel, St.
Simons Island, October 13 and 14. Sceintific program:
"Recent Advances in Eye Surgery,” Dr. B. H. Minchew
and Dr. Braswell E. Collins, Waycross; “Cardiac
Arrhythmias,” Dr. Arthur Knight, Jr., Waycross;
“Carcinoma of the Cerv x,” Dr. Enoch Callaway, La-
Grange; “Office Gynecology,” Dr. George A. Niles,
Atlanta; Taxes, Temperatures and Tonics,” Porter F.
Gould, Brunswick. Dr. J. B. Avera, Brunswick, was re-
elected president; Dr. J. L. Campbell, Jr., Valdosta,
secretary-treasurer. The spring meeting will be held
in Waycross next April.
* * *
Dr. Marion Estes, Augusta, associate professor of
psychiatry and neurology at the Medical College of
Georgia, has resigned that position to accept an appoint-
ment at Dix Hill Hospital. Raleigh, N. C. Dr. Estes
will be clinical director at the Dix Hill Hospital,
and will participate also in training residents in that
hospital. Dr. Estes, a graduate of the Medical College
of Georgia, Augusta, class of 1943, has just passed the
examination of the American Board of Psychiatry.
Dr. llervey Cleckley, Augusta, head of the department
of psychiatry and neurology, said that no one will be
appointed at present to fill Dr. Estes’ place on the
faculty of the Medical College of Georgia. The work
will he carried on by Dr. Cleckley and Dr. Corbett
H. Thigpen, assistant professor of psychiatry and
neurology.
* * *
Dr. R. W. Edenfield, Macon physician, recently
attended the annual Clinical Congress of the \merican
College of Surgeons held in Boston, Mass.
* * *
Dr. Charles B. Fulghum, Milledgeville, a member of
the Richard Binion Clinic, recently spent a week at
Duke University School of Medicine, Durham. N. C.,
taking a special cour-e at the medical center there.
* * *
The Georgia Chapter of American \cademy of
General Practice held its second annual meeting at
the Dempsey Hotel, Macon, October 26. More than
100 Georgia general practitioners attended the meeting.
Dr. Josiah Crudup, Gainesville, president of Brenau
Co'lege, was guest speaker. His subject was "Think
Twice America.” The new officers are: Dr. Walter
W. Daniel, Atlanta, president; Dr. J. B. Kay, Byron,
vice president; Dr. Albert R. Bush, Hawkinsville, sec-
retary-treasurer. Director1: Dr. Steve P. Kenyon, Daw-
son; Dr. Lee E. Williams, Cordele; Dr. Frank Vinson,
Fort Valley, and Dr. Edwin W. Turner. East Point.
* * *
The Georgia Medical Society held its regular meeting
at 612 Drayton Street, Savannah, November 14. Pro-
gram: "Blood Needs for Armed Forces and Civilian
Defense,” Dr. George B. Dowling, Medical Director,
American Red Cross, Southeastern Area. Dr. Sam
Youngblood, Jr., secretary.
* * *
Dr. Wood Goss, formerly of Richland, announces
the removal of his office to Ashburn where he will
he associated with his brother. Dr. C. C. Goss,
Ashburn, for the practice of medicine and surgery.
* * *
Dr. Harriet E. Gillette, Atlanta, medical director of
Aidmore Children’s Convalescent Hospital, recently
spoke at the annual convention of the National Society
for Crippled Children and Adults in Chicago. 111. Dr.
Gillette took part in a clinical demonstration illustrat-
ing "Easter Seals at Work.” Georgia Secretary of
State Ben W. Fortson, Jr., Atlanta, participated in
the opening day program at the convention. He was
one of a group of distinguished persons who have
overcome handicaps to attain success.
* * *
Dr. F. F. Griffith, Eatonton physician, was recently
given a surprise testimonial dinner at the First Meth-
odist Church on his twentieth anniversary as a teacher
in the Sunday School.
* * *
Emory University School of Medicine. Atlanta,
Medical staff physician inspects City Hospital. Colum-
bus. Dr. R. Bruce Logue, head of the department
of cardiology, paid a visit to the hospital. October 19,
as a part of a regular service Emory is rendering
hospitals of the State. Under the plan, each month
a professor of the Emory medical school will make
ward rounds of city hospitals to help the hospital
staff with the teaching of interns and resident physi-
cians. After a tour of the wards, Dr. Logue was
honored at a buffet supper at the hospital. Later he
addressed physicians of the hospital staff.
Dr. J. A. Thrash. Columbus, executive director of
City Hospital, said the hospital expects to obtain
interns and resident physicians next June when the
medical school year ends. At present the hospital has
542
The Journal of the Medical Association of Georgia
three interns who have completed their internships
and are being paid, as young physicians, to work at
the hospital.
* * *
The Macon-Bibb County Health Department, Macon,
recently held a Rehabilitation Clinic for persons with
“arrested" cases of tuberculosis. Dr. R. Frank Cary,
Macon, is the Macon-Bibb County health officer. The
clinic was operated in cooperation with the above
named health department, the Bibb County Tubercu-
losis Association and the Division of \ ocational Re-
habilitation of the Georgia Department of Public Health.
Dr. Sam E. Patton. Macon tuberculosis specialist and
president of the Bibb County Tuberculosis Association,
said that the clinic served “a wonderful purpose, and
the association is happy to have a part in cooperating
with the clinic.
* * *
The Medical College of Georgia, Augusta, is one
of the outstanding centers of the world in cancer
research. Its recently created department of cytology
where progress made in diagnosing cancer through
the use of what is known as the Papanicolaou smear
test has produced results that are being discussed
at medical meetings all over the world. Research on
what the physicians term as preinvasive cancer was
started some years ago at the medical college by
Dr. E. R. Pund who began a test program in which
the Papanicolaou smear test was used in detecting
cancer in its early stages. About four years ago Dr.
Pund was joined in this work by Dr. Herbert E.
Nieburgs, a native of Riga Latvia. The department
of cytology at the medical college today has the dis-
tinction of having made the largest number of such
tests on record in any one center and A.ugusta has
the distinction of being the only place where these
smear tests have been adopted as matter of routine
in screening cases for cancer in the pre-invasive stage.
The program has been written up in The Journal
of the American Medical As ociation and Dr. Nieburgs
has discussed it in medical meetings in Paris, London.
Geneva and Zurich. It was also one of the featured
subjects under discussion at the International Cancer
Conference in Paris last year, at which Dr. Nieburgs
was a participating member.
* * *
Dr. David Merren, Atlanta, announces the opening
of his office at 53 Sixth Street. Atlanta. Practice
limited to urology.
* * *
Dr. R. L. Carter and Dr. T. A. Sapington. Thomas-
ton, announce the association of Dr. R. J. Mincey, Jr.
at The Clinic. Thomaston. Dr. Mincey will limit his
practice to obstetrics and gynecology.
* * *
The Medical Advisory Committee to Selective Service
—State Committee: Dr. Carter Smith, chairman. Dr.
A. O. Linch, vice-chairman. Dr. T. F. Sellers, Dr. C.
W. Strickler, Jr., Dr. David Henry Poer. Dr. L. Minor
Blackford, all of Atlanta. Dr. Steve A. Garrett, dentist,
and Dr. Charles C. Rife, veterinarian, Atlanta.
* * *
Dr. Lucius Pa'til’o Pharr, beloved Auburn and
Barrow County physician and citizen, was honored
on his 82nd birthday, November 10. 1950. “Dr. Pharr
Day’ was celebrated at Auburn on Sunday, November
12. A “Love Offering was contributed by the many
he has administered to during his more than fifty
years of the practice of medicine, and presented him
at the “open house held at the Auburn school build-
ing. A “Dr. Fharr Baby Club has been formed, and
a register provided where each person who was brought
into the world by Dr. Pharr may sign his or her name
and make a contribution. The register will become
a permanent record of the Dr. Pharr Babies, which
number approximately 4.000. The “Love Offering’’
will be used in some way to honor Dr. Pharr at the
Barrow County Hospital.
* * *
The Polk County Health Department and the Public
Welfare Department, Cedartown, announce the pur-
chase of the Hackney home on Main Street to be
used as a Health Center. Dr. John W. Good, Cedar-
town physician and a member of the health commis-
sions, made the announcemnet.
* * *
Dr. John H. Ridley, Atlanta physician, recently spoke
before the P.-T.A. meeting at Canton, October 17.
Dr. Ridley is one of 10 physicians who are giving their
time to go over the state and speak on “Cancer.”
Dr. Ridley handles the subject most capably, giving
information in an interesting way that will prove
beneficial in this fight against cancer.
* * *
The Richmond County Medical Society held its
meeting in Dugas Auditorium at the Medical College
of Georgia, Augusta, October 19. Dr. Lloyd B. Greene,
Philadelphia, associate professor of urology at the
University of Pennsylvania School of Medicine, and
a native of Augusta, was guest speaker. His subject
was “The Role of the General Practitioner in the
Management of Certain Urologic Conditions.”
* * *
Dr. Paul L. Rieth and Dr. E. B. Dunlap. Jr.. Atlanta,
announce the opening of their offices at 207 Medical
Arts Building, Atlanta. Prcatice limited to orthopedic
surgery and fractures.
* * *
Dr. Geo. Roach. Atlanta, who is as-ociated with Dr.
Murdock Equen of the Ponce de Leon Infirmary, is at
the Harvard Medical School, Boston. Mass., where he is
taking postgraduate work in the diseases of the ear,
nose and throat.
* * *
The Southern Section of the United States Chapter
of the International College of Surgeons will meet at
the Biltmore Hotel. Atlanta, January- 11, 12, and 13,
1951. No registration fee. The Faculty: Dr. Herbert
Acuff. Knoxville; Dr. Fenry E. Bacon, Philadelphia;
Dr. Richard Cattell, Boston; Dr. Gilbert Douglas,
Birmingham; Dr. Lawrence Fallis, Detroit; Dr. Merrill
Foote. Brooklyn: Dr. William Hamm. Atlanta; Dr. D.
P. Hall. Louisville; Dr. Claude Hunt, Kansas City;
Dr. Arnold Jackson, Madison: Dr. Amos Koontz,
Baltimore; Dr. Raymond McNealey, Chicago; Dr.
Frank Ne'eney, New York: Dr. Karl Meyer, Chicago;
Dr. Phillip Thorek, Chicago; Dr. Howard Trimpi,
Philadelphia, and Dr. Exum Walker, \tlanta.
* * *
Dr. Alex B. Russell, Winder physician, is chairman
of the state medical advi-ory committee of the newly
formed Georgia Society for Crippled Children. The
organizational meeting was held at the Henry Grady
Hotel, Atlanta. October 17.
* * *
The Savannah Mental Hygiene Society held its first
meeting in Savannah. October 10. to make plans for
the fall and winter programs. One of the activities
of the society is to arrange public meetings, with
outstanding speakers on subjects concerning mental
hygiene. Dr. A. H. Center and Dr. Harry E. Rollings,
both of Savannah, are on the personnel of the educa-
tional committee. Dr. Clair A. Henderson. Savannah
health commissioner, is a member of the committee
to organize a state mental hygiene society.
* * *
Dr. H. C. Schenck. Atlanta, director of the Division
of Tuberculosis Control, Georgia Department of Public
Health, said, “Cases of tuberculosis found in Fulton
and DeKalb counties during the Greater-Atlanta Health
Program equal the maximum tuberculosis hospital facili-
ties for the entire state.” “The number of cases found
in Fulton and DeKalb counties are significant in that
December, 1950
543
(hey reveal a real need tor a greaiei and more intensive
case-finding program and an expanded treatment pro-
gram on the local level. Dr. Schenck suggested that
the state could spend half of its annual cost of tubercu-
losis to put into effect controls that would, in a few
years, reduce the cost of the disease to “a compara-
tively inconsequential sum.” The Atlanta Health
Testing Program found 896 woman and 752 men with
tuberculosis. Eighty-one per cent of them were over
35 vears old.
* * *
Dr. William Grover Skipper, a native of Lakeland,
Fla., and recently connected with a hospital in States-
ville. N. C., announces the opening of his office at
Roberta for the practice of medicine.
* * *
Dr. Earl Atkinson Mayo, Jr., a native of Richland,
announces the opening of his office for the practice
of medicine at Richland. He graduated from Vander-
bilt University School of Medicine, Nashville, Tenn.,
in 1945. He served his internship at the Baltimore
City Hospital, Baltimore, Md. During World War II
he served as a captain in the Medical Corps. For the
past two vears he has practiced medicine at Repton,
Ala.
* * *
Dr. Cosby Swanson, Atlanta, announces the associa-
tion of Dr. David L. Hearin in the practice of derma-
tology at 1017 Doctors Building, 478 Peachtree Street,
N. E„ Atlanta.
* * *
The l nited States Selective Service recently an-
nounced the medical draft had a total of 349 physi-
cians, dentists and veterinarians registered in Georgia.
Of the total, there were 219 physicians, 78 dentists
and 52 veterinarians. Those required to register in
the first call include only those who trained at govern-
ment expense and who served less than 21 months in
^ orld War II and those deferred to complete their
education. All physicians undere 50 w'ill be required
to register in the next three months.
* * *
Dr. John B. Varner, Atlanta, announces the removal
of his office form 1001 Medical Arts Building to 505
Doctors Building. 478 Peachtree Street, N. E., Atlanta.
Practice limited to obstetrics and gynecology.
* * *
Dr. John H. Venable, Griffin, Spalding County
Health Commissioner, recently sought public reaction
to plans to cut down on tooth decay in the countv.
Dr. \ enable said that his office has investigated a
system which he says reduces decay from 30 to 40
per cent and is prepared to recommend it to the city
if the public wants it. The system is fluorination of
the city water supply which calls for adding a small
amount of flourine to water just as chlorine is now
added for safety. Dr. Venable said the system has
been approved by the Spalding County Medical Society
and the dentists.
* * *
The \eterans Administration Hospital (Lenwood),
Vugusta. medical staff training program guest speakers
for October were: Dr. William L. Holt, Jr., Boston,
chief medical officer for the Boston Psychopathic
Hospital, who gave a series of two lectures entitled:
Electric Shock Therapy with Clinical Applications”
and "Electric Coma I herapy and Non-convulsive Elec-
tric Simulation Therapy. Dr. Paul Wilcox, Traverse
City. Mich., research director at Traverse State Hos-
pital. and secretary-treasurer of the Electro-Shock Re-
search Association, gave a series of lectures and clinical
demonstrations. Dr. Wilcox is one of this country’s
outstanding experts in the field of research in the
treatment ;of those suffering from nervous and mental
ailments. He presented material which is entirely new
and far advanced in this field. Dr. Arthur L. Watkins,
Boston, a member of the staff of the Massachusetts
General Hospital, also gave a series of two lectures.
II is subjects were “General Principles as Applied in
the Application of Physical Medicine in a Neuropsychi-
atric Hospital,” and “Boundaries of Physical Medicine.”
Dr. Leo R. Tige, Augusta, manager of the above named
hospital invited the medical personnel to attend the
lectures.
* * *
Dr. Jules Victor, Savannah physician, recently was
guest speaker to the members of the Opti-Mrs. Club
meeting held at the Brannon Lodge, Savannah. Dr.
Victor stressed the need in Savannah for a modern
250-bed hospital. He pointed out that the Savannah
present hospital facilities are not only antiquated
to a degree, but are distressingly limited. He endorsed
the plan to build a new institution as a memorial to
World War II dead.
* * *
Dr. Edward M. West, Atlanta, resident physician
at Crawford W. Long Memorial Hospital, recently
spent a week attending the Interstate Postgraduate
Medical Assembly held in Chicago.
* * *
Dr. T. V. Willis, Brunswick physician and surgeon,
has accepted the position as chief surgeon and medical
director of the Allegheny Memorial Hospital, Sparta,
N. C. The new hospital is a 20-bed institution and is
modern equipped in every detail. It is so constructed
that it can be enlarged when there is demand for a
larger hospital. Sparta is located in the mountains
of North Carolina.
* * *
Dr. Mervin B. Wine, Thomasville physician, is a
member of the Board of Directors of the Aidmore
Children’s Convalescent Hospital, Atlanta.
* * *
Dr. Steve Worthy, Carrollton physician and surgeon,
was elected chief of staff and president of the Tanner
Memorial Ho pital medical staff at the staff’s regular
monthly meeting held October 9. Dr. Worthy succeeds
Dr. D. S. Reese who served during the hospital’s first
year. Other officers are Dr. E. V. Patrick, vice-chief
of staff and vice-president, and Dr. H. L. Barker,
secretary and treasurer. Installation of the new officers
took place November 2 only five days prior to the
first anniversary of the first patient being admitted
to the beautiful hospital. Three changes were made
in the executive committee and two physicians were
re-elected. Dr. Patrick was named to the medical ser-
vices division. Dr. Thomas E. Reeve, Jr., to surgery
and Dr. E. C. Bass to obstetrics and gynecology. Dr.
O. E. Brannon was re-elected to head dental surgery,
and Dr. R. L. Denney renamed head of the eye, ear,
nose and throat division. Dr. S. E. Thomas remains
medical advisory chairman for the colored ward.
* * *
The Fulton County Medical Society held its semi-
monthly dinner meeting at the Academy of Medicine,
Atlanta, November 16. Scientific meeting: Dr. Charles
E. Holloway, moderator. “Rupture of the Pregnant
Uterus,” Dr. Eugene L. Griffin; “Prolapse of Gastric
Mucosa into the Duodenum,” Dr. A. Park McGinty.
* * *
Dr. T. C. Davison, Atlanta surgeon, addressed the
American Chapter of the International College of
Surgeons at the Cleveland, Ohio meeting November 1.
His subject was “Thyroiditis.” Dr. Davison is presi-
dent of the American Goiter Association.
* * *
Dr. Sandy B. Carter, Atlanta physician, is a con-
tributing editor to the new text book, “Therapeutics
in Internal Medicine,” edited by Dr. Franklin A. Kyser,
as'ociate in medicine. Northwestern University Medical
School, Chicago, 111.
* * *
Dr. William F. Friedewald, Atlanta physician, pro-
fessor of Bacteriology and Immunization, and associate
544
The Journal of the Medical Association of Georgia
professor of medicine, Emory University School of
Medicine, lias been awarded a $13,176 grant by the
National Cancer Institute, l nited States Public Health
Service, for the study of viruses and tumors.
* * *
Dr. R. Bruce Logue, Atlanta, cardiologist at Emory
University Hospital, recently wrote a paper entitled
“Recent Advances ill the Treatment of Congestive Heart
Failure,” which was published in the November, 1950
number of The Journal of the Missouri State Medical
Association, under the section “Postgraduate Review.”
* * *
Dr. Taylor S. Burgess, Atlanta, is taking a special
course in laryngeal surgery at the Chevalier Jackson
Clinic, Philadelphia.
* * *
Dr. R. Mitchell Sealey. Atlanta, is at the University
of Michigan Hospital, Ann Arbor. Mich., where he
is completing the requirements for residency for the
American College of Surgeons.
* # *
Dr. Murl M. Hagood. Marietta physician, has re-
ceived the highest accediation accorded his profession.
Dr. Hagood received his certification of membership
in the American Chapter, International College of
Surgeons at the Cleveland. Ohio, meeting, November
3. He is the only surgeon in Cobb County who has
received the above named honor and one of the 60
surgeons in Georgia.
He also attended the American College of Surgeons
annual session held in Boston, Mass., and while in
Boston took a two-week postgraduate course in surgery
at Harvard Medical School.
* * *
Dr. W. D. Hall. Calhoun physician, received the
degree of Associate Fellow in the International College
of Surgeons at the meeting held in Cleveland, Ohio.
November 3. This recognition of his ability is the
highest honor he has received.
* * *
Dr. Earle S. McKey, Jr., Valdosta physician, recently
spent several weeks attending the American Academy
of Ophthalmology and Otolaryngology held in Chicago.
* * *
Captain J. T. Rucker, Jr., Augusta, recently com-
pleted an internship at the University Hospital, Augusta,
is now serving with the U. S. Army in Korea. Captain
Rucker took part in the recent invasion of Inchon.
Korea, with the Seventh Infantry Division.
* * *
Dr. Robert C. Major, Augusta surgeon, is now a
Lieutenant Colonel in the U. S. Army. He is stationed
at the Fitzsimmons General Hospital, Denver, Colo.
* * *
The Southern States Seminar on Chronic Diseases
sponsored by the U. S. Public Health Service. Region
VI, will be held in the Auditorium of the Academy
of Medicine, 875 West Peachtree Street. N. E.. Atlanta.
January 13 and 14, 1951. The first session begins at
1:30 p.m., January 13. An interesting and helpful
program has been arranged. For full information
write Dr. F. V. Meriwether, Regional Medical Director,
U. S. Public Health Ser vice, 114 Marietta Street.
Atlanta 3, Georgia.
* * *
Dr. I. Elizabeth Fletcher, a native of Statesboro,
where she has practiced pediatrics since 1943, has
accepted a position as school physician of the Fulton
County Health Department, 160 Pryor Street, S. W..
Atlanta. Dr. Fletcher graduated from the University
of Georgia School of Medicine, Augusta, in 1939.
After her internship at the University Hospital, Augus-
ta, she served as assistant resident, resident and chief
resident on pediatrics and during her service as
chief resident was clinical instructor in pediatrics for
the University of Georgia Medical School. Dr. Fletcher,
who is a fellow of the American Medical Association,
was certified by the American Board of Pediatrics in
,1946. She is also a member of the Medical Vssociation
of Georgia, and Bulloch-Candler-Evans Medical Society
of which she is the secretary-treasurer.
* * *
Dr. Donald R. McRae, Jr., a native of Vugusta,
announces the opening of his offices at 1345 Greene
Street, Augusta, for the practice of surgery. Dr. McRae
graduated from the University of Georgia School of
Medicine, Augusta, in 1941. He spent 42 months in
the Army Air Forces during World War II. and had
54 months training in surgery up until the time he
received his surgery degree at the l niversity Hospital
in July of this year.
OBITUARY
Dr. IT ilham H . Holbrook, aged 75. retired Atlanta
physician, died of injuries received when his automobile
went over a 30-foot embankment near Pickens, S. C.,
died in a Pickens Hospital October 8. 1950. Dr. Hol-
brook graduated from Emory University School of
Medicine, Atlanta, in 1898, and had practiced medicine
in Atlanta for 35 years. For many years he was a
member of Grace Methodist Church, and in later years
he was a member of the Assembly of God Church
at Ponce de Leon and Piedmont. He was a member
of Alee Temple of the Shrine. Survivors include his
wife, Mrs. Katherine M. Holbrook; two daughters,
Mrs. R. L. Stringer and Mrs. W. C. Chalmers, both
of Atlanta: three sons, Paul. Grady, and W. H.
Holbrook, Jr., all of Atlanta, and two sisters. Funeral
services were held at Spring Hill with the Rev. Ralph
Byrd and the Rev. Jimmy Mayo officiating. Burial
was in West View Cemetery, Atlanta.
* * *
Hr. Thomas Hiram Gaines, aged 73. veteran Elberton
and Elbert County physician, died in the Anderson
Memorial Hospital. Anderson, S. C., October 13, 1950.
Dr. Gaines was the son of the late P. C. and Mary
Alexander Gaines, and spent his entire life in Elbert
County. He graduated from the Chattanooga Medical
College, Chattanooga. Tenn., in 1903. He was a mem-
ber of the Ruckersville Methodist Church. He had
practiced medicine in Elbert County since 1903 and
continued in active practice until recent months when
ill health forced him to retire. Survivors include one
son. Thomas H. Gaines, Jr., Decatur, and one daughter.
Mrs. Roy G. Grubbs, Elbert County; two brothers and
a sister. Funeral services were held at the Ruckersville
Methodist Church with the Rev. R. H. Peterson and
the Rev. Thomas H. W heelis officiating. Burial was
in the churchyard.
* * *
Dr. Homer D. Liles, aged 61, widely known physician
of Flowery Branch, died in the Hall County Hospital,
Gainesville, October 20. 1950. He graduated from
the Georgia College of Eclectic Medicine and Surgery,
Atlanta, in 1913. He was a veteran of World War I.
Dr. Li’es was a member of the Flowery Branch Baptist
Church, the American Legion, and the Disabled Ameri-
can Veterans. Born in Hall County, Dr. Liles had
practiced medicine in the county for 37 years. Sur-
vivors include four brothers, J. A. and G. P. Liles,
both of Birmingham, Ala.; H. S. Liles, Atlanta, and
C. H. Liles, Avondale Estates; two sisters. Mrs. J. C.
O'Dell, Gainesville, and Mrs. W. P. Thompson. Avon-
dale Estates. Funeral services were held at Hubert
Vickers Chapel, with the Rev. Sam Jones, and the
Rev. G. L. Roper officiating. Burial was in the Pleasant
Hill Cemetery, Flowery Branch.
* * *
Dr. E. C. Ripley, aged 81, retired physician, of
1235 Clairmont Avenue, Decatur, died October 25, 1950.
Dr. Ripley was a pioneer Atlantan, a son of the late
Thomas R. and Laura Conner Ripley, early Atlanta
settlers. He graduated from the Atlanta School of
Medicine, now Emory University School of Medicine,
(Continued from Page 556 1
December, 1930
545
WOMAN’S AUXILIARY TO THE MEDICAL ASSOCIATION OF GEORGIA
1950-1951
PRESIDENT’S MESSAGE
Greetings to every doctor in Georgia and to every member of the Woman’s Auxiliary to
the Medical Association of Georgia.- To all members of the Medical Association I urge you to have
your wife become a member of “our auxiliary”, if she has not already joined.
Our theme for 1950-1951, is, Plan — Cooperate — Progress.
Let us plan study groups, so that we will be better informed on all of the aims of our
auxiliarv. Remember we as doctors’ wives can contribute much to our doctor-husbands and their
profession in the field of Public Relations, by being informed ourselves on current legislation
and becoming acquainted with the health and welfare agencies in our community.
Let us cooperate with all the auxiliary in our State, especially in our own district.
This vear, our aim will be one or more newly organized counties in every district and an
increase in membership in every auxiliary.
Let us work together and serve the medical profession to the best of our ability. We will
always live up to our name, Auxiliary, “That which helps”.
My best wishes to each of you for a very successful year in all of your auxiliary activities.
MARTHA WILLIAMS, President
(Mrs. Lehman W. Williams)
ADVISORY COMMITTEE
Dr. Murdock Equen, Atlanta, Chair
man
Dr. Lehman V . Williams, Savannah
Dr. J. R. S. Mays, Macon
Dr. Eustace A. Allen, Atlanta
Dr. W. Bruce Schaefer. Toccoa
Dr. Ralph H. Chaney, Augusta
Dr. W. L. Bazemore, Macon
Dr. J. Harry Rogers, Atlanta
Dr. W. G. Elliott, Cuthbert
HONORARY PRESIDENTS
FOR LIFE
Mrs. James N. Brawner, Sr., 2800
Peachtree Road, N. E., Atlanta
(named at 1939 convention)
Mrs. Eustace A. Allen, 18 Collier
Road, N. W., Atlanta (named at
1949 convention)
EXECUTIVE BOARD
Past Presidents
Mrs. James N. Brawner, Sr., 2800
Peachtree Road, N. E., Atlanta
Mrs. William H. Meyers, 402 Dray-
ton St., Savannah.
Mrs. C. W. Roberts, 3250 Ridge-
wood Rd., N. W., Atlanta
Mrs. J. C. Moore (moved out of
State)
Mrs. C. C. Hinton, 2514 Forsyth
Road, Macon
Mrs. Marion T. Benson, Sr., 36
Sheridan Dr.. N. E., Atlanta
Mrs. C. C. Harrold, 350 Orange St.,
Macon
M rs. Ralston Lattimore, 109 E. 52nd
St., Savannah
Mrs. S. T. R. Revell, Louisville
Mrs. J. Bonar White, Atlanta (de-
ceased )
Mrs. J. E. Penland, 912 Elizabeth
St., Waycross
Mrs. E. R. Harris, Winder
Mrs. William R. Dancy, 308 E. Gas-
ton St., Savannah
Mrs. Ralph Chaney, Bransford Rd.,
Augusta
Mrs. Warren A. Coleman, Eastman
Mrs. Eustace A. Allen, 18 Collier
Rd., N. W„ Atlanta
Mrs. H. G. Bannister, Ila
Mrs. Lee Howard, 625 East 44th St.,
Savannah
Mrs. J. Long King, 283 Buford
Place, Macon
Mrs. Olin S. Gofer, 948 Lulhvater
Rd.. N. E., Atlanta
Mrs. Win. T. Randolph, Winder
Mrs. Bruce Schaefer, 110 East Whit-
man St., Toccoa
Mrs. W. G. Elliott, 1010 Lumpkin
St., Cuthbert
Mrs. Sam Anderson, 36 Sheridan Dr.,
N. E., Atlanta
Mrs. J. Harry Rogers, 699 E. Paces
Ferry Road, N. E., Atlanta
OFFICERS
President — Mrs. Lehman W’. Wil-
liams, 135 East 45th St., Savannah
President-Elect, Chairman Organiza-
tion-—Mrs. J. R. S. Mays, 2587
Elizabeth St., Macon
First Vice-President, Chairman Pro-
gram— Mrs. Ralph Fowler, 303
McDonald St., Marietta.
Second Vice-President, Chairman To-
day's Health — Mrs. John W. Tur-
ner, 3985 Vermont Rd., N. E.,
Atlanta
Third Vice-President, Scrapbook
Chairman — Mrs, Paul T. Russell,
513 N. Cleveland Dr., Albany
Recording Secretary — Mrs. Leo
Smith, St. Mary’s Drive, Waycross
Corresponding Secretary — Mrs. C. R.
A. Redmond, 113 Henry Ave., Sa-
vannah
Treasurer — Mrs. Robert C. Major,
Magnolia Dr., Forrest Hills, Au-
gusta
Historian — Mrs. Robert Crichton,
Milledgeville State .Hospital, Mil-
ledgeville
Parliamentarian — Mrs. W. Bruce
Schaefer, 110 East Franklin, Toc-
coa
Chairmen of Standing
Committees
Achievement Award — Mrs. William
H. Benson, Burnt Hickory Rd.,
Marietta
Archives — Mrs. C. W. Roberts,
3250 Ridgewood Rd., N. W., At-
lanta
/
Budget — Mrs. Ralph H. Chaney,
Bransford Rd., Augusta
Bulletin — Mrs. Milford B. Hatcher,
274 Jackson Spring Rd., Macon
Doctor’s Day — Mrs. Virgil Williams,
Griffin
Editorial — Mrs. Ben Hill Clifton,
1893 Wvcliff Rd.. N. W„ Atlanta
Mrs. J. Bonar White Exhibit and
Scrapbook A wards— L\i rs. K. r..
Jones, 1014 Love Ave., Tifton
Legislation — Mrs. Harold Smith, 4
Henry Ave., Savannah.
Public Relations — Mrs. J. Harry Rog-
ers, 699 E. Paces Ferry Rd., N. E.,
Atlanta
Research in Romance of Medicine —
Mrs. T. J. Ferrell, 1521 St. Mary’s
Dr., Waycross
Revisions — Mrs. Lee Howard, 625 E.
44th St., Savannah.
Student Loan Fund — Mrs. Shelley C.
Davis, 1259 Peachtree Battle Ave.,
N. W., Atlanta
Trophy — Mrs. James N. Brawner,
Sr., Mrs. J. Harry Rogers, 699 E.
Paces Ferry Rd., N. E., Atlanta
Special Committee Camellia Garden
— Mrs. R. W. Bradford. Milledge-
ville State Hospital, Milledgeville
FIRST DISTRICT
Manager: Mrs. T. A. Peterson, Sa-
vannah
Bulloeh-Candler-Evans
Counties
President, Mrs. J. L. Nevil, Metter
Daniel, Mrs. Bird, Statesboro
Deal, Mrs. B. A., Statesboro
Floyd, Mrs. W. E., Claxton
Griffin, Mrs. Louie, Claxton
Hames, Mrs. Curtis, Claxton
Kennedy, Mrs. R. L., Metter
McElveen, Mrs. J. M., Brooklet
Mooney, Mrs. John, Jr,. Statesboro
Nevil. Mrs. J. L., Metter
Olliff, Mrs. H. H., Register
Simmons, Mrs. W. E., Metter
Burke-Jenkins-Screven
Counties
President, Mrs. Cleveland Thomp-
son, Waynesboro
Bargeron, Mrs. Everette, Waynesboro
546
The Journal ok the Medical Association of Georgia
Byne, Mrs. J. M., Jr.. Waynesboro
Green, Mrs. C. G., Waynesboro
Ilillis, Mrs. W. W., Sardis
Lee, Mrs. H. G., Millen
MeCarver, Mrs. W. C., Vidette
Mulkey, Mrs. A. P.. Millen
Mul key, Mrs. Q. A., Millen
Simmons, Mrs. W. G.. Sylvania
Thompson, Mrs. Cleveland, Waynes-
boro
Chatham County
President, Mrs. S. F. Rosen, Sa-
vannah
Baker, Mrs. J. 0., 126 East Ogle-
thorpe Ave., Savannah
Barrow, Mrs. Craig, Wormsloe, Sa-
vannah
Bedingfield, Mrs. W. O.. 19 East 46th
St., Savannah
Broderick, Mrs. J. R., 37 East 49th
St., Savannah
Brown, Mrs. C. T., Guyton
Brown, Mrs. F. B., 17 East 52nd St.,
Savannah
Brown, Mrs. W. E., 139 East Victory
Dr., Savannah
Center, Mrs. A. H., 507 East 48th St.,
Savannah
Chisholm, Mrs. J. F., 201 East Gas-
ton St., Savannah
Cluxton, Mrs. Harley, 29 Chelsea Dr.,
Savannah
Cluxton, Mrs. Hayes, 2225 East Vic-
tory Dr., Savannah
Cook, Mrs. E. R., 513 Whitaker St.,
Savannah
Coward, Mrs. A. W., 1221 East 49th
St., Savannah
Craig, Mrs. J. B., 528 East 45th St.,
Savannah
Crawford, Mrs. W. B„ Jr., 2608 At-
lantic Ave., Savannah
Dancy, Mrs. W. R., 308 East Gaston
St., Savannah
Demmond, Mrs. E. C., 1001 East
Victory Dr., Savannah
Drane, Mrs. Robert, 204 East Hall
St., Savannah
Elliott, Mrs. J. L., 210 East Hunting-
don St., Savannah
Faggart, Mrs. G. H., 18 West Ogle-
thorpe Ave., Savannah
Fillingim, Mrs. D. B., 716 East 52nd
Freeh, Mrs. H. C., 516 East 53rd St.,
Savannah
Freedman, Mrs. L. M., 140 East 44th
St., Savannah
Fulmer, Mrs. W. H., 38 East 52nd
St., Savannah
Gleaton, Mrs. E. N., 32 East 45th
St., Savannah
Goldenstar, Mrs. G. W., Wymberly,
Savannah
Gottschalk, Mrs. R. B., 437 East 59th
St., Savannah
Graham, Mrs. R. E., 417 East 54th
St., Savannah
Ham, Mrs. Emerson, 2130 East 43rd
St., Savannah
Henderson, Mrs. C. A., 1117 East
48th St., Savannah
Holloman, Mrs. A. L., 27 East 34th
St., Savannah
Holton, Mrs. C. F., 606 East 45th
St., Savannah
Howard, Mrs. Lee, Sr., 625 East 44th
St., Savannah
Howard, Mrs. Lee, Jr., 626 East 52nd
St., Savannah
Iseman, Mrs. Everette, 302 East 46th
St., Savannah
Kandel, Mrs. II. M., 432 Abercorn
St., Sa\annah
Kanter, Mrs. W. W„ 502 East 57th
St., Savannah
King, Mrs. Rnskin. 10 West Taylor
St., Savannah
Lang, Mrs. G. 11., 2801 Atlantic Ave.,
Savannah
Lange, Mrs. S. J., 11 Oleander St.,
Savannah
Lattimore, Mrs. Ralston, 105 East
52nd St., Savannah
Lee, Mrs. Lawrence, Sr., 527 East
44th St., Savannah
Lee, Mrs. Lawrence, Jr., 122 Aber-
corn St., Savannah
Levington. Mrs. H. L., 209 East
Gaston St., Savannah
Lott, Mrs. Oscar, 320 East 54th St.,
Savannah
Lynn, Mrs. S. C., 2 East 45th St.,
Savannah
McGee, Mrs. 11. H., 7 West Gordon
St., Savannah
McGoldrick, Mrs. T. A., Jr., 417 East
45th St., Savannah
Maner, Mrs. E. N., 101 East 45th St.,
Savannah
Metis, Mrs. J. C., 303 Anderson Ave.,
Savannah
Miller, Mrs. B. E„ Court Apartments,
Savannah
Morrison, Mrs. H. J., 20 East Gaston
St., Savannah
Norton, Mrs. W. A., 105 East Ogle-
thorpe Ave., Savannah
Oliver, Mrs. R. L., 1133 Washington
Ave., Savannah
Olmstead, Mrs. G. T., 333 45th St.,
Savannah
Osborne, Mrs. E. S., 7 Edgewood
Ave., Savannah
Osborne, Mrs. W. W., 2112 Lincoln
St., Savannah
Osteen, Mrs. W. L., 610 Anderson
Ave., Savannah
Pacifici, Mrs. Joseph, 40 East 50th
St., Savannah
Peterson, Mrs. T. A., 719 East 56th
St., Savannah
Pinholster, Mrs. J. H., 421 East 44th
St., Savannah
Porter. Mrs. J. E„ 501 East 53rd St.,
Savannah
Portman, Mrs. H. J., 627 East 51st
St., Savannah
Powers, Mrs. L. K., 623 East 54th
St., Savannah
Prince, Mrs. C. L., 519 East 45th St.,
Savannah
Quattlebaum, Mrs. J. K., 203 East
45th St., Savannah
Rabhan, Mrs. L. J., 201 East 52nd
St., Savannah
Redmond. Mrs. C. G., 701 Whitaker
St., Savannah
Redmond, Mrs. C. R. A., 113 Henry
Ave., Savannah
Righton, Mrs. H. Y., 401 East 45th
St., Savannah
Robinson, Mrs. David, 218 East 55th
St., Savannah
Rollings, Mrs. H. E., 120 East Gaston
St., Savannah
Rosen, Mrs. E. F., 620 East 54th St.,
Savannah
Rosen, Mrs. S. F., 1512 East Henry
St., Savannah
Rubin, Mrs. Jacob, 727 East 44th
St., Savannah
Sax, Mrs. C. E., 511 East 53rd St.,
Savannah
Schley, Mrs. R. L., Jr., 114 West
Gaston St., Savannah
Schneider. \lrs. M. M„ 401 East 50th
St., Savannah
Sharpley. Mrs. John, 1127 W ashing-
ton Ave., Savannah
Sharpley, Mrs. II. F., Jr.. 215 Ander-
son Ave., Savannah
Shaw, Mrs. L. W., Isle of Hope. Sa-
vannah
Smith, Mrs. Harold, 4 Henry \ve..
Savannah
Smith, Mrs. P. H., 820 Maupas Ave.,
Savannah
Stalvey. Mrs. J. K., 1331 East 48th
St., Savannah
Straight, Mrs. G. W., 424 East 50th
St., Savannah
Touchton, Mrs. G. L„ Forsythe
Apartments, Savannah
Train, Mrs. J. K„ 1111 Bull St.. Sa-
vannah
Train, Mrs. J. K., Jr., 701 East 44th
St., Savannah
Epson, Mrs. E. T., 37 East 45th St.,
Savannah
Usher, Mrs. Charles, 6 East Liberty
St., Savannah
Victor, Mrs. Jules, Jr., 10 Chelsea
Dr., Savannah
Waring, Mrs. A. J., Sr., 133 Wash-
ington Ave., Savannah
Watkins, Mrs. Lee C., 421 Abercorn
St., Savannah
W esterfield, Mrs. C. W'., 101 Garrard
Ave., Savannah
Williams, Mrs. A. F., 622 52nd St..
Savannah
Williams, Mrs. L. W., 135 East 45th
St., Savannah
Wilson. Mrs. W. D., 911 Whitaker
St., Savannah
* Bassett, Mrs. V. H., 1010 East Park
Ave., Savannah
^Daniels, Mrs. J. W., Sr., 24 East
31st St., Savannah
^Johnson, Mrs. J. Hugo, Sr.. 116
East Oglethorpe Ave., Savannah
*Martin, Mrs. R. V., 18 East 31st
St., Savannah
* McCarthy, Mrs. Dan, 320 East 39th
St., Savannah
* Morrison, Mrs. A. A., 1702 Bull St.,
Savannah
SECOND DISTRICT
Manager: Mrs. Richard Winston,
Tifton
Colquitt County
President, Mrs. R. E. Fokes, Moul-
trie
Baggs, Mrs. W. H., Jr., 515 5th Ave.,
S. E., Moultrie
Brannen, Mrs. Cecil, 1224 1st St.,
S. E., Moultrie
Conger, Mrs. P. D., 1207 S. Main St.,
Moultrie
Fike, Mrs. R. H., 1209 9th St., S. W.,
Moultrie
Fokes, Mrs. R. E., Jr., 221 2nd St.,
S. W., Moultrie
Funderburk, Mrs. A. G., 803 1st
St., S. E., Moultrie
Holmes, Mrs. E. C., Moultrie
Gay, Mrs. Frank M., 216 Hillcrest,
Moultrie
Joiner, Mrs. R. M., 918 3rd St., S.
W., Moultrie
December, 1950
547
McCoy, Mrs. John F., 103 9th Ave.,
S. E., Moultrie
McLeod, Mrs. J. W., 1184 4th St.,
S. W.. Moultrie
McGinty, Mrs. W. R., Ill 1st St.,
S. W., Moultrie
Paulk, Mrs. James R., 1103 1st St.,
S. E., Moultrie
Stegall, Mrs. Robert, 403 S. Main,
Moultrie
Woodall, Mrs. J. B., 606 1st St.,
S. E., Moultrie
Dougherty County
President, Mrs. Mack Sutton, Albany
Armstrong, Mrs. E. S., 1311 4th Ave.,
Albany
Barnett, Mrs. J. M., 527 Pine Ave.,
Albany
Berg, Mrs. J. L., 305 N. Jefferson St.,
Albany
Bowman, Mrs. M. B., 1112 N. Madi-
son St., Albany
Brown, Mrs. C. M., 917 First Ave.,
Albany
Buckner, Mrs. F. W., 615 Third Ave.,
Albany
Cook, Mrs. W. S., 312 Flint Ave.,
Albany
Dunn, Mrs. C. S., 1142 Julia St.,
Albany
Hilsman, Mrs. P. L., 1612 Maryland
Dr., Albany
Holman, Mrs. C. M., 1005 McKinley
Dr., Albany
Irvin, Mrs. I. W., 1207 N. Madison
St., Albany
James, Mrs. A. E., 1010 First St.,
Albany
Keaton, Mrs. J. C., 526 Pine Ave.,
Albany
Lucas, Mrs. I. M., 910 N. Madison
St., Albany
Mann, Mrs. D. S., 306 S. Cleveland
Dr., Albany
McCall, Mrs. C. S., 929 Residence
St., Albany
McDaniel, Mrs. J. Z., 709 N. Jeffer-
son St., Albany
McKemie, Mrs. H. M., 1201 N. Davis
St., Albany
McKemie, Mrs. W. F., 1011 N. Mon-
roe St., Albany
Neill, Mrs. F. K., 1112 N. Davis St.,
Albany
Parrish, Mrs. L. H., 706 N. Monroe
St., Albany
Redfearn, Mrs. J. A., 527 Broad Ave.,
Albany
Rhyne, Mrs. W. P., 631 Fifth Ave.,
Albany
Roberson, Mrs. P. E., 1208 N. Madi-
son Ave., Albany
Russell, Mrs. P.T., 513 N. Slappey
Dr., Albany
Seymour, Mrs. G. E., 702 N. Slappey
Dr., Albany
Sutton, Mrs. Mack, Dolly Madison
Apts., Albany
Tye, Mrs. J. P., 413 Fourth Ave.,
Albany
Wolfe, Mrs. D. M., 1009 McKinley
Dr., Albany
Tift County
President, Mrs. Richard K. Winston,
Tifton
Andrews, Mrs. Agnew, 1205 Murray
Ave., Tifton
Andrews, Mrs. John S., 18th St.,
Tifton
Edmondson, Mrs. Tom L., 603 Wil-
son Ave., Tifton
Evans. Mrs. E. L„ 18th St., Tifton
Fleming, Mrs. Carlton A., 1008 Hall
Ave., Tifton
Flowers, Mrs. E. M., Hall Ave.,
Tifton
Harrell, Mrs. D. B., 418 N. Central,
Tifton
Jones, Mrs. R. E;, 1014 Love Ave.,
Tifton
Lucas, Mrs. Paul W., Amy Apts.,
Tifton
Pickett, Mrs. F. B„ Ty Ty
Pittman, Mrs. C. S., Sr.. 211 12th St.,
Tifton
Pittman, Mrs. C. S., Jr., 18th St.,
Tifton
Smith. Mrs. W. T., 405 N. Park.
Tifton
Webb, Mrs. M. L., Love Ave., Tifton
Winston, Mrs. Richard K., 807
Wilson Ave., Tifton
Zimmerman, Mrs. Charles E., 503
16th St., Tifton
Zimmerman, Mrs. W. F., 617 Wilson
Ave.. Tifton
Jones, Mrs. R. E., Tifton, Deceased
THIRD DISTRICT
Manager, Mrs. A. R. Sims, Richland
Houston-Peach Counties
President, Mrs. J. L. Gallemore,
Perry
Gallemore, Mrs. J. L„ Swift St.,
Perry
Hendrick, Mrs. Alford G., Swift St.,
Perry
Muscogee County
President, Mrs. James A. Elkins,
Columbus
Berman, Mrs. Dave., 1354 Virginia
Ave., Columbus
Berry, Mrs. Arthur N., 1660 Flournoy
Dr., Columbus
Bickerstaff, Mrs. Hugh J., Country
Club Apt., Columbus
Blackmar, Mrs. F. B., 1243 Forest
Ave., Columbus
Blanchard, Mrs. Mercer C., 891
Peachtree St., Columbus
Blanchard, Mrs. Mercer, 1543 Eber-
hart Ave., Columbus
Brannon. Mrs. O. C., 1318 Stark
Ave., Columbus
Boyter, Mrs. Henry H., 1425 Pea-
cock, Columbus
Butler, Mrs. Clarence C., 2004 Thir-
teenth St., Columbus
Bush, Mrs. John, 1600 Sixteenth
Ave., Columbus
Chipman, Mrs. R. A., 1234 Peacock
Ave., Columbus
Cook, Mrs. Wm. C., 926 Peachtree
Dr., Columbus
Cooke, Mrs. W. L., 2110 Oak Ave.,
Columbus
Comstock. Mrs. George, 2250 Amos
St., Columbus
Conner, Mrs. George R., 1816 Wild-
w'ood Ave., Columbus
Curtiss, Mrs. E. J., Country Club
Apts., Columbus
Dillard, Mrs. Guy J., 1919 Flournoy
Dr., Columbus
Dupree. Mrs. J. W., Jr., 2424 7th
St., Columbus
Durden, Mrs. John, Wynnton Rd.,
Columbus
Dykes, Mrs. A. N., 1617 Summit Dr.,
Columbus
Elder, Mrs. Ivan R., 1551 18th Ave.,
Columbus
Elkins, Mrs. James A., 1159 late
Dr., Columbus
Edwards, Mrs. Franklin D.. Dingle-
wood, Columbus
Fletcher, Mrs. H. Quigg, 600 Peach-
tree Dr., Columbus
Gibson, Mrs. Roy L., 2021 Wells
Dr., Columbus
Gilliam, Mrs. O. D., 1715 Carter PL,
Columbus
Graffagnino, Mrs. P. C., 1541 Dixon
Dr., Columbus
Henderson, Mrs. C. W., 1602 Forest
Ave., Columbus
Hughston, Mrs. Jack, 2009 Cherokee
Dr., Columbus
Hutto, Mrs. G. M., 2004 13th St.,
Columbus
Jenkins, Mr-. Wm. F., 1636 Dixon
Dr., Columbus
Jones, Mrs. W. R., 2408 Eighteenth
Ave., Columbus
Jordan, Mrs. Willis P., Jr.. 1231
Peacock Ave., Columbus
Land, Mrs. Polk S., 161 Richards
St., Columbus
Lapides, Mrs. Leon, Green Island
Hills, Columbus
Mayher, Mrs. John W., Plumfield.
Columbus
Mayher, Mrs. Will E., 1112 Dingle-
wood, Columbus
Monaco, Mrs. Ralph, Peacock Ave.,
Columbus
Murray, Mrs. George S., 1427 Din-
glewood, Columbus
McDuffie, Mrs. James H., 1304 E.
Tenth St., Columbus
Peacock, Mrs. Clifford A.. 1266
Cedar Ave., Columbus
Roberts, Mrs. Luther J., 1704 Wells
Dr., Columbus
Schley, Mrs. Frank B.. 1352 Peacock
Ave., Columbus
Smith, Mrs. Charles, 2127 Hillside
Dr., Columbus
Snelling, Mrs. W. R., 1101 Britt
Ave., Columbus
Stapleton, Mrs. J. L., 2861 Seven-
teenth Ave., Columbus
Storey, Mrs. W. Edward, 3387 Ma-
con Rd., Columbus
Tatum, Mrs. P. A., 1220 16th Ave.,
Columbus
Tillery, Mrs. Bert, 1544 Cherokee
Ave., Columbus
Thompson, Mrs. John B., 1603 Wynn-
ton Rd., Columbus
Threatte, Mrs. Bruce, 1900 Dimon
Circle, Columbus
Thrash, Mrs. J. A., 1314 Sixteenth
St., Columbus
Turner, Mrs. Haywood, 1611 22nd
St., Columbus
Venable, Mrs. D. R., 1710 Wildwood,
Columbus
Walker, Mrs. John E., Green Island
Hills, Columbus
Waller, Mrs. Roy M., 1307 35th St.,
Columbus
Willis, Mrs. J. N., 1240 Cedar Ave.,
Columbus
Winn, Mrs. John H., 935 Blanchard
Ave., Columbus
Wolff, Mrs. Luther H., 1818 Slade
Dr., Columbus
Youmans, Mrs. J. R., 1600 Boulevard,
Columbus
54 a
The Journal of the Medical Association of Georgia
Deceased: Mrs. Willis P. Jordan, Sr.,
1256 Peacock Ave.
Ocmulgee Society
( Dodge- Block ley-Puiaski
Counties)
President. Mrs. James L. Thomson,
Eastman
Arnold. Mrs. M. F., Jr., Hawkins-
ville
Baker, Mrs. W. R.. Hawkinsville
Batts, Mrs. A. S.. Hawkinsville
Bush. Mrs. A. R. Hawkinsville
Coleman. Mrs. W. A., Eastman
Holder. Mrs. Frank. Eastman
Jones, Mrs. E. G., Eastman
Long, Mrs. H. W., Eastman
Mayo, Mrs. J. P.. Eastman
Smith, Mrs. A. L., Cochran
Smith, Mrs. E. L„ Eastman
Smith, Mrs. R. L., Cochran
Thomson. Mrs. James L., Eastman
Whipple, Mrs. R. L., Cochran
Ramloljrh-Terrell-Webster-
Clav-Stewart Counties
President. Mrs. T. F. Harper, Cole-
man
Arnold, Mrs. J. T„ Parrott
Crook, Mrs. W. W., Cuthbert
Daniel. Mrs. Ernest F., Dawson
Elliott, Mrs. W. G., Cuthbert
Gary, Mrs. Loren, Georgetown
Goss, Mrs. W oodrow, Ashburn
Harper, Mrs. T. F.. Coleman
Kenyon, Mrs. S. P.. Dawson
Martin, Mrs. F. M„ Shellman
Martin. Mrs. R. B.. Ill, Cuthbert
Patterson. Mrs. J. C., Cuthbert
Rogers. Mrs. F. S., Coleman
Sims, Mrs. A. R.. Richland
Tidmore, Mrs. J. C.. Dawson
Sumter County'
President. Mrs. William McMath,
Americus
Boyette, Mrs. L. S., Ellaville
Collins. Mrs. Robert A., Jr., Monte-
zuma
Durham. Mrs. Bon M., 218 Taylor
St., Americus
Fenn, Mrs. Henry R., 214 Taylor
St., Americus
Gatewood. Mrs. Schley, 102 Hancock
Dr., Americus
Logan, Mrs. Colquitt, Plains
McMath. Mrs. Wm, Hancock Dr.,
Americus
Pendergrass. Mrs. R. C., 144 Taylor
St., Americus
Primrose. Mrs. A. C., 801 Hancock
Dr., Americus
Robinson. Mrs. John, 1022 Hancock
Dr., Americus
Smith, Mrs. Herschel, 601 S. Lee
St., Americus
Savage, Mrs. Carl, Montezuma
Thomas, Mrs. Russell, Leslie Rd.,
Americus
Wilson. Mrs. Frank. Leslie
Wood, Mrs. Kenneth, Leslie
FOURTH DISTRICT
Carrol 1-Douglas-Haralson
Counties
President, Mrs. C. V. Van Sant,
Douglasville
Barker, Mrs. Homer Lumpkin, 15
Spring St.. Carrollton
Bass. Mrs. E. C., 17 South St., Car-
rollton
Berry, Mrs. Robert L., Citron St.,
Villa Rica
Denney. Mrs. Roy Lumpkin, 14 Col-
lege St., Carrollton
Downey. Mrs. William Perrin, 11E.
Mill St., Tallapoosa
Holtz, Mrs. Louis, 29 Reese St.,
Carrollton
Morgan. Mrs. Floyd W., 75 Church
St., Douglasville
Parham. Mrs. John B„ Alewine Ave.,
Tallapoosa
Patrick. Mrs. E. \ ., 9 South St.,
Carrollton
Powell. Mrs. John E., Sr.. Cemetery
St., \ ilia Rica
Reese, Mrs. Davis Stephens, 49 Dixie
St., Carrollton
Reeve, Mrs. Thomas E., Jr., Griffin
Dr., Carrollton
Scales. Mrs. Seaborn F„ P. O. Box
304. Carrollton
Smith, Mrs. William Posie, College
St., Bowdon
Thomasson, .Mrs. Wm. Edward, 16
Maple St., Carrollton
\ an Sant, Mrs. C. V., 133 Broad
St., Douglasville
V atts, M;s. James Wyly, College St.,
Bowdon
Worthy, Mrs. W. Steve, 39 West Ave.,
Carrollton
A ssociate M em bers
Gilmcre. Mrs. E. L.. Tallapoosa
Pow ell. Mrs. B. C., \ ilia Rica
Troup County
Fresident, Mrs. Evan W . Molyneaux,
Hogansville
Arnold. Mrs. E. T.. Jr., Hogansville
Avery, Mrs. R. M., West Point Rd.,
LaGrange
Avery, Mrs. Wm. G., West Point
Rd., LaGrange
Callaway. Mrs. Enoch, 310 Broad St.,
LaGrange
Chambers, Mrs. James W., 226 Mc-
Lendon Ave., LaGrange
Clark Mrs. V . H.. 1401 Vernon Rd.,
LaGrange
Coxvart. Mrs. Charles T.. 401 Ridley
Ave., LaGrange
Felder. Mrs. Richard E., 510 Sylvan
Rd.. LaGrange
Foster, Mrs. Henry A., 729 N. Green-
wood St.. LaGrange
Freeman, Mrs. Thos. N., Jr., 107
Bacon St., LaGrange
Grace, Mrs. Kenneth D., 512 Park
Ave., LaGrange
Grady. Mrs. Henry W., 1400 V ernon
Rd., LaGrange
Hadaway, Mrs. W. H., 1307 Vernon
Rd., LaGrange
Hammett, Mrs. H. H., Sr., 201 Gor-
don St.. LaGrange
Hammett, Mrs. H. H., Jr., 401 Ridley *
Ave., LaGrange
Hand, Mrs. B. Hollis, Country Club
Rd., LaGrange
Hendricks, Mrs. Willis M., 512 Syl-
van Rd.. LaGrange
Herault, Mrs. Pierre C., 600 Winzor
Ave., LaGrange
Holder, Mrs. J. S., 1402 V ernon Rd.,
LaGrange
Hutchinson, Mrs. Wm. Lane, 306
Ben Hill St., LaGrange
Jones, Mrs. H. T., West Point
Krafka, Mrs. Joseph, College Ave.,
LaGrange
Lane, Mrs. J. E., 400 Gordon St.,
LaGrange
Lewis, Mrs. James W., 700 Hill St.,
LaGrange
McCall. Mrs. W. R„ 409 Hill St.,
LaGrange
Molyneaux, Mrs. Evan W„ Hogans-
ville
Morgan. Mrs. 1). E.. 618 Broad St..
LaGrange
Ncrman, Mrs. Lewis G., Jr., West
Point
O Neal. Mrs. R. S., 301 Gordon St.,
LaGrange
Phillips. Mrs. W. P„ 1003 Broad St..
LaGrange
Whitehead, Mr-. C. Mark, 103 Col-
lege Ave., LaGrange
Williams, Mrs. C. O., West Point
Upson County
President, Mrs. R. E. Dallas, Thom-
aston
Adams, Mrs. B. C., Thomaston
Carter, Mrs. R. L., Box 47, Thom-
aston
Dallas, Mrs. R. E.. Thomaston
Gower, Mrs. W. J.. Thomaston
Head, Mrs. Douglas, Jr.. Thomaston
Kellum, Mrs. Morgan, Third St.,
Thomaston
Sappington. Mrs. T. A., Canton
Pines. Thomaston
Tyler. Mrs. Herbert D.. 507 Hill St.,
Thomaston
FIFTH DISTRICT
Manager: Mrs. Murdock Equeu, At-
lanta
DeKalb County
President. Mrs. W. A. Mendenhall,
Chamblee
Ansley. Mrs. Robert B., 212 S. Can-
dler, Decatur
Beck, Mrs. John Edwin, 144 Pine-
crest Ave., Decatur
Bloomer, Mrs. Wm. E., 252 Mt. Ver-
non Dr., Decatur
Cunningham, Mrs. C. E., 350 S. Can-
dler, Decatur
Duncan, Mrs. G. A., 714 S. Candler,
Decatur
Evans, Mrs. J. R.. Stone Mountain
Kerr. Mrs. W. K., Peachtree Road,
Chamblee
Lee. Mrs. Howard B., 2840 Sanford
Rd., Decatur
Leslie, Mrs. John T., 48 Dartmouth
Ave., Avondale Estates
Litton, Mrs. J. H„ Tucker
Matthews, Mrs. Lawrence P., 2388
Westminister Way, N. E., Atlanta
Matthews, Mrs. W. A., 4100 Peach-
tree Rd., Atlanta
McCurdy, Mrs. Willis, Stone Moun-
tain
McGeachy, Mrs. T. E., 429 Adams
St.. Decatur
Mendenhall, Mrs. W. A., Chamblee
Morse, Mrs. Chester W., 920 Scott
Blvd., Decatur
Powell. Mrs. F. C„ 124 Mimosa PL.
Decatur
Sanders, Mrs. Floyd R., 212 E. Ponce
de Leon, Decatur
Shinall. Mrs. R. P., 1513 Scott Blvd.,
Decatur
Simmons, Mrs. M. Freeman, 108
Greenwood PL, Decatur
Smith, Mrs. W. P.. 192 Lamont Dr.,
Decatur
Smoot, Mrs. Richard H., 240 Third
Ave., Decatur
Stewart, Mrs. T. W., Lithonia
December, 1950
519
Fulton County
President. Mrs. 1 . Kells Boland, Jr.,
Atlanta
Abbott, Mrs. Osier A.. 3037 W.
Pine \ alley Kd.. N. W.. Atlanta
Adams. Mrs. H. M. S., 1257 Euclid
Ave., N. E.. Atlanta
Agnor. Mrs. Elbert B.. 2353 West-
minster Way. N. E., Atlanta
Akin. Mrs. John T.. Jr., 2072 Cottage
Lane, N. W., Atlanta
Allen, Mrs. Eustace A., 18 Collier
Rd., N. W., Atlanta
Allgood Mrs. Pierce, 519 Old Ivy
Rd., Atlanta
Anderson. Mrs. Robert T., 1723
Boulevard Dr.. N. E., Atlanta
Ander-on, Mrs. Samuel A., 26 Sheri-
dan Dr.. N. E.. Atlanta
Anderson, Mrs. W. W., 363 Avery
Dr., N. E., Atlanta
Armstrong. Mrs. Wm. B.. 521 Spring
Valley Rd., N. E„ Atlanta
Arnold, Mrs. W. A., 55 Briarcliff
Circle, N. E., Atlanta
Arp. Mrs. C. Raymond, 80 West-
minster Dr., N. E.. Atlanta
Arthur, Mrs. J. F„ 828 Adair Ave.,
N. E„ Atlanta
Askew. Mrs. Hulett, 1329 Springdale
Rd., N. E., Atlanta
Askew, Mrs. Rufus A., 2489 Haber-
sham Rd., N. W., Atlanta
Askren, Mrs. E. L„ Jr.. 685 Timm
Valley Rd., N. W., Atlanta
Aven, Mrs. C. C., 2325 Roswell Rd.,
N. W., Atlanta
Baker, Mrs. L. P., 52 Seventeenth
St., N. E.. Atlanta
Bancker, Mrs. Evert A., 3810 Club
Dr., N. E., Atlanta
Barfield. Mrs. Forrest M., 77 Peach-
tree-Memorial Dr., N. W., Atlanta
Barnett, Mrs. Crawford F., 2628
Rivers Rd., N. W., Atlanta
Bateman. Mrs. Gregory W., 499 Mc-
Allister St., S. W., Atlanta
Bateman, Mrs. Needham B., 88
Woodsy Way, Atlanta
Beard, Mrs. Donald E„ 1410 Peach-
tree St., N. E„ Atlanta
Beasley, Mrs. B. T.. 283 North Colon-
ial Homes Cir„ Atlanta
Bennett. Mrs. W. H., 829 W. Wesley
Rd., N. W., Atlanta
Benson, Mrs. H. Bagley, 3065 E.
Pine Valley Rd., N. W., Atlanta
Benson, Mrs. Marion T., Sr., 36
Sheridan Dr.. N. E., Atlanta
Benson, Mrs. Marion T., Jr., 3301
Habersham Rd., N. W., Atlanta
Berrv, Mrs. Maxwell, 2887 Howell
Mill Rd.. N. W., Atlanta
Bivings, Mrs. Lee, 1310 Habersham
Rd., N. W., Atlanta
Blackman. Mrs. W. W., 248 W. An-
drews Dr., N. E.. Atlanta
Blaine, Mrs. Belford C., 118 Terrace
Dr., N. E., Atlanta
Blalock, Mrs. J. C„ 734 W. Wesley
Rd., N. W., Atlanta
Blalock, Mrs. Tully T„ 4241 Club
Dr., N. E., Atlanta
Bloom, Mrs. Walter L., 845 Clifton
Rd., N. E., Atlanta
Blumberg, Mrs. Max, 251 Tenth St.,
N. W., Atlanta
Boland, Mrs. Chas. G., 123 Rumson
Rd., N. E., Atlanta
Boland, Mrs. Frank K., 252 Peach-
tree Cir., N. E., Atlanta
Boland, Mrs. Frank Kels, Jr., 128
Peachtree-Memorial Dr., N. W.,
\ I Ian ta
Boland, Mrs. J. 11., 120 Sheridan Dr.,
N. E., Atlanta
Boling, Mrs. Edgar. 1236 Springdale
Rd., N. E„ Atlanta
Bondurant, Mrs. H. W„ 118 Sheri-
dan Dr.. N. E., Atlanta
Boyd, Mrs. Hartwell, 263 The Prado,
N. E., Atlanta
Brawner, Mrs. Jas. N., Sr., 2800
Peachtree Rd., N. E., Atlanta
Brawner, Mrs. Jas. N.. Jr., 262 W.
Wesley Rd., N. W., Atlanta
Brewer, Mrs. Frank B., 4347 E.
Brookhaven Dr., Atlanta
Brown, Mr. Robert L., 189 Avery
Dr., N. E., Atlanta
Brown. Mrs. S. Ross, 1000 Peachtree
Battle, Atlanta
Brown, Mrs. Stephen T., 1088 Oxford
Rd., N. E., Atlanta
Bryan. Mrs. Wm. W.. 401 Peachtree
Battle Ave., Atlanta
Bunco, Mrs. Allen H., 368 Ponce de
Leon Ave., N. E.. Atlanta
Burge. Mrs. Dan, 1507 Markan Dr.,
N. E., Atlanta
Burnett, Mrs. Stacy W., 1884 Ponce
de Leon Ave., N. E., Atlanta
Bush. Mrs. O. B., 57 Rumson Way,
N. E.. Atlanta
Byrd. Mrs. T. Luther. 126 Blackland
Rd., N. W.. Atlanta
Calc, Mrs. Ellsworth F„ 210 Wil-
liams St., East Point
Davenport, Airs. T. F.. 1038 Peach-
tree Battle Ave., Atlanta
Davis, Mrs. Robert Carter. 1950 W.
Pace? Ferry, N. W.. Atlanta
Davis, Mrs. Shelley C.. 1259 Peach-
tree Battle Ave., Atlanta
Davis, Mrs. W. B., 720 W. Walker
Ave., College Park
Davison, Mrs. T. C., 25 Valley Rd.,
N. W., Atlanta
Denton. Airs. John F., 1503 Peachtree
St., N. E., Atlanta
Dew. Mrs. J. Harris, 214 Peachtree
Battle Ave., Atlanta
Dickson. Airs. Roger W.. 1933 Wal-
thall Dr., N. W., Atlanta
Dobes, Airs. Wm. L., 912 Lullwater
Rd., N. E., Atlanta
Dcrough. Airs. W. S., 2450 Peachtree
Rd., N. W., Atlanta
Dougherty. Airs. Alark S„ 285 Old
Ivey Rd., N. E., Atlanta
Dowman, Airs. Charles E., Sr., 630
Linwood Ave., N. E., Atlanta
Dunn, Mrs. W. AL, 2801 Andrews
Dr., N. E., Atlanta
Dunstan, Airs. Edgar AL, 604 Ponce
de Leon PL, Decatur
DuVall. Mrs. W. B., 905 Cascade
Ave., S. W., Atlanta
Earle, Mrs. W'alter C., 1930 Grey-
stone Rd.. N. W., Atlanta
Eberhart, Airs. Charles, 1206 Cum-
berland RcL, N. E., Atlanta
Edgerton, Mrs. Milton T., 788 Penn
Ave., N. E., Atlanta
Edwards, Airs. William T., 1034 W.
College Ave., Decatur
Ellis, Mrs. John Oliver, 251 N. Col-
onial Homes Cir., Atlanta
Ecpien, Mrs. Alurdock, 2505 Haber-
sham Rd., N. W., Atlanta
Evans. Airs. A. L„ 2393 Hurst l)r„
N. E., Atlanta
Evans, Mrs. Edwin C., 1460 Emory
Rd., N. E„ Atlanta
Fancher, Mrs. J. K.. 3094 Pine Val-
ley Rd., N. W., Atlanta
Fincher, Mrs. Edgar F., 109 Peach-
tree Cir., N. E., Atlanta
Fish, Mrs. John S., 564 Ridgecrest
Rd., N. E., -Atlanta
Fischer, Mrs. L. C., Sharpsburg
Calhoun, Mrs. F. Phinizy, Sr., 2906
Andrews Dr., N. W., Atlanta
Calhoun, Mrs. F. Phinizy, Jr., 540
Peachtree Battle, N. W„ Atlanta
Camp, Mrs. Reuben T., Fairburn
Campbell, Mrs. John D., 688 Dar-
lington Rd., N. E„ Atlanta
Candler, Mrs. Robert W., West Paces
Perry Rd., N. W., Atlanta
Carter, Airs. Sandy B., 2695 Sharon-
dale Dr., N. E., Atlanta
Chalmers, Mrs. Rives, 2400 West-
minster Way. N. E., Atlanta
Childs, Mrs. J. R., 1050 Ponce de
Leon Ave., N. E., Atlanta
Christopher, Mrs. F. E., 1769 Alea-
dowdale Ave., N. E., Atlanta
Clark, Airs. Jas. J., 1081 Springdale
Rd., N. E., Atlanta
Claiborne. Mrs. T. Sterling, 455 W.
Wesley Rd., N. W., Atlanta
Clifton. Airs. Ben Hill, 1893 W'ycliff
Rd., N. W., Atlanta
Codington, Airs. A. B.. 3181 Alathie-
son Dr., N. E., Atlanta
Cofer, Airs. Olin S., 943 Lullwater
Rd., N. E., Atlanta
Cohen, Mrs. Isidore R.. 2295 N. De-
catur Rd., N. E„ Atlanta
Coleman, Mrs. Reese C.. Jr., 2762
Dover Rd., N. W ., Atlanta
Collinsworth, Airs. Allen AL, 60
Alontgomery Ferry Dr., N. W.,
Atlanta
Combs, Airs. James AL, 2384 Sewell
Rd., S. W'., Atlanta
Cooke, Mrs. Virgil C., Baker’s Ferry
Rd., S. W\. Atlanta
Coppedge, Airs. Wm. W., 313 Kim-
meridge Dr.. East Point
Corley, Mrs. F. L„ 626 Alorningside
Dr., N. E., Atlanta
Cousins, Airs. Wm. L., Route No. 1,
T u cker
Crawford, Airs. H. C., 3000 E. Pine
Valley Rd., N. W., Atlanta
Cross, Mrs. John B.. 2606 Dellwood
Dr., N. W., Atlanta
Crowe, Mrs. W. R., 1069 Virginia
Ave., N. E., Atlanta-
Curtis, Airs. Walker L., 302 W.
Rugby Ave., College Park, Ga.
Daly, Airs. Leo P., 480 E. Wesley
Rd., N. E., Atlanta
Daniel, Airs. Charles H.. 801 W.
Rugby Ave., College Park
Daniel, Airs. Eugene L., 230 Howard
St., N. E., Atlanta
Daniel, Airs. Walter W., 1705 Pel-
ham Rd., N. E., Atlanta
Fitts, Mrs. John B., 31 LaFayette
Dr., N. E., Atlanta
Florence, Mrs. Thomas J., 1420 Rock
Springs Terrace, Atlanta
Floyd, Airs. Earl, 1 W. Aluscogee
Ave., N. W., Atlanta
Fort, Mrs. Chester A., Jr., 1252 Em-
ory Circle, N. E., Atlanta
Foster, Airs. Kimsey E„ 207 Colum- •
bia Ave., College Park
550
The Journal of the Medical Association of Georgia
Fowler Mrs. C. Dixon, 2375 Haven
Ridge Dr.. N. W., Atlanta
Friedman. Mrs. Milton, 939 Courte-
nay Dr.. N. E., Atlanta
Frierson, Mrs. Norton, 2908 North
Hills Dr., N. E., Atlanta
Funke, Mrs. John, 712 Durant PL,
N. E.. Atlanta
Funkhouser, Mrs. Win. L., 2419
Woodward Way, N. W., Atlanta
Galvin. Mrs. Wm. H„ 38 Andrews
Lirele. Emory, Atlanta
Gay. Mrs. Thos. Bolling, 3042 W.
Pine Valley Rd., Atlanta
Glenn, Mrs. Wadley R., 6565 Glenn-
ridge Dr., Dunwoody
Glisson, Mrs. C. Stedman. Jr., 1012
Cumberland Rd., N. E.. Atlanta
Goodwin, Mrs. Franklin H., 223 N.
Colonial Homes Cir., Atlanta
Goodwyn, Mrs. Thos. P.. 2480 Wood-
ward W’ay, N. W'., Atlanta
Green, Mrs. Samuel, 697 E. Morning-
side Dr., Atlanta
Greene, Mrs. Edgar H., 1442 W.
Wesley Rd., N. W.. Atlanta
Griffin. Mrs. Claude, 28 Brookhaven
Dr., Atlanta
Hamff, Mrs. L. Harvey, 1063 E.
Clifton Rd., N. E., Atlanta
Hamm, Mrs. Wm. G., 2877 Haber-
sham Rd.. N. W., Atlanta
Hancock, Mrs. Robert K„ 156 Con-
way Rd., Decatur
Hanes, Mrs. O. E., 2347 Virginia
PL, N. E„ Atlanta
Hanner, Mrs. James P., 2677 Arden
Rd., N. E., Atlanta
Harrison, Mrs. M. T„ 1096 E. Clif-
ton Rd., N. E., Atlanta
Hauck, Mrs. A. E., 99 Princeton
Way, N. E., Atlanta
Hecht, Mrs. Emanuel B.. 1181 Stew-
art Ave., S. W ., Atlanta
Hewell, Mrs. Guy C., 1123 Berk-
shire Rd.. N. E., Atlanta
Hill, Mrs. Haywood, 2316 Lindmont
Cir., N. E„ Atlanta
Hill, Mrs. Wm. Harry. 946 Juniper
St., N. E., Atlanta
Hobby, Mrs. A. Worth, 1740 Alea-
dowdale Ave., N. E., Atlanta
Hodges, Mrs. Fred B., Jr., 3265 Wood
Valley Rd., N. W., Atlanta
Holloway, Mrs. Chas. E., 2637 E.
W'esley Terrace, N. E., Atlanta
Holloway, Mrs. George A., 489 West-
over Dr., N. W.. Atlanta
Holmes, Mrs. Walter R., 85 Peach-
tree Circle, N. E., Atlanta ,
Hopkins, Mrs. Wm. A., 1374 ' V ilia
Dr., N. E., Atlanta
Howell, Mrs. Stacy C., 434 Brent-
wood Dr., N. E., Atlanta
Howard, Mrs. Charles K., 2289 Ve-
netian Dr., S. W., Atlanta
Hrdlicka, Mrs. George R.. 988 Win-
all Down Rd., N. W., Atlanta
Hudson, Mrs. Paul L„ 19 Brook-
haven Dr., N. E., Atlanta
Huie, Mrs. Robert E., 19 Exeter Rd.,
Avondale Estates
Hurst, Mrs. Willis,- 2857 North Hills
Dr., N. E., Atlanta
Hydrick, Mrs. Peter, 120 Ridgeway,
College Park, Ga.
Ivey, Mrs. John C., 1655 Ponce de
Leon Ave., N. E., Atlanta
Jacobs, Mrs. John L., 2883 Andrews
Dr., N. E., Atlanta
Jennings, Mrs. J. L., 683 Elkmont
Dr., N. E., Atlanta
Jernigan, Mrs. Sterling H.. 2258 \ ir-
ginia PL, N. E., Atlanta
Jernigan. Mrs. H. W'alker, 352 Red-
land Rd., N. W., Atlanta
Johnson, .Mrs. McClaren. 23 Collier
Rd., N. W., Atlanta
Jones, Mrs. Jack W., 129 Brighton
Rd., N. E., Atlanta
Josephs, Mrs. Alvin D., 939 Courte-
nay Dr., N. E., Atlanta
Kelley, Mrs. L. H„ 952 Rosedale
Rd., N. E.. Atlanta
Kelly, Mrs. James D.. 2724 Atwood
Rd., N. E., Atlanta
Kelly, Mrs. Robert P., 3016 Lenox
Rd., N. E., Atlanta
Kemper, Mrs. Clifton G., 956 Stovall
Blvd., N. E., Atlanta
King, Mrs. C. Richard. 263 N. Colon-
ial Homes Cir., Atlanta
King, Mrs. James T.. 212 Kathryn
Ave., Decatur
King, Mrs. John Dudley, 1215 W.
Wesley Rd., N. W.. Atlanta
King, Mrs. Lewell S., 119 Rugby
Cir., College Park
Kirkland, Mrs. Spencer A., 106
Peachtree Battle Ave., Atlanta
Kiser. Mrs. Wm. H.. Jr., 210 Peach-
tree Cir., N. E.. Atlanta
Kite, Mrs. J. H.. 633 E. Ponce de
Leon Ave., Decatur
Klugh, Mrs. George F„ 395 Tenth
St., N. E„ Atlanta
Krugman, Mrs. Philip I., 115 Peach-
tree Memorial Dr., Atlanta
Lamm, Mrs. J. Herman, 324 N.
Colonial Homes Cir., Atlanta
Landham, Mrs. Jackson W., 4199
Club Dr., N. E., Atlanta
Lange, Mrs. J. Harry. 2870 Arden
Rd., N. W., Atlanta
Lawrence, Mrs. Charles E„ 1182
Oakdale Rd., N. E„ Atlanta
Leigh, Mrs. Ted F., 2544 Peachtree
Rd., Atlanta
Letton, Mrs. A. Hamblin, 1 Pine
Cir., N. E., Atlanta
Lewis, Mrs. John R., Jr.. 825 W'ood-
ley Dr., N. W\, Atlanta
Linch, Mrs. A. O.. 943 Rosedale
Rd., N. E.
Logue, Mrs. Bruce, 145 Westminster
Dr., N. E., Atlanta
Long, Mrs. Leonard, 1083 E. Clifton
Rd., N. E„ Atlanta
Longino, Mrs. Dick R., 1344 Lanier
Blvd., N. E., Atlanta
Lowance, Mrs. Mason I., 877 W.
Wesley Rd., N. W„ Atlanta
Lower, Mrs. Emory G., 619 Myrtle
St., N. E., Atlanta
Lunsford. Mrs. Guy G., 4010 Osborn
Rd., Chamblee
Lyon, Mrs. Harry C., 660 W ilson Rd.,
N. W., Atlanta
McCain, Mrs. John R., 219 Sycamore
Dr., Decatur
McClure, Mrs. Robert E.. 238 A
Peachtree Cir., N. E., Atlanta
McDonald, Mrs. Lewis H., 625 Dar-
lington Rd., N. E., Atlanta
McDougall, Mrs. J. Calhoun, 2899
Andrews Dr., N. W., Atlanta
McDougall, Airs. Wm. L., 280 Black-
land Rd., N. W., Atlanta
McElroy, Mrs. Joseph D., 1551 May-
flower Ave., S. W., Atlanta
McGee, Mrs. R. W., Ben Dill
McLoughlin, Mrs. Chris J., 2465
Rivers Rd., N. W., Atlanta
McMillan, Mrs. J. C„ 804 S. Friddell
McRae, Mrs. Floyd W., 3053 Haber-
Cir., East Point
sham Rd., N. W., Atlanta
Main, Mrs. Emory H., 710 Walker
Ave., College Park
Martin, Mrs. Anthony .).. Pinegrove
Rd., Roswell
Marvin, Mr-. Charles P.. 4110 Ma-
bry Rd., N. E., Atlanta
Massee, Mrs. Joseph C., 1146 Lull-
water Rd., N. E., Atlanta
Matthews, Mrs. O. H.. 61 Barksdale
Drive, N. E., Atlanta
Matthews, Mrs. Thomas \ ., 2184
Peachtree Rd., N. W., Atlanta
Matthews, Mrs. Warren B., 216 N.
Candler St., Decatur
Miller, Mrs. Linus Jr.. 21 LaFayette
Way, N. W., Atlanta
Mills, Mrs. Clarence W., Jr.. 348 E.
Wesley Rd., N. E., Atlanta
Minnich, Mrs. F. R., 3085 E. Pine
Valley Rd., N. W., Atlanta
Minnich, Mrs. Wm. R., 21 Vernon
N. W., Atlanta
Minor, Mrs. Henry W., 4665 Peach-
tree-Dunwoody Rd., Atlanta
Mitchell, Mrs. Wm. E., 438 W. W es-
ley Rd., N. W„ Atlanta
Monfort, Mrs. J. M., 3870 Club Dr.,
N. E., Atlanta
Morris, Mrs. Albert L.. Fairburn
Morris, Mrs. S. L.. Jr., 58 Brighton
Rd., N. E., Atlanta
Mosley, Mrs. Hugh G., 3514 Nancy
Creek Rd., Atlanta
Murphy, Mrs. M. V., 150 Huntington
Rd., N. W., Atlanta
Nall, Mrs. J. D., 227 Garden Lane,
Decatur
Neel, Mrs. M. M.. Route No. 2, Col-
lege Park
Noel, Mrs. M. E., 39 Howard St.,
N. E., Atlanta
Norris, Mrs. Jack C., 511 Peachtree
Battle Ave., N. W., Atlanta
Norwood, Mrs. Samuel W., 76 Inman
Cir., N. E., Atlanta
O’Neal, Mrs. Buford L., 173 Putnam
Cir., N. W., Atlanta
Owensby, Mrs. N. M., Georgian Ter-
race Hotel, Atlanta
Parks, Mrs. Harry, 2479 Dellwood
Dr., N. E., Atlanta
Patterson, Mrs. Jos. H., 115 Peach-
tree Memorial Dr., Atlanta
Paullin, Mrs. James E., 2834 An-
drews Dr., Atlanta
Pendergrast, Mrs. Wm. J.. 5000
Briarclift Rd., Atlanta
Perry, Airs. Samuel W., 1427 Peach-
tree St., Atlanta
Phillips, Mrs. Haywood S., 1738
Homestead Ave., N. E., Atlanta
Pierotti, Airs. Julius V., 2 Collier
Rd., N. W., Atlanta
Pittman, Airs. James L., 2966 Howell
Mill Rd., N. W., Atlanta
Powell, Airs. \rernon E., 2514 Wood-
ward Way, N. W., Atlanta
Pruitt, Airs. Marion C., 431 W.
Wesley Rd., N. W., Atlanta
Raiford, Airs. Morgan B., 245 Bol-
ling Rd., N. E., Atlanta
Rasmussen, Airs. Earl, 2420 Peach-
tree Rd., Atlanta
December, 1950
551
Read, Mrs. Ben S„ 993 Stovall Blvd.,
Atlanta
Read, Mrs. Joseph C., 3970 Vermont
Rd., N. E., Atlanta
Redd, Mrs. Stephen C., 3515 Ridge-
wood Rd., Atlanta
Rhodes, Mrs. C. A., 75 Ponce de
Leon Ave., N. E„ Atlanta
Rice, Mrs. Guy V., Jr., 796 Clemont
Dr., N. E., Atlanta
Richardson, Mrs. Jeff L., 969 Clifton
Rd., N. E., Atlanta
Ridley, Mrs. Harry W., 1055 Rose-
wood Dr., N. E., Atlanta
Rieser, Mrs. Charles, 3777 Paces
Ferry Rd., N. W., Atlanta
Rieth. Mrs. Paul L., 1605 Harvard
Rd., N. E., Atlanta
Roach, Mrs. George S., Jr., 683
Juniper St., N. E„ Atlanta
Robinson, Mrs. Lisle B., 878 Myrtle
St., N. E., Atlanta
Robert;, Mrs. C. W., 3250 Ridge-
wood Rd., N. W., Atlanta
Roberts, Mrs. M. Hines, 393 W.
Wesley Rd., N. W., Atlanta
Roberts, Mrs. Stewart R., 16 Wood-
crest Ave., N. W., Atlanta
Robinson, Mrs. Robt. L., 3870 Lake
Forrest Dr., N. W., Atlanta
Rogers, Mrs. J. Harry,' 699 E. Paces
Ferry Rd., N. W., Atlanta
Rouglin, Mrs. L. C., 1136 Briarcliff
Rd., N. E., Atlanta
Rosenberg. Mrs. H. J., 846 Briarcliff
Rd., N. E., Atlanta
Sage, Mrs. Dan Y., 47 Inman Circle,
N. E., Atlanta
Sanders, Mrs. A. S., 1660 N. Emory
Rd., N. E., Atlanta
Scarborough, Mrs. J. E., 100 West-
minster Dr., N. E., Atlanta
Schroder, Mrs. J. Spalding, 2786
Atwood Rd., N. E., Atlanta
Schroeder, Mrs. Paul L., 1428 Peach-
tree St., N. E., Atlanta
Sealey, Mrs. R. Mitchel, 2905 San-
ford Rd., Atlanta
Selman, Mrs. W. A., 760 Penn Ave.,
N. E., Atlanta
Shackleford, Mrs. B. L., 120 Black-
land Rd., N. W., Atlanta
Skobba, Mrs. Joseph F., 25 Sheridan
Dr., N. E., Atlanta
Sheldon, Mrs. Walter H., 1117 Zim-
mer Dr., N. E., Atlanta
Shepard, Mrs. Duncan, 80 28th St.,
N. W., Atlanta
Skiles, Mrs. Vernon, 2500 Acorn
Ave., N. E., Atlanta
Slade, Mrs. John deR., 409 Collier
Rd., N. W., Atlanta
Sloan, Mrrs. W. P., Sr., 1282 Oak-
dale Rd., N. E., Atlanta
Smith, Mrs. Carter, 450 W. Wesley
Rd., Atlanta
Smith, Mrs. Charles W., 1002 Oxford
Rd., N. E., Atlanta
Smith, Mrs. Joel P., 1264 Burlington
Rd., N. E., Atlanta
Smith, Mrs. Linton, Pershing Hotel,
Atlanta
Smith. Mrs. Randolph, 37 LaFavette
Dr., N. E„ Atlanta
Smith, Mrs. Win. A., 2956 Lenox
Rd., N. E., Atlanta
Spier, Mrs. Eugene, 508 Twin Oak
Dr., Atlanta
Staton, Mrs. T. R„ 1026 St. Charles
Ave., N. E., Atlanta
Steadman, Mrs. Henry E., 3021 Stew-
art Ave., Hapeville
Stephenson, Mrs. Robert II., 2249
Virginia PI., N. E., Atlanta
Stewart, Mrs. Calvin B., 21 W. An-
drews Dr., N. W., Atlanta
Stillerman, Mrs. II. B., 2367 Cascade
Rd., S. W., Atlanta
Stone, Mrs. Charles F.. Jr., 4175 Club
Dr., N. E., Atlanta
Strickler, Mrs. C. W., Sr., 671 Oak-
dale Rd., N. E., Atlanta
Stickler, Mrs. C. W„ Jr., 355 Peach-
tree Battle, N. W., Atlanta
Swanson, Mrs. Cosby, 10 Cherokee
Rd., Atlanta
Swanson, Mrs. Homer S., 3834 Ver-
mont Rd., N. E., Atlanta
Tabb, Mrs. W. G., Jr., 2367 B Lind-
mont Cir., N. E., Atlanta
Tankesley, Mrs. R. M., 209 Oak
Lane, Atlanta
Taranto, Mrs. M. B., 1638 Barclay
PI., Atlanta
Thebaut, Mrs. Ben R.. 6800 Peach-
tree-Dunwoody Rd., Atlanta
Thomason, Mrs. W. L., 137 W. Wes-
ley Rd., N. W., Atlanta
Thompson, Mrs. D. O., 594 Westover
Dr., N. W., Atlanta
Thompson, Mrs. John W., 2041 Fair-
haven Cir., N. E., Atlanta
Thompson, Mrs. W. R., 3765 Peach-
tree Rd., N. E., Atlanta
Tidmore. Mrs. T. L., 963 Plymouth
Rd.. N. E., Atlanta
Timberlake, Mrs. Lloyd, 670 Long-
wood Dr., N. E., Atlanta
Turk, Mrs. L. N„ Jr., 1516 N. Morn-
ingside Dr., N. E., Atlanta
Turner, Mrs. Edwin W., 1119 Win-
burn Dr., East Point
Turner, Mrs. John W., 3985 Vermont
Rd., N. E., Atlanta
Upshaw, Mrs. Charles B., 394 W.
Wesley Rd., Atlanta
Van Buren, Mrs. E., 837 Clifton Rd.,
N. E., Atlanta
Van Dyke, Mrs. A. H„ 1925 Grey-
stone Rd., N. W., Atlanta
Varner, Mrs. John B., 181 Peachtree
Battle Ave., Atlanta
Vella, Mrs. Paul D., 984 Northcliff
Dr., N. W., Atlanta
Wagnon. Mrs. George, 360 Hascall
Rd.. N. W., Atlanta
Ward, Mrs. Emmett, 634 Flat Shoals
Ave., S. E., Atlanta
Warner. Mrs. W. P., Jr., 105 Peach-
tree- .Memorial Dr., Atlanta
Warren Mrs. Wm. C„ Jr., 980 Briar-
cliff Rd., N. E., Atlanta
Waters, Mrs. W. C., 878 Virginia
Ave., N. E., Atlanta
Weinberg, Mrs. James I., 2356 Mont-
view Dr., N. W„ Atlanta
Weinstein, Mrs. Alfred A., 380 Whit-
more Dr., N. W., Atlanta
Weitz. Mrs. Frank, 1041 West Peach-
tree St., Atlanta
Whipple, Mrs. Robert L., Jr., 919
Peachtree Battle, Atlanta
Whitaker, Mrs. Wm. G., Jr., 1412
Clairmont Rd., Decatur
Willingham, Mrs. T. Irvin, 3781
Tuxedo Rd., N. W., Atlanta
Wilson, Mrs. Richard, 1878 Monroe
Dr., N. E., Atlanta
Woddail, Mrs. Joseph D.. 891 Am-
sterdam Ave., N. E., Atlanta
Wolff, Mrs. Bernard P., 2748 Howell
Mill Rd., N. \\.. Atlanta
Wood, Mrs. R. Hugh, 900 W. Wes-
ley, Atlanta
Wooley, Mrs. Lawrence F.. 1607 Bar-
clay PI., N. E., Atlanta
Worth, Mrs. Jack J.. Jr., 1434 Miller
Ave., N. E., Atlanta
Wright, Mrs. Edward S., 2865 How-
el! Mill Rd., N. W„ Atlanta
Yampolsky, Mrs. Jos., 746 Brook-
ridge Dr., N. E., Atlanta
SIXTH DISTRICT
Manager: Mrs. J. R. S. Mays. Macon
Baldwin County
President, Mrs. R. W. Bradford,
Milledgeville
Allen, Mrs. E. W„ Allen’s Invalid
Home, Milledgeville
Allen, Mrs. H. D.. Allen's Invalid
Home, Milledgeville
Allen, Mrs. T. P., N. Jefferson St.,
Milledgeville
Bailey, Mrs. L. A., Columbia St.,
Milledgeville
Binion, Mrs. Richard, Green St.,
Milledgeville
Bostick. Mrs. W. A., Milledgeville
State Hospital, Milledgeville
Bradford, Mrs. R. W., Milledgeville
State Hospital, Milledgeville
Cary, Mrs. If. R„ 508 W. Montgom-
ery St., Milledgeville
Clodfelter, Mrs. T. C., Milledgeville
State Hospital. Milledgeville
Chesnutt, Mrs. T. H., Milledgeville
State Hospital, Milledgeville
Crichton, Mrs. R. B., Milledgeville
State Hospital, Milledgeville
Echols, Mrs. G. L., Milledgeville
State Hospital, Milledgeville
Fulghum, Mrs. C. B., 210 Jefferson
St., Milledgeville
Garrard, Mrs. J. I., Clark St., Mil-
ledgeville
Gibson, Mrs. Wallace, Milledgeville
State Hospital, Milledgeville
Longino, Mrs. L. P., Green St., Mil-
ledgeville
Peacock. Mrs. T. G., Milledgeville
State Hospital, Milledgeville
Richardson, Mrs. C. IL, Columbia
St., Milledgeville
Smith, Mrs. M. E.. Milledgeville
State Hospital. Milledgeville
Walker, Mrs. E. Y., Columbia St.,
Milledgeville
Walker, Mrs. N. P., Green St., Mil-
ledgeville
Woods, Mrs. O. C., N. Jefferson St.,
-Milledgeville
Wiley, Mrs. John D., Milledgeville
State Hospital, Milledgeville
Williams, Mrs. D. C„ Sr.. Milledge-
ville State Hospital, Milledgeville
Waller, Mrs. Robert, Milledgeville
State Hospital. Milledgeville
Bibb County
President. Mrs. William K. Jordan.
Macon
Aldrich, Mrs. Fred N., 3128 Brook-
wood Dr., Macon
Anderson, Mrs. J. C., 2616 Stanis-
laus Cir., Macon
Applewhite, Mrs. J. D., 633 College
St., Macon
Atkinson. Mrs. Harold C., Ill Buford
PL, Macon
Barton, Mrs. William L., 200 Waver-
land Dr., Macon
The Journal oe the Medical Association of Georgia
552
Bash inski. Mrs. Benjamin, 164 Bu-
ford PL, Macon
Baxley. Mrs. W. W .. 445 Pierce l)r.,
Macon
Bazemore. Mrs. Wallace L.. 193 Bev-
erly PL. Macon
Billinghurst. Mrs. Geo. A., 32o5 in-
alesicle Ave., .Macon
Boswell. Mrs. W. C., 362 Buford
PL. Macon
Brown. Mrs. Roland A., 306 Orange
St., Macon
Bush, Mrs. Holloway, 3145 vista Cn.,
Macon
Chrisman, Mrs. W. W., 165 •L.orbm
Ave., Macon
Clay. Mrs. J. Emory, 2764 Cherokee
Ave., Macon
Cole. Mrs. Allan A.. 267 Buford PL,
Macon •
Corn. Mrs. Ernest, 607 College St.,
Macon „ ,
Dove, -Mrs. W. B„ 135 Boulevard,
Macon
Dupree, Mrs. George W., Gordon
Dupree, Mrs. John T„ Gordon
Edenfield, Mrs. R. W„ 252 Riverdale
Dr.. Macon
Farmer. Mrs. C. Hall. 118 Pio Nona
Ave., Macon
Fountain. Mrs. James A., 216 Jack-
son Springs Rd., Macon
Golsan. Mrs. Willard R.. 1294 Court-
land Ave.. Macon
Goodman. Mrs. Leon J., 2670 \ me-
ville Ave.. Macon
Goolsby, Mrs. R. Cullen, 159 Rogers
Ave., Macon
Hall, Mrs. John I., 971 High St.,
Macon
Hanson, Mrs. J. Fletcher, 383^ Tlie
Prado, Macon
Harrold Mrs. Charles C.. 606 Orange
St., Macon
Harrold. Mrs. Thomas Jr., 647 Col-
lege St., Macon
Hatcher, Mrs. Milford B., 2223 Elm
Ridge Dr., Macon
Hazlehurst, Mrs. W. D.. 3270 A ista
Cir., Macon
Henderson. Mrs. D. T., A ineville Ct.,
Alacon
Hinton, Airs. Charles C., Wesleyan
Conservatory. Macon
Houser. Airs. Frank M., Waverland
Dr., Macon
James, Airs. L. P., 246 Corbin Ave.,
Macon
Jarrett, Mrs. W. Devereaux, Jr., 756
College St.. Macon
Jones, Airs. John Paul, Brookwood
Apts., Macon
Jordan. Airs. W illiam K., 923 High
St., Alacon
Kay, Airs. J. B.. Byron
Keen, Mrs. O. F., 2319 Clayton St.,
Alacon
King, Airs. J. L., 283 Buford PL,
Macon
Lewis, Airs. W. Earl. 940 Columbus
St., Macon
Alass, Airs. Alax, 125 The Prado,
Alacon
Alays, Airs. J. R. S.. 2587 Elizabeth
PL, Alacon
McAllister, Mrs. R. W., 3130 Ingle-
side Ave., Alacon
AIcFarlane, Airs. J. W., 3163 Brook-
wood Dr., S., Macon
AfcLaughlin, Airs. Charles K., 3726
Overlook Ave., Alacon
Alc.AIiehael, Airs. A. II.. I pper River
Rd., Macon
McMillan, Mrs. E. C., 166 Rogers
Ave.. Alacon
Mobley. Airs. Walter E.. 619 College
St., Alacon
Neal. Airs. Jule C., 3115 Brookwood
Dr., Alacon
Newman, Airs. W. A., 645 Orange
St., Apt. 7, Alacon
New ton, Airs. Ralph C„ 3360 Ridge
Ave., Alacon
Patton. Airs. Sam E.. 243 Beverly
PL, Macon
Phillips, Airs. A. A!.. 131 Buford PL.
Alacon
Pope, Airs. Edgar AL. 555 Arlington
PL, Alacon
Porch, Airs. Leon D.. 294 Riverdale
Dr.. Alacon
Reifler. Airs. R. AL, 2482 AIcDonald
Ave., Alacon
Richardson. Airs. Charles H., 2745
Cherokee Ave., Alacon
Richardson, Airs. Charles H.. Jr.. 135
Jackson Springs Rd.. Alacon
Richardson, Airs. Rhea W .. 3618 For-
syth Rd., Alacon
Ridley, Airs. Charles L., Jr., 3180
Brookwood Dr.. Alacon
Rogers, Airs. T. E., 186 Clisby PL,
Alacon
Ross, Airs. Thomas L.. Jr.. 310 Not-
tingham Dr.. Alacon
Rozar, Airs. A. R., 336 S. Jackson
Springs Rd.. Alacon
Rubin, Airs. Sam N., Gordon
Rumble. Airs. Charles T., 219 Albe-
marle PL, Alacon
Siegel, Mrs. Alvin E., Aledical Arts
Bldg., Alacon
Smith, Airs. Allen, 3125 Ingleside
Ave., Alacon
Thompson, Airs. O. R., 212 Pio Nona
Ave.. Alacon
Tift, Airs. Henry H., 420 Notting-
ham Dr., Alacon
A inson. Airs. Frank. Ft. A alley
Walker, Airs. I). D., 2631 Stanislaus
Cir., Alacon
W atson. Mrs. Edwin R.. 2814 A ine-
ville Ave., Alacon
Weaver, Airs. Hudnall G., 183 Callo-
way St., Alacon
Williams, Airs. W. A.. 2649 Stanis-
laus Cir., Alacon
Woods, Airs. Charles J., 179 North
Ave., Alacon
Work, Airs. Sam, 420 Overlook Ave..
Alacon
Washington County
President, Mrs. Joseph E. Lever,
Sandersville
Dillard, Airs. J. C„ Davisboro
Helton, Airs. B. L.. Sandersville
King, Airs. W. R., Tennille
Lennard, Airs. O. D.. Tennille
Lever. Airs. Joseph E.. Sandersville
AIcElreath. Airs. F. T.. Tennille
Newsom. Airs. N. J.. Sandersville
Newsome, Airs. Emory G.. Sanders-
ville
Overby, Airs. N.. Sandersville
Rawlings, Airs. F. D.. Sandersville
Rawlings, Airs. William. Sandersville
Regers, Airs. O. L.. Sandersville
SEVENTH DISTRICT
Cobb County
President, Airs. Earl Benson, Alari-
etta
Allen. Airs. George O.. 1005 Chero-
kee St., Marietta.
Benson, Airs. Regina Rambo, 406
Whitlock Ave., Alarietta
Benson. Airs. William H., Burnt
Hickory Road, Alarietta
Benson, Airs. Earl, Bell's Ferry
Road. Alarietta
Bailey, Airs. E. AL, Acworth.
Busch. Airs. John F., 310 AIcDonald
St., Alarietta
Burleigh, Airs. Bruce I).. Rt. 1,
Powder Springs Road. Alarietta
Cauble, Airs. George C., Jr., Ac-
worth
Craw ley, Airs. Walter G.. 103 Frey-
er Drive, Alarietta.
Colqirtt, Airs. Alfred O.. Jr., 1011
Whitlock Ave., Alarietta
Colquitt, Airs. Hugh, Smyrna
Clark, Airs. F. B.. Austell
Elder, Airs. C . D., 509 Kennesaw
Ave., Alarietta
Fowler, Airs. Herbert, 1110 Chero-
kee St.. Alarietta
Fowler, Airs. Ralph, 303 AIcDoirald
St., Alarietta
Garrett. Mrs. Luke, Sr., Austell
Garrett, Mrs. Luke, Jr., Austell
Garland,, Airs. Chas. Alavo, Jr.,
Smyrna
Hagood, Airs. Alurl AL, 617 Whit-
lock Ave., Alarietta
Lindley, Airs. F. P.. Powder Springs
AlcCall. Airs. Alose N.. Acworth
Musarra, Airs. Elmer A., 101 Oak-
mont Drive, Alarietta
Perkinson, Airs. W. H., 819 Church
St., Alarietta
Welch, Airs. L. L., 1011 Church St.,
Alarietta
Deceased
Hagood, Airs. George F., Sr., 710
Church St., Alarietta
Floyd County
President, Airs. Inman Smith, Rome
Battle, Airs. Lee H., Jr., Wrestmore
Road, Rome
Blalock. Airs. Frank. Battey State
Hospital, Rome
Bosworth. ATrs. Ed L.. 203 Charlton
Road. Rome
Coslett, Airs. Floyd, Battey State
Hospital, Rome
Crow, Airs. H. E., Battey State
Hospital, Rome
Davis, Airs. Ralph J., Dodd St.,
Rome
Dawson, Airs. Harry, Shannon
Dellinger, Airs. A. H„ 228 Sher-
wood Road, Rome
Dellinger. Airs. Raiden WL, Charlton
Road, Rome
Garner, Airs. J. S., Rome
Garner, Airs. Sam, Jr., Alimosa
Drive, Rome
Gilbert, W'arren, 119 W'estmore
Drive, Rome
Hackett, Airs. Walter G., Cooper
Drive, Rome.
Harbin, Airs. Lester, A’irginia Drive,
Rome
Harbin, Airs. W. P., Jr., ATrginia
Drive, Rome
Jenkins, Airs. Oliver W., Lindale
Johnson, Airs. Ralph N., 510 E.
Ninth, Rome
December, 1950
553
McCord. Mrs. M. M., E. Eleventh,
Rome
McCord, Mrs. Ralph B., Collins-
wood Road, Rome
Mull, Mrs. J. H., E. Eleventh, Rome
Norton, Mrs. Harvey, Cave Spring
Norton, Mrs. Robert, Cooper Drive,
Rome
Payne, Mrs. Rufus, Battey State
Hospital, Rome
Sewell, Mrs. Wm. A., Chatillion
Road, Rome
Smith, Mrs. Inman, Berchman Lane,
Rome
Wyatt, Mrs. C. J., Jr., Bon Air
Apts., Rome
Gordon County
President, Mr si J. E. Billings,
Calhoun
Billings, Mrs. J. E., Calhoun
Hall, Mrs. Wilbur D., Calhoun
Richards, Mrs. Charles K., Calhoun
Steele, Mrs. Byron, Fairmount
Walter, Mrs. R. D., Fairmount
Whitfield County
President, Mrs. Eli A. Rosen,
Dalton
Ault, Mrs. Jacent Henry, 401 Sel-
vidge St., Dalton
Boozer, Mrs. Albert, 300 S. Thorn-
ton Ave., Dalton
Bradley, Mr=. L. Paul, 300 Sel-
vidge St., Dalton
Erwin, Mrs. Lamar Harlan, 203
Cleveland, Dalton
Kerr, Mrs. Stafford George, Chats-
worth Road, Dalton
Ragland, Mrs. Fred, Dug Gap Road,
Dalton
Rosen, Mrs. Eli A., 200 Lynn,
Dalton
Starr, Mrs. Trammell, 201 N. Thorn-
ton Ave., Dalton
Summerour, Mrs. Brooke F., Chats-
worth Road, Dalton
Whitley, Mrs. R. James, Fairview
Drive, Dalton
Whitfield, Mrs. W. Truman, 300
Lynn, Dalton
Wood, Mrs. Lloyd David, 207 N.
Thornton Ave., Dalton
EIGHTH DISTRICT
Manager: Mrs. T. J. Ferrell, W'ay-
cross
Coffee County
President, Mrs. Horace G. Joiner,
Douglas
Clark. Mrs. R. II., Douglas
Harper, Mrs. Sage, Douglas
Jardine, Mrs. Dan A., Douglas
Johnson, Mrs. Roy, Douglas
Joiner, Mrs. Horace G., Douglas
Meeks, Mrs. C. S., Douglas
Oliver, Mrs. J. A., Douglas
Quillian, Mrs. B. O., Douglas
Ricketson, Mrs. G. M., Douglas
Wallace, Mrs. J. W., Douglas
Glynn County
President, Mrs. T. H. Johnston,
Brunswick
Brawner, Mrs. Leon E.. St. Simons
Island
Burford, Mrs. R. S., 1017 Egmont,
Brunswick
Coe. Mrs. Howard M., 3612 Frank-
lin, Brunswick
Collier, Mrs. T. W., 1117 Palmetto
Ave., Brunswick
Greer, Mrs. C. B., 1127 Union,
Brunswick
Hicks, Mrs. James M., 1005 Lanier
Blvd., Brunswick
Johnston, Mrs. T. H., 511 Ellis,
Brunswick
Mitchell, Mrs. L. C., 804 2nd Ave.,
Brunswick
Moore, Mrs. Haywood L., 2307
Gloucester, Brunswick
Muse, Mrs. J. Phillip, 1201 Pine,
Brunswick
Robben, Mrs. Francis J., 1201 Pine,
Brunswick
Willis, Mrs. T. V., 1310 Palmetto
Ave., Brunswick
Ware County
President. Mrs. A. M. Knight,
W aycross
Adkins, Mrs. H. T., 2007 Cherokee
Drive, Waycross
*Atwood, Mrs. G. E., 1110 Elizabeth
St., Waycross
Bates, Mrs. W. B„ 1306 Elizabeth
St., Waycross
Bradley, Mrs. D. M., 629 Nichols
St., Waycross
Bussell, Mrs. B. R„ 604 Euclid
Ave., Waycross
*Carswell, Mrs. H. J., 505 Slate
St., Waycross
Collins. Mrs. B. E., 2003 Cherokee
Drive, Waycross
Davis, Mrs. F. E., Churchwell Apts.,
Waycross
DeLoach, Mrs. A. W„ 1015 Cherokee
Drive, Waycross
Ferrell, Mrs. T. J., 1521 St. Marys
Drive, Waycross
Flanagin, Mrs. W. M., 909 Cars-
well Ave., Waycross
Fo'ks, Mrs. W. M., Cherokee Drive,
Waycross
Gay, Mrs. J. R., 504 Ava St., Way-
cross
Hafford, Mrs. W. C., 229 Rievrside
Drive, Waycross
Johnson. Mrs. R. L., 509 Nicholls
St., Waycross
Knight, Mrs. A. M., Jr.. 110 Thomas
St., Waycross
Massey, Mr?. C. M., Churchwell
Apts., Waycross
McCullough, Mrs. K„ 1014 Satilla
Blvd., Waycross
Minchew, Mrs. B. H., 412 Williams
St., Waycross
*Mixson, Mrs. W. D.. 619 Nicholls
St., Waycross
Muecke, Mrs. H. W„ 310 Dean
Drive, W aycross
Oden, Mrs. L. H., Jr., Park Ave.,
fjlcick hear
Pen'and, Mrs. J. E., 912 Elizabeth
St., Waycross
Pierce, Mrs. L. W., 1003 Atlantic
Ave., Waycross
Pomeroy, Mrs. W. L., 1421 St. Marys
St., Waycross
Reavis, Mrs. W. F., 1105 Satilla
Blvd., Waycross
Seaman. Mrs. H. A., 802 Brunei
St., Waycross
Smith, Mrs. Leo, 1507 St. Marys
Drive, Waycross
Stamps, Mr?. E. R„ Macon
Stoner, Mrs. W. P., 707 Haines
Ave., Waycross
*Walker, Mrs. J. I... 502 Gilmore
St., Waycross
Winner, Mrs. C. A., 501 Gilmore
St., Waycross
Crisp County
Adams, Mrs. Charles, 714 15th Ave.
E., Cordele
*Cannon, Mrs. Maud, Cordele
Dorminey, Mrs. J. N., 315 5th Ave.
E, Cordele
Gower, Mrs. O. T.. Jr., 505 13th Ave
E, Cordele
Harvard, Mrs. V. O.. Arabia
McArthur, Mrs. Charles E., 703 20th
Ave. E, Cordele
Smith. Mr;. M. R.. Sr., 606 13th
Ave. E, Cordele
Whelchel, Mrs. A. J.. 505 12th
Ave. E, Cordele
Williams, Mrs. L. E.. Albany Road,
Cordele
Williams, Mrs. P. 1... Sr.. 502 11th
Ave., Cordele
Williams, Mrs. P. L.. Jr. 502
11th Ave., Cordele
Wootten, Mrs. L. O., Jr.. 19th Ave.
E., Cordele
Wootten, Mrs. L. O., Sr., 201 11th
Ave., Cordele
South Georgia
President, Mrs. Ira M. Gibson,
Valdosta
Austin, Mrs. G. J.. Jr.. Valdosta
Burns, Mrs. D. L., Valdosta
Campbell. Mrs. J. L„ Jr.. Valdosta
Eldridge, Mrs. F. G., Valdosta
Gibson, Msr. Ira M., Valdosta
Johnson, Mrs. A. M„ \ aldosta
Little, Mrs. A. G., Jr., Valdosta
McKey, Mrs. Earl S., Jr., Valdosta
Mixson. Mrs. E. Harry. Valdosta
Mixson. Mrs. J. F., Valdosta
Mixson, Mrs. J. F„ Jr.. \ aldosta
Owens, Mrs. B. G., Valdosta
Perry, Mrs. Robert E., Valdosta
Saunders, Mrs. A. F., Valdosta
Sherman, Mrs. Henry T„ V aldosta
Smith, Mrs. J. R., Hahira
Smith, Mrs. T. H., Valdosta
Stump, Mrs. Robert L., Jr., Val-
dosta
Williams, Mrs. T. C., V aldosta
NINTH DISTRICT
Manager: Mrs. C. J. Roper, Jasper
Jackson-Barrow Counties
President, Mrs. Paul Scoggins,
Commerce
Almond, Mrs. C. B., Winder
Bryson, Mrs. L. R., Jefferson
Etheridge, Mrs. E. H„ Winder
Freeman. Mrs. Ralph, Hoschton
Harris, Mrs. E. R., Winder
Lord, Mrs. C. B., Jefferson
McDonald, Mrs. E. M., Winder
Pittman, Mrs. O. C., Commerce
Randolph, Mrs. W. Q., Winder
Randolph, Mrs. W. T., Winder
Rogers, Mrs. A. A., Jr., Commerce
Rogers, Mrs. A. A., Sr.. Commerce
*Ross, Mrs. S. T., Winder
Russell, Mrs. A. B., Winder
Scoggins, Mrs. Paul Commerce
Stovall, Mrs. J. T., Jefferson
* Honorary members.
554
The Journal of the Medical Association of Georgia
Cherokee-Pickens Counties
Andrews, Mrs. Charles R.. Canton
‘Boring, Mrs. James R.. Canton
Brooke, Mrs. Carter. Canton
Coker, Mrs. Grady N„ Canton
‘Coker, Mrs. N. J.. Canton
‘Faulkner. Mrs. George, Canton
Hendrix. Mrs. Arthur M., Canton
‘Hendrix, Mrs. M. G„ Ball Ground
Jones, Mrs. Robert T., Ill, Canton
Looper, Mrs. Ben K., Canton
‘Pettit, Mrs. John T.. Canton
Roper, Mrs. C. J., Jasper
Roper, Mrs. E. A., Jasper
‘Turk, Mrs. John. Nelson
Van Sant. Mrs. T. J., Woodstock
Gwinnett County
President. Mrs. R. E. Smith, Buford
Cain, Mrs. Sylvester, Norcross
Chastain. Mrs. J. R., Buford
Hutchins, Mrs. Harry, Buford
Hutchins, Mrs. W. J., Buford
Kelley, Mrs. D. C., Lawrenceville
Puett, Mrs. W. W., Norcross
Sims, Mrs. Fayette A., Jr., Law-
renceville
Smith, Mrs. R. E.. Buford
Williams, Mrs. A. D.. Lawrenceville
Habersham County
President, Mrs. L. J. Walker,
Cornelia
Arrendale, Mrs. J. J., Cornelia
Garrison, Mrs. D. H., Clarkesville
Harden. Mrs. O. N., Cornelia
‘Jackson. Mrs. John Brady, Cornelia
Nicholson. Mrs. Geo. T., Cornelia
Roberts, Mrs. B. J., Clarkesville
Walker. Mrs. J. L., Cornelia
Stephens County
President. Mrs. Arthur G. Singer,
Toccoa
Ayers, Mrs. Clarence L., Big A
Road. Toccoa
Chaffin, Mrs. E. F., 743 E. Tugalo
Toccoa
Henry, Mrs. Charles M., Mountain
View Road, Toccoa
Isbell, Mrs. J. E.D., 706 E. Tugalo,
Toccoa
McNeely. Mrs. Henry H„ 121 Hayes
St., Toccoa
Schaefer, Mrs. William Bruce, 110
E. Franklin, Toccoa
Shiflet, Mrs. Robert E.. Big A Road.
Toccoa
Singer, Mrs. Arthur G., 210 Boule-
vard, Toccoa
Good, Mrs. William H., Jr., Cur-
rahee Road, Toccoa
TENTH DISTRICT
Richmond County
President, Mrs. J. P. Hitchcock,
Augusta
Agee, Mrs. M. P., 3028 Cardinal
Drive, Augusta
Akerman. Mrs. Joseph, 831 15th
St., Augusta
Bailey. Mrs. T. E., 2548 Central
Ave., Augusta
Battey, Mrs. W. W., Jr., 2239 Kings
Way, Augusta
‘Battey. Mrs. W. W., Sr., 822
Hickman Road, Augusta
Bazemore, Mrs. J. Malcolm, 3028
Pine Needle Road, Augusta
‘Honorary members.
Beard, Mrs. Byron C., Country Club
Apts., Augusta
Bowen, Mrs. J. B., 1538 Schley
St., Augusta
Boyd. .Mrs. W. S.. 2315 Laurel Lane,
Augusta
Brititngham, Mrs. J. W., 3046 Pine
Needle Road, Augusta
Brown, Mrs. Stephen W., 3018
Bransford Road, Augusta
Burpee, Mrs. C. M., 1127 Monte
Sano Ave., Augusta
Butler, Mrs. J. H., 1103 Milledge
Road. Augusta
Chandler, Mrs. J. L., 2923 Lake
Forest Drive, Augusta
Chaney, Mrs. Ralph H., Jr., 2651
Henry St., Augusta
Chaney, Mrs. R. H.. Sr., 2918
Bransford Road, Augusta
Clary. Mrs. T. L.. Jr., 1329 High-
land Ave., Augusta
Davis, Mrs. David A., 2728 Walton
Way, Augusta
DeVaughn. Mrs. N. M., 802 Monte
Sano Ave., Augusta
Estes, Mrs. Marion M., Lumpkin
Road, Augusta
Flanagan, Mrs. W. S., 2431 Mc-
Dowell St., Augusta
Greenblatt, Mrs. R. B.. 3011 Brans-
ford Road, Augusta
Harper. Mrs. H. T., 2739 Walton
Way, Augusta
Harrison, Mrs. F. N.. 1502 Pendle-
ton Ave., Augusta
Hitche.ock, Mrs. J. P„ 827 Milledge
Road. Augusta
Hock, Mrs. C. W., 909 Highland
Ave., Augusta
Holmes, Mrs. L. P., 2810 Hillcrest
Ave., Augusta
Hopkins, Mrs. E. C., 2353 Minto,
Augusta
Hummell, Mrs. J. E., 1751 Pine
Tree Road. Auugsta
Jones, Mrs. G. Frank, Laurel Lane,
Augusta
Kelly, Mrs. G. L., 2131 Gardner
St., Augusta
Lee, Mrs. F. Lansing, 901 Heard
Ave., Augusta
Leonard. Mrs. R. E., 2903 Lake
Forest Drive, Augusta
Levy, Mrs. Jack H.. 307 Broad St.,
Augusta
Lokey. Mrs. Julian L.. Country Club
Apartments, Augusta
Major, Mrs. R. C., 1402 Magnolia
Drive, Augusta
Martin. Mrs. L M., Milledaeville
Road. Box 502. Rt. 2. Augusta
Massengale, Mrs. L. R., Laurel Lane,
Augusta
Mathews, Mrs. W. E., 2735 Walton
Way, Augusta
McGahee, Mrs. R. C., 2617 Hill-
crest Ave., Augusta
Mealing. Mrs. H. G., 103 Forest
Ave., W., North Augusta, S. C.
Miller, Mrs. A. W„ 314 Broad St.,
Augusta
Miller, Mrs. J. M„ 2837 Helen St.,
Augusta
Milligan, Mrs. K. W., 942 Greene
St., Augusta
Mulherin, Mrs. Charles M., 2236
McDowell St., Augusta
Murphey, Mrs. Eugene E., 432
Telfair St., Augusta
New, Mrs. J. S., 625 Milledge Road,
Augusta
Palmer, Mrs. J. R„ Walton W'ay
Extension, Augusta
Perkins, Mrs. H. R., 1118 Milledge
Road, Augusta
Pinson, Mrs. H. D.. 1751 Kings
Wood Drive, Augusta
Rhodes, Mrs. R. L., 2501 Bellview
Ave., Augusta
Rinker, Mrs. J. Robert, 2114 Gard-
ner St., Augusta
Risteen, Mrs. W. A., Skinner Mill
Road, Rt. 1, Box 27. Martinez
Sanderson, Mrs. E. S., 1030 Kath-
erine St., Augusta
Schmitt, Mrs. H. L.. Jr.. 2910 Henry
St., Augusta
Sell, Mrs. M. B„ 1314 Milledge
Road, Augusta
Shepeard, Mrs. Walter I... LaFayette
Drive, Augusta
Sherman, Mrs. J. H., 2251 Walton
Way, Augusta
Templeton, Mrs. C. M., 910 Caro-
lina Ave., North Augusta, S. C.
Tessier, Mrs. C. E., 1320 Buena
Vista Road, Augusta
Todd, Mrs. Lucius N., 3005 Wrights-
boro Road, Augusta
Torpin, Mrs. Richard. 2618 Walton
Way, Augusta
Traylor, Mrs. G. A., 2311 Kings
Way, Augusta
Volpitto, Mrs. P. P., 3024 Bransford
Road. Augusta
Watson, Mrs. W. G., 619 West
Avenue, North Augusta, S. C.
White, Mrs. William O., Jr., Heath
Drive, Augusta
Wilkes. Mrs. W. A., 1203 Highland
Avenue, Augusta
Williams, Mrs. D. C., Jr., 13-B
Country Club Apartments, Augus-
ta
Williams, Mrs. W. J., 1107 Johns
Road, Augusta
Wright, Mrs. P. B.. 3037 Park Ave.,
Augusta
Wylie, Mrs. M. H., 3126 Bransford
Road, Augusta
Fuller, Mrs. W. A., 603 Peachtree
Road, Augusta
Thompson, Mrs. C. E.. 1303 Monte
Sano, Augusta
Members-at-Large,
1950-1951
Alexander. Mrs. G. A.. Forsyth
Arnold, Mrs. Maurice F., Hawkins-
ville
Bridges, Mrs. R. R.. Leary
Brown, Mrs. S. D.. Royston
Busey, Mrs. T. J., Fayetteville
Bush, Mrs. Albert R.. Hawkinsville
Claxton, Mrs. E. B., Dublin
Dickens, Mrs. O. H., Madison
Ehrlich, Mrs. M. A.. Bainbridge
Elliott, Mrs. C. B., Cedartown
Fisher, Mrs. Albert, Jr.. Monticello
Gallemore, Mrs. J. L., Perry
Goodwin, Mrs. H. A., Summerville
Green, Mrs. Charles Gray, Waynes-
boro
Harris, Mrs. Raymond, Ocilla
December, 1950
555
H\den, Mrs. William U., Trion
Little, Mrs. G. H., Trion
Little, Mrs. R. N., Summerville
Mashburn, Mrs. Marcus, Sr., (Hum-
ming
McCarver, Mrs. W. C., Vidette
Milford, Mrs. J. H., Hartford
Powell. Mrs. C. E., Swainsbroo
Ridgway, Mrs. R. E., Royston
Robbins, Mrs. A. I., llomerville
Simonton, Mrs. F. H., Chicka-
mauga
Simpson, Mrs. A. W., Jr., Wash-
ington
Thompson, Mrs. Cleveland, Waynes-
boro
Thompson, Mrs. D. N., Elberton
Tucker, Mrs. J. P., Bainbridge
Wasden, Mrs. H. A., Jr., Pavo
Williams, Mrs. Virgil B., Griffin
Willis, Mrs. L. W., Bainbridge
C\LLS FOR SUPPORT OF BETTER
WORLD HEALTH PROGRAMS
There is likely to be a great demand for qualified
American medical personnel to aid in the overseas
health programs being conducted by the World Health
Organization of the United Nations, according to Dr.
Edward J. McCormick of Toledo, Ohio.
Dr. McCormick, a member of the Board of Trustees
of the American Medical Association and a member
of the United States delegation to the third WHO
assembly in Geneva, Switzerland, last May, said these
programs demand the full support of the American
medical profession. He characterized the projects as
“an essential part of the over-all effort of the freedom-
loving nations of the world to create conditions which
will provide a firm foundation for a lasting peace.”
Writing in the October 7 Journal of the American
Medical Association, he said:
“The World Health Organization is engaged in a
gigantic task. It is concerned with raising standards
of medical education, fortifying national health ser-
vices, assisting in control campaigns against infectious
diseases and modifying and classifying medical informa-
tion of international importance.
“The WHO works closely with the World Medical
Association (composed of 39 national medical associa-
tions, including the A.M.A.) on technical problems.
It works with governments in raising health standards
in member countries. The WHO is meeting a real
need in this shrinking world in fulfilling the obliga-
tions of an international pub'ic health agency.”
The W HO was formed in June 1946 and its consti-
tution recognizes that the “health of all people is
fundamental to the attainment of peace and security
and is dependent upon the fullest cooperation of
individuals and states.” At the third assembly, dele-
gates were present from 57 member states. All of the
members of the Soviet block, with the exception of
Poland, have withdrawn, and Poland did not send
a delegate.
“This meeting of delegates from nearly all the
non-communi t nations of the world assures the con-
tinuity of cooperation in public health and determines
the strategy for the international offensive against
the major diseases,” Dr. McCormick said.
When the WHO was formed, malaria, maternal
and child health, tuberculos’s, environmental sanita-
tion, venereal diseases and nutrition were assigned
priorities. At the last meeting, plague, cholera, yellow
fever, smallpox and typhus were added to the list
of priority programs.
The United States will provide $2,481,159, or approxi-
mately one third, of the 1951 budget of $7,300,000.
HEALTHGRAMS
Nothing is more completely proved than the fact
that approximate'y one-half of all cases of significant
tuberculosis have no symptoms, or symptoms so
slight as to escape notice. A. C. Christie, M.D.. Pub.
Health. Rep., June 2, 1950.
* * *
The continued responsibility for the care of a
chronically sick person adds immeasurably to the edu-
cation of a physician. It requires maturity to be able
to recognize limitations, to avoid becoming angry
because the patient does not get well, to avoid be-
coming discouraged or discouraging, and to continue
to wish to help within the limits of one’s ability. John
Romano, M.D., J.A.M.A., June 3, 1950.
SUCCESS
He has achieved success who has lived well,
laughed often and loved much; who has gained the
respect of intelligent men, the trust of pure women
and the love of little children; who has made the
world a better place than he found it, whether by
an improved poppy, a perfect poem or a rescued soul ;
who has never lacked appreciation of earth’s beauty
or failed to express it ; who has looked for the best
in others and given them the best he had; whose life
is an inspiration. — Copied.
CORTISONE, ACTH FOUND HELPFUL
IN TREATING SERIOUS SKIN DISEASE
Good results are reported by a group of doctors at
Mount Sinai Hospital in New York who have used
coritsone and ACTH to treat patients critically ill
with acute disseminated lupus erythematosus, a serious
disease beginning with a skin disorder and spreading
to the heart, lungs, kidneys and other vital organs.
Writing in the October issue of Archives of Internal
Medicine, published by the American Medical Associa-
tion, Drs. Louis J. Softer, Marvin F. Levitt and George
Baehr caution, however, that “although these agents
are capable of inducing clinical remissions they do
not affect a cure of the underlying disease process.”
Of the 14 patients treated with the hormones, 11
responded to the extent that the acute evidence of
the disease promptly subsided and the patient could
move about more comfortably. However, the diseased
cells, the anemia, the abnormal kidney findings and
other characteristics of the disease persisted.
The report continues:
“The treatment of acute disseminated lupus with
cortisone or ACTH may be complica’ted by frequent
untoward side effects. However, with careful clinical
observation these effects may be minimized and cor-
rected and therapy continued.
“The exacerbations which follow attempts to dis-
continue therapy indicate that long-range or even per-
manent treatment may be necessary to control the
disease.”
WHAT IS HEART DISEASE?
Each year more deaths occur from heart disease
than from any other single cause. The Educational
Committee of the Illinois State Medical Society, in a
Health Talk, states that knowledge and care could
reduce deaths from the many illne ses which stem
from 'conditions affecting the heart.
Acting l'ke a pump, the heart circulates the blood
through the body. The heart itself is composed of a
mass of muscles forming four chambers which receive
the b'ood brought to it from all parts of the body
through the veins. This blood is first pumped to the
lungs, where it receives fresh oxygen, and goes back
to the heart, from which it is again pa sed out to
every part of the body through the arteries. After
it has distributed its oxygen and other essentia] sub-
stances to the individual organs, it is collected into
tiny vessels called capillaries, which feed it into the
veins and thus back to the heart. The essentials of
the circulation of the blood were discovered in 1615
by William Harvey, an English physician.
In the heart there is a series of chambers to let
the blood in and out, a procedure systematically con-
trolled by a series of valves. The four chambers of
the heart are the right and left ventricles and the
556
The Journal of the Medical Association of Georgia
right and left auricles. The veins pour t he blood into
the right side of the heart, from which the ventricle
pumps it out to the lungs through the pulmonary
artery. It returns oxygenated from the lungs to the
left side of the heart, from which the left ventricle
pumps it into the aorta or main artery, which dis-
tributes it through the arterial system throughout the
body. There are thus four elements in heart action,
the correct timing of which is controlled by a nerve
“switchboard." Any trouble with the nerve control or
any of the four chambers or with the valves which
keep the flow going in the proper direction can thus
be a source of heart disease.
The six most important causes of heart disease are
rheumatic fever, which may damage the valve system;
high blood pressure, which may overload the heart;
sclerosis or hardening of the coronary arteries which
supply blood to the heart muscle itself; syphilis, which
especially affects the first part of the great artery,
the aorta; subacute bacterial endocarditis, due to
inflammation of the inner lining membrane and valves
of the heart by a germ, streptococcus viridans, and
congenital defects, meaning those existing at birth.
Other conditions may damage the pericardium or
outer covering of the heart.
Thus certain diseases may cause damage, slight or
great, to the heart. Among specific heart conditions are
angina pectoris, a pain in the chest which sometimes
extends down the arm, and caused by interference with
the blood supply to the heart mu-cle ; coronary throm-
bosis or occlusion, caused by a clot of blood forming
in a hardened artery to block off the flow of blood
to the heart muscle; myocarditis, or inflammation of
the muscular walls of the heart, and chronic valvular
disease of the heart. Various conditions can be re-
sponsible for so-called heart murmurs, or irregular
heart beat, interruption of the blood to and -from the
heart.
Thus there are many specific types of heart disease,
each of which is influenced by different factors.
Heart disease can be reduced. Let your doctor check
your heart so that it cannot check you.
OBITUARY
(Continued from Page 544)
Atlanta, in 1892, and practiced in Atlanta for many
years, before moving to Barnesville where he lived
until his retirement several years ago. He was a
member of the Emory Presbyterian Church, and for
39 years had been a member of Lodge No. 41, F. &
A. M. Surviving are his wife; two daughters, Mrs.
Edward R. Terrell and Mrs. Curtis Thompson; a son
E. C. Ripley, Jr., several grandchildren and great-
grandchildren. Private funeral services were held at
the residence with the Rev. Donald Bailey officiating.
Burial was in the Barnesville Cemetery, Barnesville.
* * *
Dr. Clyde B. Slocumb, aged 63. prominent Doerun
and Colquitt County physician, died October 29, 1950.
He graduated from the Atlanta School of Medicine,
now’ Emory Universtiy School of Medicine, Atlanta,
in 1912, and began the practice of medicine in Funston.
He later moved to Doerun, serving this community
and Colquitt County for 38 years. He was an honorary
member and past president of the Colquitt County
Medical Society, the Medical Association of Georgia,
and the American Medical Association. He was also
a member of the Doerun Baptist Church. Surviving
are his wife; a daughter, Mrs. R. D. Houser, Athens;
two sons, Lt. Col. Clyde Slocum. Jr., Washington, D. C.
and Billy Slocumb, Doerun and Moultrie; two sisters
and five grandchildren. Funeral services w'ere held
at the Doerun Baptist Church with the Rev. Milton
S. Overby and the Rev. T. H. Wilder officaiting. Burial
was in the Doerun Cemetery.
Dr. Charles D. II ard, aged 60, one of Augusta’s
best known and highly esteemed surgeons, died un-
expectedly at a fishing camp on Briar Creek, October 12,
1950. He had gone on a fishing trip with Dr. Good-
rich Henry, who found he had died in his sleep,
apparently of a heart attack. Dr. Ward was born in
\ illanow. Walker County, Ga. He was the son of
the late John Anderson and Mrs. Lou Puryear Ward,
lie graduated from the University of Georgia Medical
College, Augusta, in 1920, and began the practice of
medicine in his home town, and came to Augusta in
1921, where he spent his entire medical career. He
was a member of the Richmond County Medical
Society, the Medical Association of Georgia, and the
American Medical Association. In 1925, he became
resident surgeon at the University Hospital. Augusta.
He was instructor in surgery at the Medical College
of Georgia, later he became clinical associate instruc-
tor in surgery, and in 1936 he became assistant clinical
professor in surgery at the Medical College of Georgia.
He had attained top recognition in the field of surgery
and had published a number of papers on medical
subjects. Dr. Ward was not only widely known as a
surgeon but wras loved bv all who knew' him. Dr.
Ward was a bachelor. He is survived by a sister, Mrs.
Joe Hunt, of East Armuchee, and one nephew, Louis
Hunt, student at the University of Georgia, Athens.
Funeral services were held at the East Armuchee Baptist
Church, of which he was a member, with the Rev.
Roy Easterly and the Rev. J. A. Smith officiating.
Burial was in the churchyard cemetery, A illanow.
NEW BOOKS
Principles of Interna! Medicine, by T. R. Harrison,
M.D., 1.590 pages wtih 245 illustrations. Philadelphia,
The Blakiston Company, 1950. Price $12.00.
This new text of internal medicine was written with
the aim of presenting within the confines of a single
volume a consideration of the disorders that comprise
the province of internal medicine. In this intention
it is admirably successful.
Edited by Dr. T. R. Harrison, with the able assist-
ance of Drs. Paul B. Beeson, William H. Resnik,
Georgia W. Thorn, M. M. Wintrobe and forty-eight
contributing authorities, the book is divided into seven
parts comprising the cardinal manifestations of disease,
physiologic considerations, reaction to stress and to
antigenic substances, metabolic and endocrine dis-
orders, disorders due to chemical and physical agents,
diseases due to biologic agents and diseases of organ
systems.
Considerably more emphasis is placed on the func-
tional approach to internal medicine in the first five
parts of this book than is found in the older standard
texts of medicine. In general diseases of greater
numerical frequency a^e discussed in more detail
than rare disorders.
Physicians in the State of Georgia will note with
pride that nine of the contributors to this text reside
within the State. Among them are Drs. Paul B. Beeson,
Philip Kramer Bondy, Wil’iam F. Friedewald. W.
Elizabeth Gambrell, Albert Heyman. Max Michael, Jr.,
J. C. Ransmeier and Arthur P. Richardson, all associ-
ated with the Emory University School of Medicine,
and Dr. T. F. Seller5, Director of the Georgia Depart-
ment of Public Health.
This book is recommended to students of medicine
and the practicing physician as one of the best texts
available in the specialty of internal medicine.
EDGAR SHANKS, JR.. M.D.
* * *
Atlas of Human Anatomy, by Barry J. Anson, Ph.D.,
Professor of Anatomy, Northwestern University Medical
School, Chicago. 518 pages, 8x11 inches, illustrated.
(Continued on Page XVI)
I'riE Journal of the Medical Association of Georgia
XV
DRAMAMI N E Brand of Dimenhydrinate — for the prevention or
treatment of motion sickness — is supplied in 50 mg. tablets and in liquid form.
RESEARCH IN THE SERVICE OF
MEDICINE
SEARLE
Please mention this Journal when writing advertisers.
XVI
The Journal of the Medical Association of Georgia
NEW BOOKS
(Continued from Page 556)
Philadelphia and London. W. B. Saunders Company,
1950. Price: $11.50.
This atlas, which is based on the dissections of
the author, is one of the latest published and has
received much acclaim. Dr. Anson stated that the
purpose of the atlas was “to be of service to students
in medicine and to practitioners for whom illustrations
must serve in substitution for actual specimens.” Only
essential descriplive matter is included so that the
medical student will not be slowed down in the
dissection laboratory. The hundreds of drawings,
many of which are in color, were prepared for Dr.
Anson by professional artists working with the cadaver
as a model. This book would be a great asset to any
physician’s or student’s library.
THE NEW ORLEANS GRADUATE
MEDICAL ASSEMBLY
The fourteenth annual meeting of The New Orleans
Graduate Medical Assembly will be held March 5-8,
1951. headquarters at the Municipal Auditorium, New
Orleans.
Nineteen outstanding guest speakers will participate
and their presentations will be of interest to both
specialists and general practitioners. The program
will include a panel discussion on ACTH and Cortisone,
a series of talks on trauma and neoplastic diseases, a
review of the application of radioactive isotopes in
medical practice, clinicopathologic conferences, round-
table luncheon discussions and many other features of
special interest.
Another attraction of the meeting will be daily
demonstrations of medical and surgical procedures
in color television. This program will be telecast from
Charity Hospital to the auditorium and is sponsored
by Smith, Kline & French Laboratories.
The Assembly has planned another interesting post-
clinical tour to follow the 1951 meeting in New
Orleans. On Saturday, March 10, a party composed
of doctors and their families will leave by plane for
Panama. The itinerary also includes Medellin and
Cali, Colombia; Quito, the capital of Ecuador, and
Lima, Peru. Medical programs and visits to hospitals
have been arranged, together with a full schedule of
sightseeing. The group will return to New Orleans
on Sunday, March 25. Details and a complete itinerary
are available at the office of the Assembly, Room 103,
1430 Tulane Avenue, New Orleans 12, La.
FOR SALE — Tice’s Loose Leaf System of
Medicine. Half of normal sale price.
C. R. Sikes, M.D., Grady Mem. Hospital,
36 Butler St., S. E., Atlanta, Ga.
WANTED
Resident psychiatrist. Graduate of
Class A medical school and with ade-
quate hospital training for work in
private mental institution located in
ideal climate. Excellent salary and
maintenance. If interested in employ-
ment under excellent conditions near
thriving southern city, apply imme-
diately to Orin R. Yost, M.D., Psy-
chiatrist-in-Chief, Edgewood Sani-
tarium Foundation, Orangeburg, S. C.
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Metrazol is indicated for narcotic depression,
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Inject 3 cc. Metrazol intravenously, repeat if
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Bilhuber-Knoll Corp. Orange, N, J.
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